The pictures appears to be taken when Trump visited a children's hospital over the weekend.
Miles Kahn tweeted the photo with the caption: "Don't you f*cking flip on me," playing on Trump's mob-boss tendencies.
This set off a chain reaction on Twitter, each person trying to outdo the other, turning the image into a brilliant meme.
People seem to have covered the entirety of his presidency in these memes, ranging from the horror of separating children from their families at the US-Mexico border, to more jovial matters like his underwhelming hand size.
It doesn't matter who you are or what you do, there is no way you don't find this picture particularly menacing, especially considering Trump's surroundings.
Perhaps the ultimate winner of these memes, has to be this one referencing the sharks in 'Finding Nemo'.