Luis Ramirez has lived in the U.S. without immigration papers for two decades, but he is more worried about deportation now than ever before.
Ramirez said he and his wife, Luz Cadeo, who is also here illegally, have already made plans in case they are arrested by immigration police: The couple, who live in Lakewood, Calif., would try to find work in their native Mexico while their youngest U.S.-born children, ages 15 and 18, stayed in the U.S. with a relative.
"We are taking it very seriously," Ramirez, who works as a welder, said in Spanish. But, he added, "it's very difficult to explain to [our children] the reality of what could happen."
Immigrant families like Ramirez's are living with heightened fear and uncertainty because of stricter immigration policies and increased enforcement under the Trump administration, according to a report released Wednesday by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
The fear, and the stress it creates, is compromising children's health, possibly for the long term, the report said. It is also causing some parents to forgo health care or withdraw from public health programs such as Medicaid, which covers people with low incomes, and Women, Infants and Children, which provides nutritional assistance.
The report, based on focus groups with 100 parents and interviews with 13 pediatricians, found that immigrants across the nation are anxious about being deported and separated from family members. Some parents are reluctant to leave their homes or participate in recreational activities.
This post-election anxiety isn't limited to immigrants without papers, according to the report.
"These feelings of fear and uncertainty extend broadly across different groups of immigrants, including immigrants who are here legally," said Samantha Artiga, director of the disparities policy project at the Kaiser Family Foundation and one of the authors of the report. "They no longer feel like a green card is enough and [believe] that they really need to seek citizenship to feel secure and stable in the country."
Shirley Avalos, a U.S. citizen, said she saw that anxiety in her mother, a legal permanent resident, also known as a green card holder. At one point, her mom couldn't find her green card, and she was scared to drive until she found it. Donald Trump has gone "overboard," said Avalos, who lives east of Los Angeles.
In the interviews, parents and pediatricians reported that immigrant children were suffering from depression, anxiety, stomach ailments and headaches. They also saw children who were having problems eating, sleeping and doing schoolwork. The overall stress could have lifelong consequences for the health of those children, said Lanre Falusi, a pediatrician at Children's National Health System in Washington, D.C., and past president of the local chapter of the American Academy of Pediatrics.
"The ongoing, consistent, serious fears and stress that these families are experiencing can have actual physical effects on kids," Falusi said. "Their brains are still developing, so they are particularly sensitive to their environments and their experiences."
While most parents said they were still taking their children to the doctor, the report showed that some families have shifted toward more walk-in visits to avoid having to provide personal information to schedule an appointment.
Ramirez said his family still goes to the doctor when needed, but they try not to give any more personal information than necessary.
Falusi said she has seen a diminished use of health care services firsthand since the 2016 election. "When there are rumors around immigration raids, the parking lots are empty," she said. "The clinics are empty."
To try to help families feel more secure, physicians are posting welcoming signs and stationing bilingual staff out front. They are also reassuring families that their information will be kept confidential.
Both parents and pediatricians also reported that racism, discrimination and bullying -- especially toward Muslims and Latinos -- had increased since the election.
"The anti-immigrant rhetoric has really emboldened people to be outwardly hateful, and that is damaging for our kids in particular," said Jenny Rejeske, senior health policy analyst at the National Immigration Law Center.
In addition, many aspects of daily life -- including everything from driving to seeking jobs -- have become more difficult for immigrant families, according to pediatricians and parents. One Latino parent from Boston, for example, said the children used to go to the park but now they spend more time inside for fear of being deported.
Daisy Juarez, 27, who was born in the U.S. and lives in Los Angeles, said the strict immigration policies have affected her entire family, especially her stepfather, a construction worker who is here illegally. Juarez's sister, 10-year-old Amy, said she gets nervous about her dad being arrested by immigration officers. "What if they deport him and I can't see him anymore?" she wondered. "If they deport him, I'm gonna miss him a lot."
While deportations also soared under President Obama, those mostly targeted undocumented immigrants with criminal records, Rejeske said. President Trump has shifted that focus to all immigrants here illegally, regardless of how long they have been in the U.S. or whether they have children who are U.S. citizens, she said.
Trump also has banned travel from certain countries, boosted immigration enforcement and announced the end of the Deferred Action for Childhood Arrivals program, which provides temporary legal status to people brought to the U.S. illegally when they were children.
The two older children of Ramirez and Cadeo are both part of that program, known as DACA. Cadeo said she worries because now authorities have all of their children's information and can easily find and deport them.
The pediatricians, interviewed this fall, were from eight states and the District of Columbia, and they serve immigrant populations. The focus groups were conducted in five languages with parents from 15 countries, including Mexico, Syria, Brazil and Korea. The discussions took place in Chicago; Boston; Bethesda, Md.; and five California cities -- Fresno, San Diego, Oakland, Los Angeles and Anaheim.
Many of the parents who participated in the focus groups came to the U.S. after fleeing war and violence in their native countries, said Artiga of the Kaiser Family Foundation.
"They don't have an option to return to their native country and now they are really worried about whether they are going to be able to remain here," Artiga said. "Those individuals are in a really difficult situation."
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
