How pediatricians are quietly preparing immigrant families for the unthinkable: leaving their children behind

CNN

a day ago

On a warm June day in Nashville, Briana cradled her one-year-old son in the pediatrician's waiting room. She was there for his routine checkup, expecting to talk about vaccines and growth charts.
Instead, as Briana bounced her baby on her lap in the exam room, Dr. Linda Powell leaned in and asked a question that stopped her cold: If you were taken away, who would take care of your baby?
It was a conversation Briana never imagined having in a doctor's office even though as an undocumented immigrant, the concern hit close to home. Just weeks earlier, her husband — the family's breadwinner — had gone to Walmart to buy sugar.
He never came home.
The next time she heard his voice, he was calling from a Louisiana immigration detention facility.
Briana, 32, had no warning. She learned later he had been swept up in an Immigration and Customs Enforcement raid in Nashville, part of a broader campaign of mass arrests across the country. Within a month, he was on a plane back to Guatemala, recounted Briana, who requested use of a pseudonym due to concerns about retaliation.
The life they had built together – modest but steady – fell apart overnight.
Suddenly alone with no income, no transportation and no family nearby, Briana began taking whatever work she could find — selling ice cream on the street, cleaning homes. Her toddler missed his father so much he refused to eat, pushing away food for days afterwards, she told CNN.
And Briana lived with a gnawing fear: that she, too, could be detained by ICE, leaving her US-born baby boy alone.
So when her pediatrician – who has cared for the boy since birth – gently suggested she create a legal guardianship plan, Briana listened.
The doctor explained Briana could draft a simple document allowing a trusted friend to care for her son if she were detained. She connected Briana with a local nonprofit that helps immigrant families prepare guardianship paperwork – a legal arrangement to ensure her son wouldn't end up in foster care if she were also detained.
Briana made an appointment, determined to put something in writing. But the only person she could think to name as guardian was an undocumented friend she'd met just months earlier. It was a choice made out of desperation.
She fought back tears as she explained, 'I'm worried, I'm scared because they (ICE) keep grabbing people outside. But I have a lot of faith in God.'
Briana's predicament is far from unique. She is one of millions of parents facing the possibility of sudden separation from their children.
Briana's son is one of an estimated 4.7 million US citizen children living with at least one undocumented parent, according to a 2025 Brookings Institution report. And about 4% of all citizen children in the US are at risk of losing both parents to deportation – sometimes without a chance to say goodbye.
Mass deportations under President Donald Trump's second term have created an unlikely new responsibility for pediatricians — protectors of those children's futures. Long trusted by parents to safeguard children and trained to navigate sensitive topics, pediatricians are quietly initiating some of the hardest conversations of their careers: If you're detained, who will care for your child?
Many of the people who spoke with CNN for this story requested use of pseudonyms out of concern for their safety and privacy amid widespread immigration raids.
In exam rooms from California to Tennessee to New York, pediatricians shared with CNN how they are privately helping parents think through guardianship options – sometimes in hushed tones after the children have left the room. They connect families with legal aid nonprofits, explain options like caregiver affidavits and power of attorney and urge parents to make arrangements before an emergency.
'These people (immigrants) are being scooped up and taken without any warning,' said Powell, who is using a pseudonym out of concern for potential retaliation against the patients at her practice. 'This poses a significant risk to these kids. One in terms of just the psychological trauma of your parents being taken without notice and not knowing when you will see or talk to them again, but also just in terms of the safety and health of these kids.'
Every day before school, a 10-year-old boy in San Francisco asks his mother the same question: Will we see each other again?
The boy's mother, originally from Guatemala and seeking asylum in the US, says she tries to reassure him, but she's anxious too. She had received deportation notices in her mailbox, she later revealed to his pediatrician.
During a routine food insecurity screening, Dr. Raul Gutierrez, former chair of the American Academy of Pediatrics Council on Immigrant Child and Family Health and pediatrician at Zuckerberg San Francisco General Hospital and Trauma Center, discovered the family was surviving on food bank donations rather than enrolling in the state's CalFresh benefits. The reason: the mother feared that applying could bring unwanted attention from immigration authorities.
For over 20 years, Gutierrez has been helping families like hers create 'preparedness plans' in case of separation. He likens them to earthquake drills.
'As much as we can clarify and support families in these really hard decisions, the better we can try to mitigate some of these fears and anxieties,' said Gutierrez, who is using his real name.
