Despite increased health-harming exposures associated with poor child development outcomes, immigrant children consistently receive medical diagnoses and access treatment at lower rates than native-born peers. Critics of behavioral and cultural protective explanations for this pattern, known as the immigrant health paradox, suggest structural disadvantage drives artificially low diagnostic prevalence. This study tested if adverse exposures related to immigration are associated with child health concerns and access to the clinical pathway for mental health services. This study aims to 1) describe parent concerns for child health across clusters of immigration-related exposures, 2) understand the relationship between parent concerns and screening tools routinely used in primary care, and 3) test mediating associations across the clinical pathway for mental health. This study uses survey data and developmental assessments from n = 935 Latinx immigrant families of children between 9 and 60 months recruited at community sites in Philadelphia. I use hierarchical cluster analysis, adjusted regression models, and structural equational modeling to evaluate the study aims. The sample clustered into two groups based on high and low exposures related to immigrant health, such as xenophobia, fear of deportation, and poor economic integration, which predicted parent concerns for child health. Parent concerns were positively and moderately correlated to screening results, with stronger agreement for child behavior than development. In the clinical pathway, screening results partially mediated the association between parent concerns, diagnosis, and service access, with proportionally larger direct associations. Results support modifications to clinical practices that identify, diagnose, and provide early child behavior and development services. This study suggests that diagnostic and treatment disparities are sensitive to improvements in medical systems, social policies, and legal protections that promote equitable health for immigrant children.