To study the demographic and socio-economic characteristics of foreign born children visiting an inner city pediatric emergency department (PED) and to assess their access to care, unmet health care needs, barriers to care and follow-up care. A cross-sectional study was conducted in October and November 2006; parents of children visiting an inner city PED underwent face-to-face interview regarding their socio-economic status, access to health care, unmet medical needs and barriers to care. A follow-up telephonic interview was conducted within 1 week of the ED visit to assess compliance with follow-up care. 385 patients (Mean age 4.63 years, 51.9% male) were enrolled prospectively. 297 (77%) children had health insurance and 88 (23%) were uninsured. 38 (43%) uninsured children were foreign born. Of those uninsured, 53 (60%) were uninsured for >a year and 35 (40%) had been uninsured part year. Compared with insured children, fewer uninsured children had a regular place for medical care (89 vs. 46%, P < 0.001), a regular Primary Care Provider (95 vs. 68%, P < 0.001), and regular dental care (46 vs. 26%, P < 0.001). Almost one-third of parents of uninsured children reported a perceived barrier to care (31 vs. 8%, P < 0.001). Uninsured children, who were foreign born, were older (mean age 8.9 vs. 4.9 years, P < 0.001), primarily Spanish speaking (95 vs. 76%, P < 0.02), poorer, with household income less than 100% of the Federal poverty level and had poorer access to care. They also used the PED as their primary source of care more frequently (87 vs. 66%, P < 0.03). In a multivariate logistic regression analysis, children with no health insurance, and those children who were foreign born were more likely to have poor access to care with odds ratio (95% CI) of 0.19 (0.08–0.46) and 0.35 (0.13–0.95), respectively. Conclusions: Significant proportions of uninsured children visiting our PED are born in Mexico and from low income immigrant families, many do not qualify for public insurance, have poor access to care, and use the PED for their healthcare needs. This is likely to be a growing problem in certain regions of the country requiring targeted health policy intervention.