Trauma & Adverse Childhood Experiences (ACEs)

Frequently Asked Questions

People may experience an array of emotions after experiencing a traumatic event, including sadness, anxiety or anger. For most people, these responses are normal and go away over time (i.e., a few weeks). In some cases, these thoughts and feelings don’t go away on their own and may get in the way of everyday life, which can result in the child needing more help. 

What are some examples of Adverse Childhood Experiences? 

• Emotional abuse 
• Physical abuse 
• Sexual abuse 
• Emotional neglect 
• Physical neglect 
• Mother treated violently 
• Household substance abuse 
• Household mental illness 
• Parental separation or divorce 
• Incarcerated household member 
• Bullying (by another child or adult) 
• Witnessing violence outside the home 
• Witnessing a brother or sister being abused 
• Racism, sexism, or other forms of discrimination 
• Being homeless 
• Natural disasters and war 

What are some of the physical, behavioral and mental health outcomes for children who are struggling with trauma or ACEs?

Research has found that ACEs, and exposure to other stressful things can lead to something called toxic stress in your body. Toxic stress has been associated with a number of health conditions. Below are some of the physical, behavioral, and mental health outcomes for children who have experienced trauma.

Health

• Failure to thrive 
• Obesity 
• Diabetes 
• Cancer 
• Heart disease 
• Stroke 
• Asthma 

Behaviors

• Alcoholism 
• Smoking 
• Drug use 
• Unsafe sex 

Mental Health

• Depression 
• Anxiety 
• Suicide attempts 
• Posttraumatic stress (PTSD) 

What are some signs that my child needs more support coping with trauma?

• Worrying a lot or feeling very anxious, sad, or fearful 
• Crying often 
• Having trouble thinking clearly or concentrating 
• Having scary thoughts about the trauma 
• Feeling angry 
• Having nightmares or difficulty sleeping since the trauma 
• Avoiding places or people that remind them of the trauma 
• Physical symptoms like headaches, stomach pain and digestive issues, feeling tired, racing heart and sweating, being very jumpy and easily startled 

What is the Pediatric ACEs and related Life-events Screener (PEARLS)?

At your child’s pediatrician visit, you may be asked to complete the Pediatric ACEs and Related Life-events Screener (PEARLS) to better understand your child’s trauma experiences. 

The score on the PEARLS screener will provide your medical provider with information on the number of childhood traumas your child has experienced. Research has found that the higher the total PEARLS score, the greater the risk for poorer physical, behavioral, and mental health outcomes; however, we know that getting help earlier is key to helping your child. Your child’s PEARLS assessment will help your provider connect you to the appropriate resources. 

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Tips for Parents and Caregivers

It is important to know that parents/caregivers play a critical role in buffering the impact of childhood trauma and building their child’s resilience. Research has found that creating positive experiences with your child and being a caring, consistent adult in your child’s life can serve as a protective factor against adversity. 

Don’t be afraid to talk about the trauma 

Children do not benefit from ‘putting it out of their minds.’ Talk about the incident in a calm manner. If a child feels that their parents are upset about the event, they will not want to talk about it. This may make the child’s recovery even more difficult. 

Let the child lead the conversation. When the child brings it up or seems to be thinking about it, it is important to provide space for open discussions. Let your child ease into talking about the event at their own pace and listen to them while answering questions in a developmentally appropriate manner, while also providing comfort and support. 

Listen and support 

We often have no adequate explanations about senseless death or traumatic events. In the end, just listening to and comforting your child will have long-lasting positive effects on your child’s ability to cope with the traumatic event. It’s okay to let children see that you are sad or upset, especially when you name the emotions you are experiencing for them (i.e., “I am feeling sad that our dog passed away because I will miss him so much”). It helps the child increase their emotion literacy and normalizes feelings. 

Create a sense of safety and control 

Allow for the child to regain a sense of control that they may have lost after a traumatic event. Parents can provide the child with choices on tasks, such as picking out their clothes for the day or their snacks. 

Keep a predictable routine going for the child that helps them feel safe. You can elicit their feedback when creating this schedule and then post it somewhere in the home where they can see it and refer to it.  

Seek professional help if necessary 

For children who continue to show signs of trauma for months afterward, they may have post-traumatic stress disorder (PTSD). It is important to seek professional help if you are worried your child might have PTSD. 

A therapist, such as a psychologist, social worker or counselor, can help your child understand and manage her moods and feelings. Effective treatments for PTSD include evidence-based therapy (such as, Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) or a combination of therapy and medicine. 

Get immediate help if your child expresses thoughts about wanting to kill themselves, harm themselves, or is saying scary things, call 911 or bring your child to the nearest emergency department. 

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Tips for Kids and Teens

In addition to the lifestyle recommendations above, there are ways to build your emotional resilience to improve your mental health in the face of trauma. From breathing techniques to cultivating gratitude, these simple practices can be incorporated into your daily routine and help you relieve your stress. 

Find ways to relax

Try to notice things around you if you feel overwhelmed and use your five senses: name two things that you can see, two things that you can hear, and two things that you can smell. 

Take deep breaths to help your body get back to a resting state. One way to practice deep breathing is to pretend your belly is a balloon. Breathe in and make the balloon bigger, then breathe out and make the balloon shrink. 

Practice using your imagination to think of positive images, such as being in a favorite spot, to help relax and reduce stress. An example of guided imagery could be found here by one of our pediatric psychologists: Guided Imagery: Leaves on a Stream. 

Take charge of your thinking

Pay attention to what you are saying to yourself. Ask yourself, “What would I tell my friend if they were in this situation?” or “What’s the worst thing that could happen? If the worst thing DID happen, what could I do to handle it?” 

Practicing gratitude 

When life is chaotic and unpredictable, it can be difficult to focus on the positive. However, there may be small moments in your day where things have gone well or you have experienced a random act of kindness, that you want to allow yourself time to reflect on.  

Gratitude activities can include: Engaging in gratitude journals or gratitude check-ins by writing or telling someone you love about 3 things you are grateful for on a daily basis; writing thank you cards to people you appreciate or are grateful for; performing acts of kindness yourself by returning a favor to someone else or volunteering  

Get support 

Talk to your parent or caregiver if you are feeling sad, worried, angry or overwhelmed after experiencing a trauma. A therapist, such as a psychologist, social worker or counselor can help you understand and manage your moods and feelings. 

You can call a helpline such as 1-800-273-TALK or Text “HOME” to 741741. Call 911 if you are in a crisis or want to hurt yourself. 

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