There are two ways I can tell when my pediatric patients have lost a relative to gun violence. One is the mother, who is wearing the dead person’s smiling face on her T-shirt. The other is the father, who has tattooed initials along with birthdates and death dates into the flesh of his arm.

I calculate the ages of the deceased more easily now, since I’ve been at it a while. Sometimes I ask, “Who is this? I’m so sorry. What happened?”

Too often the answer is the same: “He was shot.”

On Sunday evening, six people standing outside in North Philadelphia were sprayed with bullets. The youngest was 14 years old. Two more were killed and seven injured in five additional shootings over the weekend.

Each of these numbers represents someone’s parent, someone’s child, someone’s neighbor, someone’s best friend. The impact of their injuries and deaths ripples across entire communities and through generations.

For the children who love them, the shock, fear, and loss are especially devastating because trauma affects children in profound and unique ways. Studies show that the “fight or flight response,” while protective in small doses, can permanently alter a child’s endocrine, immune, and neurologic systems if severe or prolonged.

This is why “toxic stress” in childhood increases the lifelong risk for mental health disorders such as depression and anxiety, and for medical disorders such as heart disease and diabetes. This is why the Centers for Disease Control and Prevention implicates childhood trauma as a major determinant of early mortality.

One of my patients does not remember her father. He was robbed and killed before her first birthday.

Another has been too anxious to go to school since his brother was murdered in a drive-by shooting.

A mother in my practice has identical twin sons. She keeps them inside because of the gangs on her street. One evening when they were toddlers, there was a loud commotion in front of her home and someone was screaming her husband’s name. She ran outside, not realizing the boys would follow and see their father, lying lifeless in a puddle of blood.

It is not only that they are gone. It is the sudden, violent nature of their deaths that shake the foundation of the children who love them. When one moment you are wrestling with your brother and the next moment your mother is wailing and sirens are blaring and your father is sprawled on the pavement, you are forever changed.

Gun violence is sickening an entire generation. Like all epidemics, it requires swift action. It requires Philadelphia to enact common sense gun control.

But Pennsylvania has a “preemption law.” This means our city cannot pass gun legislation more restrictive than what our state allows. We cannot ban assault-style weapons. We cannot keep firearms out of city parks. We cannot limit the number of guns a person may own or require safe storage.

The bullets keep flying.

It may be that not all communities across our state welcome limits on firearms. Rural Pennsylvanians tend to use guns differently, for hunting and sport, and their children are not at risk when they leave the house. But if we cannot agree on one set of laws to serve the needs of our wide and varied territory, then each municipality should be able to regulate itself to keep citizens safe.

We as pediatricians and mental health professionals are doing our best to minimize the trauma, through case management and ongoing therapy. But prevention is the only true solution. In order to reduce the devastation that ripples out from gun violence, we need to quell the violence itself.

Local legislators and advocates such as CeaseFirePA are leading the fight against state preemption. We need our lawmakers in Harrisburg to listen. We need them to allow our city to regulate the guns on our streets.

This is our home. These are our children. It is their future.

Dorothy R. Novick is a pediatrician at Children’s Hospital of Philadelphia (CHOP) and a fellow with CHOP’s Violence Prevention Initiative. Identifying details have been altered to protect patient privacy.