The American Academy of Pediatrics publications on trauma-informed care and toxic stress1–3  are timely as our children face an increased risk of toxic stress from the myriad adversities heightened by the coronavirus disease 2019 pandemic. The American Academy of Pediatrics, like much of the medical field, has done tremendous work on the primary prevention of toxic stress: preventing child abuse, boosting relational health, and addressing social determinants of health and unmet social needs.1–3  However, through our work on California’s Adverse Childhood Experiences (ACEs) Aware Initiative, and observing rising mental and physical health needs in our patients through the pandemic, we worry that primary prevention and addressing social needs are not enough.

Although it is imperative to focus on preventing toxic stress altogether, primary prevention efforts will not prevent all childhood adversity, and some children will still experience the negative effects of the toxic stress...

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