The study, titled “Immigrant Family Access to Pediatric Health Care after Executive Order 14161 and Operation Midway Blitz,” examined ambulatory appointments at the unnamed referral center, a condition of the institution’s request to protect patient and family privacy. The researchers assembled a dataset spanning 2018 to 2025, capturing every outpatient visit scheduled at the center while excluding inpatient stays, emergency department encounters, telephone contacts, and electronic MyChart communications. This design focused the analysis squarely on scheduled, in-person ambulatory care, the kind of routine and specialty visits that depend on a family’s willingness to travel to a clinic and appear in person.

The enforcement context is central to understanding the findings. In January 2025, Executive Order 14161 was enacted, intensifying federal immigration enforcement and coinciding with a surge in activity by U.S. Immigration and Customs Enforcement, known as ICE. One prominent example was Operation Midway Blitz, launched on September 6, 2025, which involved the arrest of thousands of immigrants living in the Chicago area. The researchers asked a straightforward question: did the rate of missed and canceled pediatric appointments change after this operation began, and if so, for whom?

To answer it, the team employed a methodologically elegant approach. For each of the appointments scheduled after Operation Midway Blitz, patients served as their own controls, allowing the investigators to compare each child’s rate of no-shows and cancellations before and after the enforcement operation using a two-sided t-test. A one-way analysis of variance then determined which demographic variables predicted changes in no-show and cancellation rates, with the researchers controlling for active ZIP code, age, insurance type, clinic type, clinic location, and the number of post-operation no-shows and cancellations. This within-patient comparison helps isolate the effect of the enforcement period from individual characteristics that might otherwise confound the results.

The scale of the dataset lends the findings considerable weight. Among 99,743 patients with appointments scheduled after Operation Midway Blitz, no-show and cancellation rates increased significantly across all groups studied. But the magnitude of the increase differed sharply by ethnicity, language, and neighborhood. Latine patients showed a greater rise in no-show rates than non-Latine patients, with a mean change of 4.2 percentage points compared with 1.5 percentage points. Spanish-speaking families fared worse still, with an 8.7 percentage-point increase versus 1.6 percentage points among non-Spanish speakers. And children living in ZIP codes with high ICE activity saw a 5.1 percentage-point increase, compared with 2.2 percentage points elsewhere in the service area.

The statistical confidence behind these differences is substantial. The comparison between Latine and non-Latine patients yielded a p-value below 0.00005, as did the comparison between Spanish-speaking and non-Spanish-speaking patients, while the ZIP code analysis reached p equals 0.0001. When the researchers controlled for other variables, the post-operation period showed a significant increase in no-show and cancellation rates among Spanish-speaking patients and among patients identifying as Latine. In a striking reversal, English-speaking patients actually showed a significant decrease in no-show and cancellation rates after the operation began, underscoring that the disruption was not a generalized phenomenon but one concentrated among specific communities.

The absolute numbers are sobering. The authors identified more than 1,258 missed appointments among Latine patients alone in the period following the enforcement crackdown, out of nearly 100,000 appointments scheduled overall. Each of those missed visits represents a child who did not receive a scheduled vaccination, a developmental screening, a chronic disease check, or a specialist evaluation at a referral center that serves children with complex medical needs. At a pediatric referral center in particular, appointments are often not easily replaced; families may have waited months for subspecialty slots, and a missed visit can push diagnosis and treatment further into the future.

The clinical stakes extend beyond individual children. Missed and canceled visits related to immigration enforcement may contribute to delays in preventive care and timely diagnosis, and the researchers note that these disruptions can negatively affect both individual and community health. Non-English-speaking and Latine patients, and patients living in neighborhoods targeted by enforcement actions, were significantly more likely to miss scheduled appointments than their counterparts, a pattern the authors say contributes to health care inequities. Preventive pediatric care depends heavily on continuity and timeliness; when entire communities disengage from scheduled care, the consequences accumulate quietly in the form of undetected conditions, delayed immunizations, and worsening chronic disease.

Behind the statistics are individual stories that shaped the research itself. “I took care of a girl on the oncology service whose parent was unable to come visit her due to fears of being taken by ICE,” said co-author Frances Ho, MD, a pediatric resident. “Her story stuck with me, and this project is a way to understand the scope of ICE’s impact on patient care in the city of Chicago.” Her co-author, pediatric resident Teresa “Tess” Trinka, MD, framed the broader implication: “When families fear leaving home, children miss more than appointments, they miss opportunities for both life-saving and preventive care. Our findings highlight the downstream impact of immigration policy on pediatric healthcare utilization in Chicago.”

The researchers conclude that health care systems and policymakers must consider the unintended health consequences of immigration enforcement and implement strategies to ensure equitable access to care. The study was presented during the Council on Health Equity sessions of the AAP conference, held October 2 through 6 at the San Diego Convention Center, with the authors scheduled to present on October 4, 2026. As enforcement activity continues to shape daily life in immigrant communities, the Chicago findings offer a quantitative warning: policies that make families afraid to leave their homes do not stop at the clinic door, and their costs are measured in the preventive care, timely diagnoses, and treatments that children never receive.

Subject of Research: The impact of intensified U.S. immigration enforcement on pediatric appointment attendance and health care access in Chicago

Article Title: Latine, Spanish-speaking patients missed pediatric appointments after immigration enforcement crackdown

Article References: Latine, Spanish-speaking patients missed pediatric appointments after immigration enforcement crackdown. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: immigration enforcement, ICE, pediatrics, health care access, Operation Midway Blitz, health disparities, no-show rates, Chicago, Executive Order 14161, Latine health, preventive care, American Academy of Pediatrics