Background: Refugee families (both adults and children) face numerous health inequalities, barriers, and disparities to accessing healthcare services and oftentimes present with complex medical and social needs unfamiliar to healthcare providers. It is therefore critical to analyze these health issues and healthcare requirements amongst this minoritized population. This study examines barriers to care and acculturation among refugee and underserved families with children in Roanoke, Virginia. This study aims to add to needs-assessments to enhance pediatric refugee healthcare models in Roanoke and similar resettlement areas. Methods: A 10-item questionnaire in 2023 and an 18-item questionnaire in 2024 were administered to attendees at community events for refugee and immigrant children in Roanoke City. The survey included questions about healthcare barriers including language interpretation needs and difficulty scheduling medical appointments as well as acculturation topics, including perceived familial safety and usage of resettlement resource aid. The questionnaires were adapted from screening tools, including the Accountable Health Communities Screening Tool and the Hispanic Community Health Study Acculturation Questionnaire. Results: 149 respondents completed the questionnaires across both years. 62.9% (2023) and 79.5% (2024) identified Spanish as their preferred language. 13.9% (2023) and 54.1% (2024) found obtaining personal transportation to medical appointments challenging. 65.8% (2024) of families did not use any local resettlement resources and 41.0% (2024) reported significant familial support during these periods. 97.2% (2024) were provided with a language interpreter during clinic and hospital visits, and 91.2% (2024) preferred a human interpreter for translation in these settings. Conclusion: Personal transportation may not be feasible for families with financial constraints, preventing access to medical care. Familial support systems were shown to positively impact the acculturation process for these families, and there is an opportunity for community outreach to increase awareness of unused local resources to aid in resettlement. Language interpreter use may improve patient ease and understanding during medical visits. Further analysis of healthcare needs within this community emphasizes the importance of advocating for resources that assist in equitable healthcare delivery and acculturation in similar-sized resettlement communities.