During the first few months of the Trump administration, officials have implemented new executive orders and actions that have had sweeping impacts on pediatrics and child health.
Many pediatricians have deepening concerns about cuts to the federal workforce and billions of dollars in funding for public health, research and programs. New policy efforts aim to end diversity, equity and inclusion (DEI) policies, limit immigration, restrict access to gender-affirming care and impact other issues important to children (Click the links above to jump to each section).
Actions undermining vaccine confidence amid ongoing measles and pertussis outbreaks also have increased the time and complexity of vaccine immunization counseling across pediatric practices.
Many of the moves are being challenged in court, which ultimately may blunt their impact. But those allowed to stand could cause serious harm to patients and practices. In the meantime, pediatricians are practicing in a constantly changing landscape and fending off misinformation from multiple sources, including top health officials.
The AAP has been speaking out in the media and to members of Congress about many of the administration’s new orders and urging pediatricians to do the same.
“Nothing should ever interfere with the trusted relationship between pediatricians and families,” said AAP President Susan J. Kressly, M.D., FAAP. “Pediatric practices need to be safe spaces for patients, families and every member of their care team.”
Cuts to public health employees, state health programs
In late March, the Department of Health and Human Services (HHS) slashed $12 billion in public health funding for state health departments. Congress appropriated the money to support efforts to combat the COVID-19 pandemic and meet a wide range of public health needs, including immunization initiatives. Grants for mental health and substance use initiatives also were cut.
The move left AAP chapters wondering what will happen to funding they rely on and concerned about the impact of cuts to public health initiatives in their states.
Twenty-three states and Washington, D.C., filed a lawsuit and a judge blocked the funding cuts in early April, but HHS quickly asked the judge to reconsider.
In addition to cutting funds to states, HHS has terminated 20,000 employees, including pediatricians.
“When coupled with executive orders and other administrative actions, these cuts hinder core aspects of our work beyond infectious diseases, including preventing injuries, taking care of children with disabilities, overcoming child health disparities and protecting the relationship between physicians and families,” Dr. Kressly said.
Diversity, equity, inclusion, accessibility
Overcoming the disparities Dr. Kressly noted became even more challenging as President Donald J. Trump dismantled federal programs related to DEI, accessibility and environmental justice. Attorney General Pam Bondi has threatened to penalize such programs at private companies and universities that receive federal funds, saying they constitute illegal discrimination.
The moves followed an October 2024 report from U.S. Sen. Ted Cruz (R-Texas) that criticized National Science Foundation grants during the Biden administration going toward DEI-related research that it categorized as social justice, gender, race, environmental justice and social status. The Trump administration also has told federal agencies to avoid or limit words like bias, race, inequity, mental health, clean energy, disabilities, trauma and women, according to a New York Times report.
A pediatrician who has worked extensively on health equity initiatives and who asked to remain anonymous said state and federal efforts to attack DEI and accessibility (DEIA) initiatives are akin to censorship. Without being able to talk about or work on health disparities, she feels like she and her colleagues are just going through the motions of delivering health care.
“Everything has become political,” she said. “If I bring up the fact that we have data linking air pollution to cognitive neurodevelopment and mental health, I don’t know who is on the other side of the conversation and whether I could be at harm or reported for having these conversations that are based on data and science.”
Without honesty in science, the pediatrician added, “your conclusions are useless.”
She also is concerned that pediatricians she is training are being put “in a place where they also have to compromise their ethical or moral values in the setting of these political actions/maneuvers that aren’t data-based, aren’t evidence-based but nevertheless impacting all of us.”
Efforts to rescind DEIA initiatives also come at a time when there are too few primary care pediatricians as well as medical and surgical subspecialists. Shortages mean many patients wait months to see a doctor or forgo care, said Jesse M. Hackell, M.D., FAAP, chair of the AAP Committee on Pediatric Workforce.
“It is critical that all of us reach out, both as individuals and as part of our institutions, to qualified students who are underrepresented in medicine or who may not have considered a career in pediatrics in the past and share our experiences of the joy and rewards that caring for children can bring,” Dr. Hackell said.
Trump’s efforts also have targeted immigrants. On the first day of his second term he declared a national emergency at the southern border and signed multiple executive orders (EOs) to restrict entrance into the U.S. and deport or detain noncitizens.
The administration’s actions include a directive from the Department of Homeland Security that rolls back a Biden administration policy limiting Immigration and Customs Enforcement (ICE) agents from making arrests at or near hospitals or doctor’s offices, schools, playgrounds and places of worship.
“Families are scared to come into the hospital and clinics, fearing that they will be apprehended and deported by ICE officials,” said Sural Shah, M.D., FAAP, chair-elect of the AAP Council on Immigrant Child and Family Health. “We have also heard of families afraid to go to school, get needed labs drawn or pursue necessary imaging because of this same worry.”
Dr. Shah said some families are asking to forgo well-child visits or conduct them virtually.
“As pediatricians, we know how much these well-child visits matter in maintaining and promoting healthy development, meeting preventive care goals and early identification of any medical issues,” Dr. Shah said. “These are families wanting to do the right thing for their children and seeking guidance on how to best protect their children's health and safety.”
That guidance may include legal advice to understand the possible ramifications of the federal government’s actions.
