Federal Immigration Enforcement Deployment and Emergency Department Utilization Among Children

Importance: Heightened immigration enforcement in the US has been associated with reduced health care utilization in immigrant communities. Pediatric emergency departments (EDs) serve as a critical safety net for children, yet the impacts of acute immigration enforcement activity in pediatric ED utilization remain incompletely characterized. Objective: To evaluate whether deployment of federal law enforcement in Washington, DC, was associated with changes in pediatric ED utilization and whether these changes differed by the patients' preferred language, race, and ethnicity. Design, Setting, and Participants: This repeated cross-sectional interrupted time series analysis compared daily pediatric ED visits from June 1 to September 30, 2025, with visits in the same calendar period in 2024 at a single pediatric ED at a freestanding children's hospital in Washington, DC. Participants included all patients younger than 26 years presenting to the pediatric ED during the study period. Exposures: Deployment of federal law enforcement personnel, including Immigration and Customs Enforcement and National Guard troops, in Washington, DC, beginning August 11, 2025. Main Outcomes and Measures: The primary outcome was daily pediatric ED visit counts. Interrupted time series models estimated immediate changes in ED utilization and postdeployment trends by patient-preferred language, race, and ethnicity, adjusting for age, sex, and acuity. Results: A total of 21 822 pediatric ED visits were included in the analysis (median age, 6.5 [IQR, 2.0-13.1] years; 11 505 visits [52.7%] by male patients). Among these visits, 6253 patients (28.7%) identified as Hispanic, 10 649 (48.8%) as non-Hispanic Black, 2200 (10.1%) as non-Hispanic White, 558 (2.6%) as non-Hispanic multiracial, 1411 (6.5%) as non-Hispanic additional race, and 652 (3.0%), unknown. Patients who preferred to speak Spanish experienced an estimated immediate change in visits following federal deployment of -10.4 visits per day, whereas patients who preferred English experienced an estimated immediate change of 5.6 visits per day (difference, -16.0 visits per day). Hispanic patients similarly experienced an estimated immediate change of -13.3 visits per day, whereas non-Hispanic patients experienced an estimated immediate change of 6.2 visits per day (difference, -19.4 visits per day). Among Hispanic patients, those preferring Spanish had greater estimated immediate changes (-12.1 visits per day) than those preferring English (-0.8 visits per day; difference, -11.3 visits per day). No significant differences were observed across non-Hispanic racial and ethnic groups. No comparable declines were observed during the same period in 2024. Conclusion and Relevance: In this repeated cross-sectional study of pediatric ED visits before and after a federal immigration enforcement deployment, heightened immigration enforcement activity was associated with an immediate reduction in pediatric ED utilization, particularly among patients who preferred to speak Spanish. These findings suggest that immigration enforcement may have unintended consequences for children's use of emergency care.