Immigrant Child Health: Creating Evidence-Based Practice in a Changing Environment


Introduction by co-guest editors Karla Fredricks, MD, MPH, FAAP and Janine Young, MD, FAAP

The spring of 2019 saw an unprecedented number of children and families crossing the border between the United States (US) and Mexico, with over 100,000 individuals (either children traveling without parents or children and parents traveling together) in the month of May alone.1 This sudden increase in immigration at the US southern border led to a flurry of media attention, particularly as the squalid conditions inside border processing facilities were brought to light. While the executive, legislative, and judicial branches of the US government clash over responses to this humanitarian crisis, the lives of immigrant children and families hang in the balance. Chronic and increasing violence and extreme poverty threaten the safety and health of children and families in many countries around the world, including in Guatemala, Honduras, and El Salvador. Gang control, crime, and some of the highest homicide rates in the world are a daily reality for children and families living in these Central American countries.2 War and instability worldwide have led to more people feeing from their homes than ever before; more than 70 million were displaced at the end of 2018.3 Parents and children from these situations of crisis are increasingly being forced to make the excruciating choice to leave their homeland -- and risk significant perils along the journey -- in order to seek safe haven in another country.

However, within the US, immigrant children and families are facing a growing environment of hostility. Immigration raids and increased scrutiny of immigrant communities have led to widespread fear across the US, while proposed changes to both the eligibility for and consequences of using public benefits present additional challenges to immigrants' well being. There has been a documented decrease in immigrant families enrolling in safety net programs such as the Supplemental Nutrition Assistance Program (SNAP)4 and Medicaid,5 a concerning trend since both have been shown to improve the health and educational outcomes of children. 6,7,8 Furthermore, there has been mounting rhetoric portraying immigrants as criminals, despite data showing that crime generally decreases as immigration increases.9

This two-part special issue of the Journal of Applied Research on Children presents a multi-faceted look at the impact of immigration on the health of children. In the first part of the series, authors explore different aspects of US immigration policy, including historical, legal, and public health perspectives as well as humanitarian responses. In the second part of the series, original research articles will provide valuable evidence regarding the experiences and needs of immigrant children, focusing on education and nutrition in addition to mental and physical health. The two-part issue will highlight current concerns and provide key insights into potential policy solutions to address some of the most pressing issues in the lives of immigrant children today.


1. Southwest Border Migration. U.S. Customs and Border Protection website. https://www.cbp.gov/newsroom/stats/sw-border-migration. Updated July 3, 2019. Accessed August 8, 2019.

2. United Nations. 2019. "Global Study on Homicide." Vienna, Austria: United Nations Office on Drugs and Crime.

3. United Nations. 2019. "Global Trends: Forced Displacement in 2018." Geneva, Switzerland: United Nations High Commissioner for Refugees.

4. Bovell-Ammon A, Ettinger de Cuba S, Coleman S, Ahmad N, Black MM, Frank DA, Ochoa E, Jr, Cutts DB. Trends in Food Insecurity and SNAP Participation among Immigrant Families of U.S.-Born Young Children. Children. 2019; 6(4):55. doi.org/10.3390/children6040055

5. Bernstein, Hamutal, Dulce Gonzalez, Michael Karpman, and Stephen Zuckerman. 2019. "One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018." Washington, DC: Urban Institute.

6. Collins AM, Klerman JA. Improving nutrition by increasing Supplemental Nutrition Assistance Program benefits.American Journal of Preventive Medicine. 2017; 52(2):S179. doi.org/10.1016/j.amepre.2016.08.032

7. Beharie N, Mercado M, McKay M. A Protective Association between SNAP Participation and Educational Outcomes Among Children of Economically Strained Households. J Hunger Environ Nutr. 2017;12(2):181. doi:10.1080/19320248.2016.1227754

8. Thompson O. The long-term health impacts of Medicaid and CHIP. J Health Econ. 2017;51:26. doi: 10.1016/j.jhealeco.2016.12.003

9. Light MT, Miller T. Does undocumented immigration increase violent crime? Criminology. 2018; 56(2):370. doi.org/10.1111/1745-9125.12175




Discrimination against Mixed-Status Families and its Health Impact on Latino Children
Margaret A. Singer BA; Manuela Gutierrez Velez BS; Scott D. Rhodes PhD, MPH; and Julie M. Linton M.D.


First Foods Nutrition Curriculum for New Immigrant Families: A Pilot Study
Elizabeth E. Dawson-Hahn M.D., MPH; Lorren Koceja RD, CD; Abigail R. Grant M.D.; Anisa Ibrahim M.D.; Beth Farmer LCSW; H. Mollie Grow M.D., MPH; Sarah Lowry PhD, MPH; and Suzinne Pak-Gorstein PhD, MPH

Perspectives from the Field


Children as Pawns of US Immigration Policy
Sarah Polk M.D., ScM, MHS; Shamelle Richards; Mary Ann Hernando; Margaret Moon M.D.; and Joshua Sharfstein M.D.


The Biology of Hope
Fernando Stein M.D.


The ripple effects of US immigration policy on refugee children: A Canadian perspective
Shazeen Suleman M.D., MPH; Ripudaman Minhas M.D., MPH; and Tony Barozzino M.D.