Adverse childhood experiences (ACE) studies have clearly shown that trauma in childhood places one at risk for long-term health consequences .1 This trauma is also recognized to manifest as behavioral and learning issues even in childhood.2
In the same vein, Keenan et al (10.1542/peds.2020-0638), in an article being early released this month, surveyed almost 200 parents whose children had experienced physical abuse to determine if there was an association between healthcare related quality of life (HRQoL) and childhood adversity. These researchers noted that not only was there a clear worsening of this HRQoL with each ACE, but that the reductions in health-related quality of life were similar to those seen in children with special health care needs.
This study also highlights opportunity. Researchers also found that over 90% of families had identified a primary care provider (PCP) for their child. In addition, over 80% of these children had visited their PCP in the past year. Parents also identified that they trusted the child’s PCP and that they would be open to any help that the PCP was able to provide. However, a majority of these families were reluctant to bring up their child’s recent trauma.
There are a number of screening tools which can be used in an office setting. The simplest is asking: “Since the last time I saw you, has anything really scary or upsetting happened to you or your family?”3 Some may argue that the few seconds it takes to ask this question are too long in an already packed clinic visit, but I disagree, because the implications of childhood trauma can last a lifetime.
- V.J. Felitti, R.F. Anda, D. Nordenberg, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ace) study. Am. J. Prev. Med., 14 (4) (1998), pp. 245-258, 10.1016/S0749-3797(98)00017-8
- Tenah K.A. Hunt, Kristen S. Slack and Lawrence M. Berger. Adverse childhood experiences and behavioral problems in middle childhood. Child Abuse & Neglect, 2017-05-01, Volume 67, Pages 391-402
- Forkey H, Conn A. Childhood trauma management in primary care. Advances in Pediatrics. https://doi.org/10.1016/j.yapd.2018.04.004