One in five children in North Carolina (NC) live in immigrant families, in which the child or at least one parent was born outside the US. In the setting of rapidly evolving immigration policies, the physical and mental health of many children in immigrant families is being threatened by fear and uncertainty. A group of NC pediatricians and child health experts developed a White Paper to summarize the current state- and federal-level issues impacting children in immigrant families in NC and to offer recommendations to support their health and well-being. Recommendations included: (1) Task Force Development: Create a state-level, cross-sector task force for immigration that is comprised of a multidisciplinary team of health care professionals from diverse practice settings (e.g. academic centers, private practices, public health, and Federally Qualified Health Centers) as well as members from community-based organizations, faith organizations, and other government sectors; (2) Health Policy: Unite NC health care professionals in advocating for public coverage of medical (language) interpretation in order to reduce barriers to accessing care; (3) Refugee health: Prioritize local and regional collaborations, increase efforts to connect refugee families to a medical home in a timely manner, and fund community caseworkers who can act as health care navigators; (4) Public Education: Promote trauma-informed and cultural training on immigration issues for school-based professionals and emphasize increased funding for school nurses and counselors, who can serve as liaisons and increase access to health care; (5) Economy and health: Promote advocacy efforts to emphasize the economic contributions of immigrants in NC and share the benefits of those contributions on the health of their families; (6) Medical-legal needs: Train health care professionals to screen immigrant families for legal needs and increase pro- or low-bono legal representation for children and families seeking safe haven; (7) Immigration Enforcement: Support community-based and legislative opportunities to minimize actual or threatened separation of parents from children and eliminate enforcement in sensitive locations (schools, health care facilities, places of worship); (8) Public Safety: Encourage community-based organizations to work with local law enforcement, minimizing fear about deportation so immigrant families can report crimes and access resources; (9)Transportation: Advocate for eligibility to apply for driver’s licenses, regardless of immigration status; and (10) Early childhood education: Increase immigrant families’ access to early childhood education and daycare centers. The White Paper summarizes challenges impacting the health and well-being of immigrant families in NC and provides recommendations to mitigate these challenges and foster optimal health and well-being for all NC children and families. The Board of Directors of the NC Chapter of the AAP subsequently approved the formation of a task force, to include pediatricians and external stakeholders. Next steps are developing the task force and strategic planning.