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ACEs – Adverse Childhood Experiences

Adverse Childhood Events - ACEs - Adverse Childhood Events - ACEs -

​​​​By: Nerissa Bauer, MD, MPH, FAAP

As a behavioral pediatrician, I have seen and heard it all. Children who have tantrums to end all tantrums in the middle of a store. Children who refuse to eat or won't sit still at a restaurant―which quickly escalates to screaming and throwing food. Children who unbuckle themselves from car seats or kick other children at school for no apparent reason.

It can be scary, overwhelming, and challenging to confess these situations out loud.

Not simply because these behaviors are happening, but because parents often feel confused, hurt, bewildered and embarrassed when they do. Why won't my child listen to me? What did I do wrong? Is there something wrong with my child?

Let's face it, children don't come with instructions. And life is beautiful and messy, complicated, and hard. And there is no such thing as a "perfect" parent. Sometimes, a child's behavior happens not because of family genes or anything a parent did or did not do―but because of something that happened to the child or happened to someone in the family.

Adverse Childhood Experiences (ACEs)

I think of a child's behaviors as a set of clues to help me understand the child and family better. For children who have tantrums, it can be because they don't yet have the words to tell you what is bothering them. Or maybe they can't make sense of what is happening around them and the strong feelings inside are hard to control.

For many families, events happen that are unpredictable; these events can affect how a child feels and behaves.

For example, when parents make the hard decision to separate or divorce, it can be very confusing for young children. They may act out, cry or feel sad, lose developmental skills, or have trouble sleeping. Some have problems concentrating and have a hard time at school.

Events like these are referred to as ACEs―Adverse Childhood Experiences―and they are more common than you may think.  

​There are lots of examples of ACEs, including: 

Exposure to childhood ACEs can increase the later risk of:

How ACEs Cause Stress―and How to Relieve It

Our body has stress​​ systems to protect us so that when faced with a scary situation, we are ready to run and hide. This "fight or flight" response can be triggered whenever a child is scared of any number of things such as dogs, the dark, or spiders. This same system can also be turned on when a child experiences any adverse experience.

ACEs are likely to last longer than a single moment, which causes children's stress systems to be turned on for a long time. When this happens, the stress becomes "toxic" to their overall health. The more ACEs children face, the more harm they can have over time. In fact, adults who've experienced one or more ACEs as a child are at higher risk of depression, cancer, heart disease, diabetes and other health conditions during their lifetime.

The good news is that parents can buffer children from this stress before it becomes toxic. Providing safe, secure, and nurturing relationships help reset the body's stress system. 


Your Pediatrician Can Help

You don't have to navigate a challenging situation alone. Your pediatrician can be a resource. Pediatricians are trained to not only monitor how your child is growing physically, but also socially and emotionally.

Pediatricians also want to know how you are doing, how your family is doing, and if you feel supported and able to navigate those messier moments of parenting. Expect to be invited to share stories about your family life and the daily stresses and struggles of parenting. So, bring your questions. Remember, no question or concern is silly, minor, stupid or unimportant. When parents share what is happening within the family, it helps pediatricians understand why a child may be acting out or having problems at home and school.

There is Hope

When parenthood gets challenging, talking with your child's pediatrician is a great first step. Pediatricians can help you build your "team" and support system―whether your child is relatively healthy or has ongoing developmental or behavioral concerns.

We want to ensure all children have a chance to thrive. To that, we will always be ready to listen, without judgment and with compassion.

More Information

About Dr. Bauer

Nerissa BauerNerissa S. Bauer, MD, MPH, FAAP, is an Executive Committee member of the American Academy of Pediatrics Council of Early Childhood and past executive committee member of the AAP Section of Developmental and Behavioral Pediatrics. She is a behavioral pediatrician and sees patients in Indianapolis, Indiana in a private practice. She also served on the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) steering group and Technical Assistance Project Advisory Committee for AAP Screening In Practices Initiative. Follow her on Twitter @nerissabauer and on her blog, Let's Talk Kids' Health.

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American Academy of Pediatrics (Copyright © 2019)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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