It’s become my morning ritual on the way to the hospital. Cruising down a main Philadelphia stretch, just as the road crests and the hospital becomes visible, I steel myself for the line. Is it going to be long today? In just a few more blocks, my second reflexive check-in: Are there news vans outside of the hospital?

Both glances are woven into the larger story of Philadelphia’s gun violence epidemic and how that epidemic is butchering the city’s children.

The first, the line, is at the Philadelphia Gun Permit Unit, where permits for the city’s legal guns are issued. Some days just a few people are waiting in line, still standing 6 feet apart by habit, waiting for their appointments to add to the city’s arsenal. On other days, the line has more than a dozen people waiting before the unit opens. Gun carry licenses in Philadelphia swelled by 600 percent in recent years, from 7,444 in 2020 to 52,230 in 2021, according to state police reports.

The second look is more ominous. News vans outside of my pediatric hospital almost always mean a horrific act of violence was inflected on a Philadelphia child. All too often, this means gun violence.

Gun violence is robbing Philadelphia children of their futures. Just through the first half of 2023, 44 youths, from infancy through 21 years old, died from gun violence. Another 214 were non-fatally injured. With summer here, the death toll will certainly rise. Summer is a deadly time to be a child in Philadelphia. Last year, from Memorial Day weekend through Labor Day, 50 children died by guns, plus 188 injured. In 2021, it was 28 dead and 168 injured.

Philadelphia’s Office of the Controller maps these incidents, updated in a database each day that shows a yellow dot for non-fatal shootings and red dots for fatalities. Even before the year is halfway over, certain swaths of the city appear colored in by overlapping dots.

It’s too easy to see these dots as statistics, as a headline or a news story quickly forgotten. We shake our heads about the violence, the news vans leave our impoverished neighborhood and everyone moves on. Almost everyone, that is. Because each dot contains multitudes of trauma, medical appointments, lost time in school and work, lost growth and development, shattered peace of mind and fears for reprisals, and the endless cycle of violence that’s settled over Philadelphia.

A single gunshot turns into years of turmoil. Families contend with homes now unsuitable for wheelchairs and other medical equipment; they struggle to find mental health resources for their traumatized kids. Parents who before were planning their daughter’s quinceañera or son’s graduation now are raising children with traumatic brain injuries, paralysis, PTSD, and more.

This year, I started screening my teenage patients for exposure to guns. Do you have a gun? Is there one in your home, and could you get to it if you wanted? Do any of your friends carry? Has someone ever pulled a gun on you?

The last question is often the most illuminating, and heartbreaking. Some patients are barely fazed by incidents that could have meant their own dot added to the city’s gun violence database. When I asked one teen whether she’d had a gun pulled on her, she easily said, “Yeah, two days ago.” A friend drove her home but stopped to grab his loaded gun first, suddenly pointing it at her in the car. Instead of being scared, she was annoyed. She hadn’t thought about not getting back into a car with that friend or cutting off contact altogether. This incident was barely a blip in her week.

Research shows exposure to gun violence puts kids at high risk of being hurt in other ways. A 2019 study in the Journal of Traumatic Stress that partially took place in Philadelphia showed that merely hearing gunshots was related to post-traumatic stress symptoms in young children. “This suggests that the level of threat does not need to be especially serious to create significant distress in younger children,” the authors concluded.

I worry for my patients with school out, warm weather, and late sunsets. The lack of secure recreation centers in poorer neighborhoods, dimly lit parks, and few safe spots for teens to gather mean a heightened risk of violence in a city awash with guns. The victims will pay a lifetime price after the gunshot rings out. Our city’s children are in the crosshairs and cannot wait for adults to do something about it any longer.

Lauren Burgoon is a pediatrics resident.