For doctors like Gutierrez, protecting children from the chaos outside the clinic walls is as wrenching as it is necessary.
'Health care workers are in a very unique and opportune position … to support families in guidance, to do it with compassion and to really advocate for safeguarding children and to help families navigate this uncertainty,' Gutierrez said.
Often, these conversations begin when a parent's anxiety surfaces during a routine screening.
Like other pediatricians who see families regularly and know their histories, Gutierrez has built relationships with parents who will share details they would never tell a stranger – like fears about applying for food assistance or hesitation to run daily errands during weeks of raids.
His process is methodical – he walks parents through a step-by-step handout from the Immigrant Legal Resource Center and asks direct but sensitive questions:
Who are the trusted people around you?
What kinds of decisions do you want to make about your child?
Will they stay here in the US, or join you if you're deported?
How can we ensure you're reunited?
Even for families with relatives nearby, the uncertainty can be overwhelming.
In California, one in five children are part of mixed-status families, according to a 2024 report from child health equity advocacy group the Children's Partnership. Chronic stress from the threat of separation can harm those children's mental and physical health, according to Gutierrez.
For children with complex medical needs, the stakes are even higher. Losing a parent who manages appointments, insurance and medications can disrupt treatment and trigger lasting harm. It can mean missed therapies, disrupted medication regimens and long-term emotional scars.
'There are plans in place to make sure that that child is supported by some other adult: someone who is given the authority to make decisions about school and medical care,' Gutierrez said. 'We really want to make sure that kids don't fall victim to being in a place of instability or to lose access to their care.'
When the undocumented father of a 2-year-old girl with Down syndrome was asked by her pediatrician who could take care of her in his absence, he replied bluntly: 'Everyone else around us is the same.'
She understood instantly – everyone he trusted was also undocumented. Choosing a guardian felt impossible.
Dr. Nancy Fernández, who has treated immigrant families in New York City for five years, says the relationships she builds with patients are key to having these conversations.
'People just know that you care about them because you've shown up in many other situations over the years,' said Fernández, who is using a pseudonym to protect her patients from possible retaliation.
In her practice, where 90% of her clients are immigrants, Fernández avoids asking directly if someone is undocumented; instead, she asks if they've been affected by recent ICE raids. She assures them the conversation won't be documented in their medical records or impact medical care.
But the fear in her patient population is still palpable. One teenager at the clinic overdosed on Tylenol after panicking that her father would be deported. A 10-year-old boy began asking his mother if his dad should stop taking the subway to avoid detection.
'What should I say to my kid?' the mother asked Fernández.
In those moments, Fernández said she realized how much of the burden children of undocumented parents are quietly carrying.
Doctors in Fernández's network once hoped letters documenting the medical harm separation could cause would persuade ICE to exercise leniency. But after writing many such letters, Fernández hasn't seen evidence they work nor has she received any responses.
'We're trying to do something to help our families, but I'm not sure that it's really that helpful in this moment in time,' she said.
In the Bronx, sign-up rates for guardianship workshops at nonprofit Terra Firma National were so low that they forced the organization to incorporate the topic into broader immigrant rights sessions.
'With our families, there's been a lot of trepidation, a lot of anxiety in even thinking about this concept of having a family separation due to ICE taking a parent away,' said Dr. Alan Shapiro, Terra Firma's co-founder and chief strategy officer. Shapiro is identified by his real name.
Daniel, a 58-year-old undocumented hotel worker who has lived in the US for nearly 30 years, stopped sleeping at night when ICE raids began in Nashville this spring. Instead, he said he would toss and turn in his bed, kept awake by thoughts of being separated from his family and kicked out of his home with just one knock on his door.
For the first time in his life, the Guatemalan-born father of four said he began experiencing anxiety so crippling that he needed medication.
'I feel something like a void inside of you, like a vacuum that's sucking you somewhere,' said Daniel, who requested a pseudonym out of concern for possible retaliation.
Daniel's life before the raids had been steady: cleaning offices at Belmont University, then working at a hotel for the last 12 years. He and his wife raised their children with weekend trips to parks, beaches and aquariums.
But after the first arrests, even grocery shopping became something only his children would do. And Daniel prayed daily he'd be able to return home from work.
'If it was just me, it would be one thing, but I have a family and kids and their well-being is in jeopardy, and that's terrifying,' Daniel said.
