He came into the room wearing a Spiderman sweatshirt, light-up Spiderman shoes, a Spiderman backpack, and clutching a teddy bear with one eye missing and threads visible throughout. He looked at me and quickly sat down and hugged his bear even more tightly. He was with his grandmother who explained that he loved Spiderman and that this teddy bear belonged to his older brother when he was young. He had given it to him, and it has not left his sight since.

His grandmother brought him in today to talk about his asthma, which has not been under good control since he came into her care full time six months ago. His grandmother stated he had lost his mother recently, and she had sole custody of her boys, leaving him and his older brother in their grandmothers’ care. He was only four.

Upon reviewing the social work notes prior to them entering the room, I learned he came from a physically abusive home, witnessed several violent attacks against his mother by a father who had been physically abused himself. The wounds this little boy experienced have left behind physical scars on his body, but the emotional wounds run even deeper and will affect him in ways that even he will not understand.

They will shape his experiences with new people and with his own family. They will not only affect his ability to achieve good asthma control at this moment but will increase his risk of chronic diseases in the future. They will impact his brain development and ability to regulate emotion. They will increase his risk of mental health issues such as depression, anxiety, and substance abuse disorders. They will impact his education, impact his chance of future employment and economic success and his relationships in adulthood. They may also decrease his life expectancy. The impact does not stop with this little boy. These adverse childhood experiences will increase the chances of his children experiencing similar events as well, leading to their own consequences and perpetuating this cycle for generations to come, as it was likely passed down to him from generations prior.

We know the severe impact adverse childhood experiences (ACES) have on people’s health and well-being. We know that three out of four high school students report having experienced one or more ACES in their lifetime, most commonly emotional or physical abuse or living in a household affected by poor mental health or substance abuse. In clinical practice, we have a tool that measures an ACE score based on questions about one’s experiences in their lifetime, which hopes to help categorize their future risk of various health consequences. Many of the questions will address the experiences of this little boy who loves Spiderman and his teddy bear and it is easy to imagine his risk for future adverse consequences is quite high.

Trauma can be within the home, outside the home, can be directed at you, or can be witnessed. Regardless of where the trauma originates or who is it directed towards, it can have lasting effects on individuals and communities.

We are living and breathing trauma right now. The traumatic effects caused by ICE is breaking the ACES scale as we speak. The traumatic effects of being restrained, detained, deported, and even witnessing these events are beyond measurable. The lasting impact when it comes to mental and physical health and emotional wellbeing will not be reversible. The people that suffer will be the men, women and children who are being detained; the men, women and children who are being deported; the men, women and children who may get released; the men, women and children who witness these acts; the men, women and children who see communities become smaller; the men, women and children who see their colleagues or classmates not present the next day; the men, women and children who question what the “land of the free” means when singing the National Anthem; the men, women and children who question what it means when people say America is a “melting pot”; the men, women and children who journeyed here under the assumption this was a land of opportunity.

When I see a child in clinic, a child walking on the street, or an immigrant mother carrying her baby, I think about the little boy with his Spiderman sweatshirt and his teddy bear. I think about the weight of his trauma and their trauma. For we could all be wearing that Spiderman sweatshirt. This is a call to action, a plea to understand and believe the lasting impact of this trauma which has permeated our nation. This is a plea to do your part, call your representatives, read the hard stories, donate, vote. This is a plea to empathize; to feel; to not look away. This is a plea to stand up for what is right and what is humane. This is a plea to make the Spiderman sweatshirt be what it was meant to be – a sweatshirt with a superhero worn by a smiling child living in a world where he belongs, where he is taken care of and will thrive.

Mansi Kotwal MD MPH is an Assistant Professor of Pediatrics at the George Washington University Hospital