Immigration 101 for the pediatric practice

April 1, 2005

When immigrant families enter your practice, their legal status affects every aspect of their health care. This primer on immigration law will help you understand their problems and provide care that meets their needs.

Whether you practice in an urban center or amidst suburban sprawl, in a border state or a rural community where local farmers depend on migrant workers to harvest their crops, in a clinic or an emergency department or a pediatric group practice, children of immigrant parents likely are among your patients.

Familiarity with the unique challenges faced by immigrants-particularly impoverished or low-income immigrants-can only enhance the quality of medical services you deliver to these patients. Furthermore, the ability to identify common problems experienced by immigrants and make appropriate referrals to social or legal service providers can allow you to have a profound impact on the life of a family. The goal of this article is not to make you an expert on immigration law, but rather to familiarize you with the vocabulary of immigration and help you understand how immigration status impacts the health and well-being of your patients.

An immigrant nation Most people use the term immigrant in everyday conversation to describe someone living in the United States who was not born here. The terminology and classifications are much more complicated and technical than that, but for purposes of this article, we use immigrant in this colloquial sense.

The types of immigrants described thus far are all-temporarily or permanently-present in this country legally. But legal immigrants are only part of the story. The immigrant community that tends to get the most media and political attention is the community of illegal aliens (also known as undocumented persons). As of January 2000, there were an estimated 7 million people illegally present in the US.2 While statistical assessments in this area are difficult, some experts estimate that there are 1.6 million undocumented children in the US.3

One type of immigrant family is particularly salient to pediatric practice: This is the quite common situation in which parents are not citizens but their children are because they were born in the US. In immigration and public benefits parlance, families of this type (which can exist in many familial configurations) are referred to as mixed households or mixed-status families. One recent estimate is that 85% of all immigrant families with children fall within this classification.4

Talking the talk: The vocabulary of immigration Like every specialized field, immigration has a vocabulary all its own, and it is one that pediatricians working with immigrant families need to learn. First, the acronyms for key immigration decision makers: