AAPCA1 & ACEs Aware
ACEs Aware February Initiative: Toxic Stress

The ACEs Screening tool and initiative to address childhood trauma is a small step in a long history of pediatric research and programs on understanding how children thrive, and how we can support them. 

This month, we look at the effects of toxic stress and their associated medical conditions.
Pediatric Perspectives: Toxic Stress
Our Unique View: Associated Health Conditions and Pediatric Stress

By Dr. Diane Dooley, MD,MHS, FAAP and Dr. Renee Wachtel, MD, FAAP
“The associations between childhood experiences and life course trajectories may be quite strong, but they are also imperfect.” 
- Andrew S. Garner MD, PhD; Health Forkey, MD; Moira Szilagyi MD, PhD
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.
More information on screening for Child Development, Perinatal Depression and Social Determinants of Health can be found here.
Free Upcoming Events
An Inward Facing Trauma Approach: A Medical Perspective

February 23, 2021
12:15-1:15 PM

Learn more about one FQHC’s experience in integrating trauma-informed care through an inward-facing approach within healthcare clinics.

February 24, 2021

12-1:30 PM

Join us for our next ACEs Aware webinar to discuss the secondary health effects associated with stress caused by COVID-19. Presenters will share how ACEs Aware training and resources to treat toxic stress can equip providers with the knowledge and tools they need to effectively incorporate ACE screening into patient care.
Parental and Provider Resources for ACEs
AAPCA1 and ACEs Aware Website
Our ACEs Aware and AAPCA1 webpage allows you to explore resources based on your comfortability with ACEs. We address a diverse array of topics ranging from trauma informed care, referrals, and toxic stress.
California ACEs Academy: "What Happens After ACEs Screening?"
This webinar discusses opportunities for ACEs screening implementation in the medical setting, identifies evidence-informed clinical approaches for responding to ACEs within pediatric and family medicine practice, and presents effective strategies for responding to ACEs through community partnerships. Time for discussion and Q & A will be included.
ACEs Parent Tool
This tool on how to best create positive experiences for your children is available in English and Spanish.
We look forward to communicating future ACEs initiatives with you and your practice! For more information on the ACEs initiative, visit our website here or contact [email protected].
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The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

President: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer: Nivedita More • Past President: John Takayama
Executive Director: Isra Uz-Zaman

California Chapter 1, American Academy of Pediatrics | www.aapca1.org | [email protected]| 916-274-4173