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> The December 2017 issue of Pediatrics featured the first and second place articles from the First Annual SOPT Advocacy Essay Competition, which focused on the effects and management of toxic stress. The Editorial Board of the SOPT Monthly Feature is pleased to continue this discussion on toxic stress with the following article by Dr Paul E. George. In the article, he poignantly describes the numerous challenges faced by undocumented immigrants and advocates for several key solutions to mitigate the severe effects of toxic stress associated with immigration. > > Catherine Spaulding, MD, Editor, Pediatrics , SOPT Monthly Feature “ This patient is an adorable 5 y/o F with spina bifida, complicated by paraplegia, bilateral Grade 3 reflux, admitted with a urinary tract infection and infected urachal cyst, status post drain placement, currently on IV antibiotics. ” The sign out for Anayansi was perfect. This little girl with giant hazel eyes and curly, black hair, whose lack of English didn’t stop her from talking with anyone in her hospital room, certainly fit the “adorable” description. Yet Anayansi did not garner the most attention on rounds; rather, the gaze of the team members kept drifting toward her mother, or more specifically, toward the conspicuous ankle monitor and charger that confined her to the corner of the room while we discussed her daughter. “I wonder what she did?” whispered my coresident as we left. A simple question with a bitter answer. Anayansi’s mother was born outside of the United States. Knowing her daughter would not receive the medical care she needed in her home country, she left with her 2 young … Address correspondence to Paul E. George, MD, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77054. E-mail: george.paul.e{at}gmail.com