When I first met Daniel, he was 2 months old. His aunt, Sandra, brought him to the clinic in South Los Angeles where I work as a pediatrician because he had persistent coughing.

While I was examining his lungs, he coughed so hard that he vomited in my hair. I was worried that he might have whooping cough and I started asking more about his history.

First question: Why was he with his aunt and not his parents?

Sandra told me that U.S. Immigration and Custom Enforcement, known as ICE, had detained both of Daniel’s parents in June after a domestic violence event that occurred in public. (Daniel and his family members’ names have been changed in this article to protect patient confidentiality.) Daniel’s mother and father had been sent to a detention facility in Tennessee.

Many of the families at my clinic are immigrants and some have had incursions with ICE. However, Daniel has been my youngest patient affected by federal immigration enforcement. Before his mother’s detention, he was still breastfeeding.

“The ICE men had little regard for the children,” Sandra told me through a Spanish interpreter.

She is also caring for Daniel’s siblings: 14-month-old Jacob and 2 ½-year-old Krista, as well as her own 7-year-old son. Daniel and his siblings were left with a neighbor when ICE took their parents; Sandra picked them up later that day. Fortunately, they have a relative to care for them.

Otherwise, they likely would have ended up in Los Angeles County’s crowded foster care system. In a 2011 study conducted by Race Forward, nearly 5,100 children were placed in foster care because parents were detained or deported by immigration authorities. The researchers estimated that number could rise to 15,000 this year. Immigrants who are domestic violence victims or perpetrators are at particular risk of having their children removed.

“The impact on families and children is startling,” said Julie M. Linton, a pediatrician in North Carolina and co-chairperson of the Immigrant Health Special Interest Group of the American Academy of Pediatrics. She noted that 6 million children live in mixed-citizenship families in the U.S. Studies have shown that separation from a parent, such as with divorce, is an adverse childhood experience. Known as ACEs, these life events are associated with poor health outcomes as an adult, including early death.

“It is easy to extrapolate that the loss of a parent from deportation is also an ACE,” said Linton.

“Living with fear of separation from parents can be a toxic stress,” said Linton, “Toxic meaning severe, chronic stress; it’s threatening to the developing brain, as well as [a child’s] short-term and long-term health.” With this in mind, the American Academy of Pediatrics issued a policy statement against the use of immigrant detention centers and separation of children and parents.

In 2013 ICE issued the “parental interests” directive, which guided the agency to enforce immigration laws fairly and with consideration for a parent’s rights and responsibilities for minor children. The ICE website notes that this directive is archived and no longer reflective of current practices.

The current administration’s approach to undocumented immigrants, including the parents of U.S.-born children, has wreaked havoc among families and policymakers. In response to ICE’s increased enforcement actions, last week Gov. Jerry Brown signed a “sanctuary state” bill, Senate Bill 54, which limits cooperation of state law enforcement agencies with ICE.

Some law enforcement groups are concerned that ICE’s practices have immigrant communities afraid of interacting with police. Since the beginning of the year, Los Angeles County police has seen a 10 percent decrease in domestic violence reports from Latinos, though rates have remained stable for other ethnic groups.

Similarly, safety-net programs, including Women Infant and Children’s (WIC) supplemental food program and Medicaid health insurance, have also seen a decline in enrollment by immigrants. Loss of these services may compromise health and wellbeing of children.

Daniel and his siblings were born in the U.S. and are eligible for WIC and Medi-Cal, the state’s low-income health program. Even with this help, Sandra’s income has been stretched beyond its limits. Like many families, the financial strain of caring for her relative’s children has been daunting. Researchers have shown that deportation of parents can lead to poverty, homelessness, illness and inferior education for their children.

Sandra and the children haven’t had any contact with Daniel’s parents since they were detained. The transition for Krista, the 2 year old, hasn’t gone smoothly. With the abrupt separation from her parents, she withdrew from interacting and didn’t talk for 2 months. Jacob, 14 months, coped in the opposite manner—he acted out. He became aggressive and difficult to console. At first, neither toddler slept through the night. The family will soon start therapy, including play therapy for the toddlers.

Daniel’s story isn’t fully written yet. Fortunately, he didn’t have whooping cough and with treatment made a full recovery from his respiratory infection. He adjusted to being formula fed, and now at 5 months of age, seems well bonded with his aunt, who has become his primary caregiver. However, the loss of a parent is profound and some consequences may not be seen until later.

ChrisAnna Mink is a pediatrician who practices in South Los Angeles.