“Many pediatricians have worked with their institutions to develop and disseminate policies on how to appropriately respond if ICE were to arrive at their institutions,” Dr. Shah said. “This includes working with hospital administration and legal counsel to develop policies that follow the law while also ensuring we are minimizing fear of health care spaces.”
Some families are requesting letters from their doctors about the dire nature of their child’s health condition. The letters would be used during potential removal proceedings to argue in favor of a parent staying in the U.S.
“Even though many of their rights have not actually changed, there is a chilling effect,” Dr. Shah said. “The downstream effect is children losing access to critical support needed for healthy growth and development.”
Dr. Shah points to the AAP Immigrant Health Toolkit as a resource for pediatricians who also may be feeling the chilling effect.
“Pediatricians are scared for their patients and also for themselves, their families and communities, and their colleagues,” Dr. Shah said. “Immigrants of many different statuses are a key part of the health care workforce, so these EOs affect many health care workers personally as well as professionally.”
Before she became a clinical professor of pediatrics at Stanford University in California, Morissa J. Ladinsky, M.D., FAAP, cared for patients in Alabama, where a law banning puberty blockers and hormones to treat transgender minors was signed in 2022.
Alabama is one of 26 states that has some form of ban on gender-affirming care.
The family of a transgender youth under Dr. Ladinsky’s care in Alabama moved to a state without a ban, thinking the youth would be able to continue receiving care there.
That family and many others, however, are wondering if gender-affirming care will be banned throughout the U.S. after Trump signed targeted executive orders restricting access to care as a matter of federal government policy.
“One of the dads … said, ‘It feels like you’re on this spaceship and you got sucked out of an escape hatch,’” Dr. Ladinsky said.
Trump’s orders include a stipulation that the U.S. will not “fund, sponsor, promote, assist, or support” any child’s transition. Another says the federal government will only recognize two sexes, male and female. In addition, multiple executive orders signed by President Joe Biden have been revoked, including “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation.” The White House also has called for a study on whether people who are transgender regret transitioning, according to the journal Nature.
One of Trump’s orders that describes puberty blockers and hormone therapies as “chemical and surgical mutilation” have some institutions “hitting the pause button” on certain aspects of care, Dr. Ladinsky said.
She related the story of a law student living in their identified gender who waited a year and a half for a gender-affirming care appointment that was canceled with no explanation. “That’s happening in Pennsylvania, New York, even the District of Columbia, Virginia,” she said, referencing places with no bans on such care.
But Dr. Ladinsky maintains the majority of providers in states without existing bans have not changed course.
“We’re just quietly taking care of our people. All our people,” she said.
Dr. Ladinsky also said that preliminary injunctions issued by the federal courts against many of Trump’s executive orders “buys us time for our people to live, to receive the health care that they deserve to be receiving.”
Research funding cuts, vaccine hesitancy
Melissa Stockwell, M.D., M.P.H., FAAP, and her team were starting the second year of a four-year study on the effectiveness of text message reminders for COVID-19 and flu vaccines when they received a notice that their National Institutes of Health (NIH) grant had been terminated. The team was conducting the study through the AAP Pediatric Research in Office Settings network, of which Dr. Stockwell is the associate director.
The project was among hundreds abruptly terminated in March, which now are the subject of lawsuits. The terminated projects covered topics like vaccine hesitancy, transgender health, climate change and discrimination. The termination notices for vaccine hesitancy projects said, “It is the policy of NIH not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment,” and that they are not a good use of taxpayer dollars.
Dr. Stockwell and two fellow pediatricians decried the move in a recent JAMA viewpoint article.
“This is a stunning justification for abandoning research dedicated to improving uptake of one of public health’s greatest achievements,” they wrote.
Dr. Stockwell said it is devastating to think about the time and effort including from practices and families that had gone into the project as well as the loss of funding for colleagues who study vaccines.
“We really need to make sure we’re not eroding the scientific foundation that has been such a part of the U.S. for decades,” Dr. Stockwell said.
The cuts to vaccine research landed amid a measles outbreak and rising pertussis cases and following a severe flu season.
“I very much worry about the impact on the health of children,” said Dr. Stockwell, chief of the Division Child and Adolescent Health at Columbia University Irving Medical Center. “I know that we all want the same thing, we want kids that are healthy, we want kids that are growing and thriving. We do truly believe this kind of research helps that.”
The AAP and other leading physician organizations called for the NIH to restore grant funding on vaccine hesitancy and uptake.
“This action is a dangerous intrusion into critical work that seeks to protect our patients from vaccine-preventable illnesses,” the groups said in a statement.
That statement came just two days after the AAP denounced news that the Centers for Disease Control and Prevention would conduct a study of the discredited theory that linked vaccines and autism. In late March, the Washington Post reported that HHS Secretary Robert F. Kennedy Jr. had chosen a anti-vaccine activist to lead the study.
Dr. Kressly said such a study does a disservice to individuals with autism and their families, and any effort to misrepresent decades of research that has found no link between vaccines and autism “poses a threat to the health of children and our nation.”
“Devoting more research dollars to answer a question that is already known does not add to our knowledge about the safety of vaccines,” Dr. Kressly said in a statement.
Dr. Kressly is calling on pediatricians to counter misinformation on vaccines and to contact their members of Congress about the impact of federal actions including funding cuts, layoffs and the potential for billions in cuts to Medicaid.
“Every day we show up as pediatricians is a better day for kids,” Dr. Kressly said. “Even when, and especially when, it’s hard.”
