Gov. Phil Murphy released a statewide action plan on Feb. 4 to promote resilience and address the effects of Adverse Childhood Experiences (ACEs) in New Jersey. The Office of Resilience at the New Jersey Department of Children and Families will be leading the statewide implementation of this plan, but partners from all sectors — including pediatricians — have a critical role in ensuring its success.
ACEs are pervasive afflictions, currently affecting thousands of children and families in New Jersey, with the potential to leave behind the persistent effects of trauma for years to come. Sadly, ACEs are far too commonplace even in the best of times, with nearly 40% of children in New Jersey estimated to have experienced at least one ACE. During times of heightened anxiety, isolation and uncertainty, such as the COVID-19 pandemic, the incidence of ACEs grows considerably. Not only do ACEs cause immediate damage to a child’s overall health and welfare, but also studies show they contribute to poor social, economic and health outcomes in adulthood — including premature death.
The Centers for Disease Control and Prevention defines ACEs as potentially traumatic incidents that occur in childhood, including bullying, abuse or neglect; domestic violence; death of a family member by suicide; substance use in the household; or instability resulting from parental separation or the incarceration of a member of the household. The higher the number of ACEs a child experiences, the greater the impact on their health and well-being.
In our medical practice, we see the daily struggles many families must endure, and we witness the cruel and blunt-force impact these adverse experiences can have on children. Whether a child is a victim of school bullying, physical or sexual abuse, violence or divorce, they will manifest their pain in their behavior. They may withdraw or act out. They may become unruly or seek risk. They may find it difficult to focus or express affection.
We have seen teens struggle with school and with day-to-day interactions with their mother following the loss of their father to violence. We have also seen parents reduced to tears as they tell us they don’t have enough food for the family and are unsure where the next meal will come from. And we have seen young children berated for behaviors that are normal and expected for their age by caregivers who themselves are experiencing stress and trauma. In each case, the experience is made more heartrending with the knowledge that the harm to children is cumulative and the effect long-lasting, and the parent may not be aware of the cause or equipped to deal effectively and sensitively with the behavior.
At the same time, our work as pediatricians has also shown us the potential we hold in supporting families with young children to reduce the incidence of ACEs and mitigating the effects of ACEs after they occur. As pediatricians who continue to practice while training pediatric residents, we strongly advocate expanding pediatric residents’ skills to provide anticipatory guidance and education on caregiving to families.
Anticipatory guidance (or preventive counseling) is the advice pediatricians provide to avoid problems that could occur in the future. Topics such as nutrition, injury prevention, behavior management, developmental stimulation, sex education and general health education all may be covered during every visit.
A pediatrician will interact with children and their families at least 10 times in the first two years of life during well-child visits. These interactions are essential opportunities for us to spot potential problems as well as model and reinforce positive parenting behaviors that contribute to a child’s healthy development and mitigate the effects of ACEs. Pediatric residents are also thirsty for this knowledge: One survey found that 76% of graduating pediatric residents felt unprepared to advise parents on ways to promote early childhood development.
Increasing ACES awareness among future pediatricians
In New Jersey, we are taking steps to equip our future pediatricians with these skills through the New Jersey Pediatric Residency Advocacy Collaborative (NJPRAC), one of seven such statewide pediatric residency advocacy-training collaboratives in the nation.
NJPRAC, funded by the Nicholson Foundation and the Burke Foundation, and supported by the New Jersey Chapter, American Academy of Pediatrics, provides an ideal platform to educate pediatric residents on creating supportive parenting environments. With guidance from Dr. Carrie Quinn, executive director of the Mount Sinai Parenting Center, we are using the Center’s Keystones of Development parenting curriculum to educate approximately 300 pediatric residents across the state. This curriculum is now in use in 75 locations across the country, and it promises to yield excellent results long into the future as residents begin their careers in pediatric care. This type of curriculum and training is prime for adoption by other health care providers, mainstreaming critical information and skills for addressing childhood adversity that all practicing pediatricians should be equipped with. As such, we recommend that all heath care providers become more mindful about childhood adversity and expanding the training to all practicing pediatricians.
ACEs are a public-health epidemic, and they can have serious consequences that last a lifetime. When pediatric trainees receive formal training in positive parenting, they possess the tools to encourage caregivers to develop the kinds of family dynamics that can improve the health and well-being of all children in their community. By fostering positive and supportive family relationships, we can break vicious cycles of toxic stress, and help families develop relationships and skills that buffer the impact of trauma and adversity in their lives.