With his wife also being undocumented, the question of who would care for his youngest son, 11, haunted Daniel.
In early May, more than 100 people were detained in a joint operation between ICE and the Tennessee Highway Patrol. The fear that rippled through the city's immigrant neighborhoods in the weeks that followed had noticeable impacts: At Nashville's Siloam Health, where Daniel is a patient, cancellations surged to 40% — mostly from patients afraid to drive to the clinic. And at Powell's clinic, which serves mostly Hispanic immigrant families, appointment attendance dropped by half during the surge in raids. That means missed vaccines, delayed newborn checkups and untreated illnesses.
'There's always been barriers for those families in terms of navigating a health care system in a country that is unfamiliar to you and in a language that you're trying to learn,' Powell said. 'What's going on with ICE has just added another layer of difficulty, because now we have families that are just truly scared.'
The Tennessee crackdown is part of ICE raids that have intensified across the country since January: parents are being detained at home, at work and even during routine traffic stops. Often, they have no chance to say goodbye to their children or arrange child care, pediatricians told CNN. Without a plan, children can be placed in foster care or with unfamiliar guardians chosen by the state. CNN has reached out to ICE for comment.
'For every 10 people that are deported, there may be 20 American children that are dependent on that adult,' Powell said she has observed at her practice and throughout the Nashville area.
When Daniel confided in his doctor at Siloam Health about his fears, he was given a 'know your rights' card and advised to complete custody paperwork. He and his wife signed a power of attorney naming their 28-year-old daughter as guardian for their youngest son.
But for many others, just imagining separation is overwhelming.
Dr. Jule West, chief medical officer at Siloam Health, says she can often see her patients' fear manifest physically in real time the moment the topic arises: 'You can see their bodies tense up. You can see their respiratory rate go up a little. They become more agitated,' said West, who is using her real name. 'I see in people's eyes that it's very overwhelming, and they're already concerned with their safety, their family's safety, their children's safety.'
That visible fear is often enough to stall the conversation before it begins.
West says that for many of her patients, even talking about guardianship plans feels unbearable because it forces them to imagine a sudden and traumatic separation from their children.
Some parents say they don't have anyone with legal status to name as a guardian. Others have options but feel paralyzed by the idea of entrusting their child to someone else.
Despite the urgency, many parents don't formalize custody arrangements. The thought of preparing for separation feels like inviting it. For others, logistical barriers — like long wait times at overburdened nonprofits — stand in the way.
And efforts by doctors to advocate more broadly – such as distributing 'know your rights' cards, mailing supportive letters to families or hosting informational sessions – are sometimes blocked by hospital leadership wary of political backlash, some pediatricians told CNN.
Still, pediatricians persist – some after witnessing the consequences of family separation firsthand.
Shapiro shared a case involving one of his patients during Trump's first term. He said an 8-year-old boy with a severe learning disability was placed in foster care after his mother was deported to Guatemala. When he called her for her son's medical history, she broke down, unsure if she'd ever see her son again.
'It was probably one of the most heartbreaking moments in my 35-year career as a pediatrician,' he said.
The boy was eventually reunited with extended family in the Midwest, Shapiro said, but he worries about the long-term impact on both mother and child.
Now, he discusses guardianship planning in the same breath as diet and exercise guidance, marking a profound shift in what anticipatory guidance means. He often has the child wait outside the room with a book as he privately asks parents a question that is now as routine as asking about car seats, smoke alarms or safe sleep.
Shapiro reflects on the shift: 'I never thought anticipatory guidance would include anything like this … where we have to have parents prepared for their deportation and for their children to be placed with other family members.'
For families like Briana's and Daniel's, those conversations could be the difference between a child finding safety in familiar arms or facing the chaos of the foster system.
Daniel takes some comfort knowing his daughter will care for his youngest.
'Thank God, it is a relief to know of the well-being of my youngest kid,' Daniel said.
But the future remains uncertain for Briana, who still hasn't completed her son's guardianship paperwork. After hours of waiting, she left the legal aid office to make it to work.
If deported, she plans to take her baby with her to Guatemala. But she is still working to get her son a passport.
For now, she pushes forward, faith in one hand and her baby in the other.
'Every day I go outside with faith in God,' she said in Spanish. 'And I just go out to work to make money for my son.'
CNN's Caroll Alvarado and Jamie Gumbrecht contributed to this report.