MARYLAND — On a hot summer day earlier this year, a mother left a troubling voice message on this reporter's WhatsApp. "My child woke up this morning feeling like he was suffocating. I am worried," she said in Spanish. The boy had a history of asthma, she added.
The woman asked to be referred to by her first initial, M, because although her son is a U.S. citizen, she and her husband are undocumented. In response to being told she should seek professional medical help, M said she had been debating whether to take him to the local clinic, worried that she could be detained by immigration enforcement.
It's a troubling pattern that has emerged in immigrant communities: staying away from medical care due to fear.
"All the roads northbound have had ICE operations on them," she said in another voice message. She was worried about getting detained.
She decided to wait it out.
M's situation is increasingly common. A new national survey, conducted between April and June 2026 by the American Academy of Pediatrics, found that 40% of pediatricians have noticed families staying away from care due to immigration concerns. Thirty percent said they've seen families who are hesitant to apply for public health services and support, such as Medicaid. They also noted that there are families in their practice who are avoiding sending their children to school.
Dr. Lee Beers, the academy's chief medical officer, says keeping children away from school has health implications. "They can receive health services within the school. They can receive mental health services. It's a place where caring and supportive adults can help identify if there's an emerging health issue or mental health issue."
"His lips were turning blue"
Back in southern Maryland, the boy was taking a turn for the worse. M recalled how pale he was. "His lips were turning blue."
They took the bus to the local clinic. It was nighttime, and when they got there, the doctor told her the child was in serious condition. He was given oxygen.
In another voice message, she says, her son has been medevaced to Washington, D.C. "Please," she says. "Let him be ok."
There wasn't room for her on the helicopter. She was told to meet them at the hospital. "And now I'm wondering whether I will be safe in an Uber. If my whole family drives, what happens if we get stopped. Do ICE agents board public transportation?"
A nurse at the Maryland clinic paid for an Uber.
"I just passed by the Washington Monument," she says in another message. She called it the needle. "And the White House. This feels dangerous."
As she got closer to the hospital, another fear: that she might be asked for her immigration papers.
A quiet shift in immigration enforcement
Legally, hospitals can ask for immigration status — in Florida and Texas they are required to in order to report on healthcare costs of undocumented patients. In both states, patients have the right to refuse to answer questions about immigration status. But across the U.S., hospitals cannot deny emergency care because of immigration status.
There have, however, been reports of ICE agents at medical facilities.
Recently, there's been another reason for immigrants — including those here legally — to be apprehensive about seeking medical care. As of this week, immigration officials deciding whether people can enter the U.S. or get legal residency will consider a wider range of public benefits that a person receives. They will also consider what benefits family members get — that could include Medicare and food assistance, like SNAP. Previous administrations had specifically excluded certain benefits from ever being considered in immigration applications.
This is part of a larger shift in how the Trump administration is approaching immigration enforcement. Earlier this year, there were loud, bombastic ICE raids in Minneapolis. Last year they took place in Los Angeles and Chicago. Those operations drew heavy backlash; the new strategy is quieter. There are still raids and detentions — the number skyrocketed this summer. But increasingly, enforcement also means cutting off access to services and benefits — pushing people to self deport.
Twenty-two states and D.C., are jointly suing the Department of Homeland Security, saying the new Trump administration interpretation about considering public benefits in immigration decisions could keep people away from basic health services.
"Hardworking families should not be forced to go without the support they need because they fear asking for assistance will get them deported," said Democratic New York Attorney General Letitia James in a news release.
In an email to NPR, DHS responded: "This is the ideological contortion required by left-wing leaders to justify their defrauding of the American taxpayer at the hands of illegal criminals."
A delay that could have had serious consequences
"A visit with your pediatrician is an opportunity to catch acute issues before they get worse," says Dr. Beers, from the American Academy of Pediatrics. If those concerns are not identified early and addressed promptly, they can have really long term and serious health impacts on children and ultimately, you know, place a greater burden, not just on the family and the child, but also on the health system as a whole."
A doctor at one health clinic in Maryland requested NPR not use her name for fear of her patients (who are largely immigrants) being targeted. She said she suspects the health effects will soon become apparent. "We're seeing patients who aren't coming in not just for routine screening, but their diabetes checkup, their blood work done. Maybe in a year we'll see a bump in heart attacks and strokes in this population. We know that people are afraid. We know right now the immediate effect is worsening mental health."
Ultimately, she says it's an issue that should concern people beyond immigrant families. "If we have patients who are afraid to go get vaccines, that affects everybody. And that's just one example. We've already seen what's happened with measles in this country in the last few years. It hurts the whole community."
As for M, the morning after her son was hospitalized, she wrote again. The boy had a respiratory infection, which had triggered a severe asthma attack.
The hospital told her she should have brought him in sooner.
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