Pediatricians are in a unique position to recognize adverse childhood experiences (ACEs) as well as the chronic medical conditions associated with these experiences. In daily practice though, it’s hard to know how family stresses and the health concerns for an individual child interact. We know that the screens for ACEs and social determinants of health tell us who belongs to the population at risk for toxic stress, but they do not predict who’s going to have toxic stress or an associated health condition. We also know that everyone with asthma does not have toxic stress.
Most of us recognize that children from stressed environments are far more likely to have tantrums, sleep disorders, and developmental delay. Similarly, children from food-insecure families are more likely to have obesity and families living in areas of increased air pollution have a higher likelihood of asthma. Previously, we felt that it was enough to treat the symptoms of these disorders – offer sleep hygiene information, nutritional advice, or an inhaler. But now we realize that these conditions may well be linked to, or exacerbated by the endocrine, inflammatory, immunological and autonomic nervous function dysfunction secondary to toxic stress.
The ACEs Aware initiative recommends annual ACEs screening for children using the PEARLS screen, followed by offering trauma-informed care, patient education and stress-reducing strategies to help families understand and address toxic stress.
