It was already clear that Donald Trump’s policies, actions, and words have put millions of children at risk. But although the longest government shutdown in American history is coming to an end, this nearly 40 day financial crisis added a whole new dimension to the challenges facing children living in poor, working poor, and even many middle-class families.

It has become undeniable that after only two years, the Trump administration is already showing itself to be the most anti-child of any presidency in memory.

Let’s start before the shutdown, with the forcible separation of migrant children from their parents that began last spring under the administration’s “zero tolerance” policy. This policy was intended to deter people seeking asylum or work in the United States. Based on abject cruelty and eventually retracted after a massive public outcry, it traumatized thousands of children, even as the policy actually failed to deter immigration attempts.

How many? The original reported number was 2,500. But in fact, as recently reported, the number of children separated from parents may be significantly higher than that. And as many as 15,000 migrant children and adolescents may still remain in federal custody.

Then there is the ongoing threat to children related to the elimination or slashing of environmental protections of the air, water, and soil. Of the dozens of critical protections eliminated by Trump’s disgraced former Environmental Protection Agency head, Scott Pruitt, none is more cynical and dangerous than his attempt to eliminate the ban on pesticides containing chlorpyrifos.

Following Pruitt’s decision to ignore calls to ban the chemical and allow its continued use, the Ninth Circuit Court of Appeals in August 2018 ordered the EPA to ban it. As of September 2018, the EPA has appealed the decision to ban the dangerous chemical. This substance, sprayed widely on food including cereals, apples, oranges, and nuts, is highly toxic to a child’s brain.

Meanwhile, as hundreds of demoralized EPA scientists and professionals have left the scuttled agency, let’s not forget that some children in Flint, Michigan are still ingesting leaded water. Kids in more than 1,000 other U.S. communities have lead and other toxin-contaminated water flowing from home and school faucets.

Still, Trump’s EPA has continued to drag its feet on updating the rules governing when pipes must be replaced to keep lead from entering drinking water. The administration’s latest action plan included plans to revise the rule, which has already been delayed twice.

“ Already some 7 million Americans have lost health coverage. I estimate that would include at least two to three million children. ”

Third, as the Trump administration, with the support of many Republican members of Congress, attempts to dismantle the Affordable Care Act, the inevitable consequence will be to dramatically slash the health-care safety net.

Since 2017, Trump’s first year in the White House, the president and Republican lawmakers have been proposing legislation that would result in at least 14 million Americans losing health insurance coverage. Already, some 7 million Americans have lost coverage. I estimate that would include at least two to three million children.

On top of all this are the consequences of what was the longest government shutdown in U.S. history, a crisis personally and enthusiastically precipitated by President Trump himself.

The precise data don’t exist, but we can make a stab at determining on how many children were–and still will be–potentially affected by the shutdown. There are some 800,000 people working directly for the federal government, plus some 4 million contractors indirectly affected by loss of work as a result of the shutdown.

Even if we conservatively estimate that only half of the affected workers have families, and assuming that each family has on average two children, it is not unreasonable to conclude that somewhere between 4 and 5 million children were affected by the shutdown.

Many of the affected families are supported by very low-end salaries from a multitude of government agencies. This includes more than 1,000 janitors, security workers, and food service workers in the Washington, D.C. area alone—and many multiples of that across the nation.

They depend on regular paychecks for life’s basics like rent, clothing, and food. And if the shutdown had continued for a few more weeks, we’d be on the verge of running out of funding for food stamps and subsidized school lunches and breakfasts.

Besides the directly employed federal workers and the contractors supported by government funds, there are the cascading impacts of the shutdown that hit the families of restaurant workers, cab drivers, and many others who depend on the ability of government workers to pay for services that are a basic part of the economic ecology.

According to the American Association of Marriage and Family Therapy, “Economic hardship and financial distress can have devastating effects on families.” This would not be a news flash for any family facing the economic hardships that inevitably accompany even relatively short-term loss of income. Increased incidents of domestic violence, depression, and anxiety are all seen in families where income has abruptly stopped.

And with a prolonged period of financial stress and uncertainty, children are deeply affected, often exhibiting symptoms of anxiety and depression including sleep disorders, and behavioral changes and reduced academic performance.

Even with a re-opening of the government now, the residual consequences from the families’ psychological stress and turmoil may be long felt by their children. And remember, it is only the directly salaried federal employees who are back at work, most eligible for back pay. This is decidedly not the case for the millions of contractors and service workers whose families and children will bear the pain of uncompensated income loss from Trump’s misbegotten domestic crisis.

There may not be metrics to objectively assess the comparative child friendliness—or unfriendliness—of one president versus another. But for me, as a pediatrician and children’s advocate with more than four decades of practice and program experience working with some of the nation’s most disadvantaged children, Donald Trump represents a material threat to the well-being of America’s children and, consequently, to the future greatness to which we all aspire.

Intentional or not, no president in modern memory has exhibited the callous disregard for the protection and well-being of children as has Donald Trump. However long his presidency may last, this fact will be part of a legacy that will be judged accordingly by history.

Irwin Redlener, a pediatrician, is president emeritus and co-founder of Children’s Health Fund, a professor at Columbia University’s Mailman School of Public Health and director of the National Center for Disaster Preparedness. His Twitter handle is @IrwinRedlenerMD.