MENTAL HEALTH GUIDE
Trauma & Adverse Childhood Experiences (ACEs)
Trauma is a shocking, scary, or dangerous experience that leads to strong feelings of sadness, stress or worry. Traumas can be natural disasters, like a hurricane or earthquake, or a life event, like the sudden loss of a loved one. They can also be caused by other people. For example, sexual or physical abuse, a car accident, crime, or terrorist attack. Traumatic events can occur across the lifespan, and sadly, most children experience trauma before they turn 16 years old. Additionally, children may experience multiple and repeated traumatic events. Childhood traumas, also known as adverse childhood experiences (ACEs), have been linked to serious and lasting physical, emotional, and mental health consequences.
Crisis Resources
If your child expresses thoughts of wanting to harm themselves or others, call 9-1-1 or visit the nearest emergency department.
988 Suicide and Crisis Lifeline:
Call 9-8-8
Text any message to 9-8-8
Chat online at 988lifeline.org/chat
Crisis Text Line:
Text “HOME” to 741741
Save for later
Download, print or share on social media.
Resources
CDC Adverse Childhood Experiences (ACE)
www.cdc.gov/violenceprevention/aces
Childhood trauma TED talk by Dr. Nadine Burke Harris
www.ted.com
ACES 101
acestoohigh.com/aces-101
The National Child Traumatic Stress Network
www.nctsn.org
Center for Youth Wellness centerforyouthwellness.org
ACEs AWARE
www.acesaware.org
Find a mental health provider
Check your insurance website or the back of your insurance card.
Explore Psychology Today’s “Find a Therapist” tool.
www.psychologytoday.com/us
Call CalOptima Behavioral Health (Orange County, CA).
855-877-3885
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.
Learn more about CHOC’s Pediatric Mental Health Services
At CHOC, we specialize in providing a full continuum of pediatric mental healthcare, including inpatient, intensive outpatient and outpatient program services.
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.
How parents and caregivers can increase resiliency in children overcoming Adverse Childhood Experiences (ACES)
There are many ways to reduce the effect of Adverse Childhood Experiences (ACEs) in children by instilling resilience. Resilience is the ability to return to being healthy and hopeful after bad things happen. Research shows that if parents provide a safe environment for their children and teach them how to be resilient, that helps reduce the effects of ACEs.
One way of reducing the impact of Adverse Childhood Experiences (ACEs) in children is by instilling resilience. Resilience is the ability to return to being healthy and hopeful after bad things happen. Research shows that if parents provide a safe environment for their children and teach them how to be resilient, that helps reduce the effects of ACEs.
Being a resilient parent
Parents who know how to solve problems, who have healthy relationships with other adults, and who build healthy relationships with their children.
Building nurturing relationships
Children who have adults who support them by listening and responding patiently and paying attention to their physical and emotional needs do better with physical and mental health.
More face-to-face time
If children have too much screen time (TV, phones, video games), then other social and physical activities are more limited. Spend some face-to-face time with your child playing games or just talking. For example, you can dedicate 5 minutes a day for special play time, where all electronics are silenced, and your sole focus is playing and spending time with your child. Research has found that just those 5 minutes can help enhance the parent-child relationship.
Meeting basic needs
The California Surgeon General recommends the following seven stress-busting strategies for kids to help mitigate toxic stress in their bodies
- Quality sleep: Children and teens need more sleep than you think! For example, toddlers need 12-14 hours and teens need 9-10 hours each night. Too little sleep can lead to problems with concentration, fatigue, and mood swings.
- Balanced nutrition: Ensure that your child is getting proper nutrition to combat stress with meals that include fruits, vegetables, and foods rich in omega-3-fatty acids (i.e., fish, nuts, fiber)
- Physical activity: Exercise can be very helpful in decreasing the effects of toxic stress! Experts say that children should have at least 60 minutes each day of activity, such as running, playing a sport, or playing outdoors.
- Mindfulness practices: Practice the daily dozen at home – 12 minutes of meditation, yoga, prayer, or guided imagery on a daily basis. There are some great apps that include specialty programs for children and teens or go on a mindful walk around the neighborhood where you point out things you see, hear, and feel all around you.
- Experiencing nature: Spending time in nature and being active outside has been found to help combat toxic stress. This can include hiking, watching the sunrise, or going on a picnic.
- Mental healthcare: Taking care of our mental health can include seeing a provider, seeking social support, or minimizing stressors or triggers (i.e., media content that may be upsetting).
- Supportive relationships: Having family, friends and/or neighbors who support, help, and listen to children. It does “take a village” and parents often need help. Try to identify others you can trust to support your child when you can’t be there or need a break.
Building social skills
Helping children learn how to get along with others, be able to talk about their feelings without having to act out (like hitting someone when they are mad) and being able to solve problems with others.
Building coping skills
Teaching children about effective ways to cope is important.
- Name and talk about their feelings
- Help them calm down by taking deep, slow breaths
- Discuss different ways to solve a problem and let the child come up with ideas
- Help identify healthy ways to deal with anger (draw pictures, play with clay, use their feeling words, run around outside)
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.
Featured video series
Stress relief video series
Serie de videos de técnicas para aliviar la ansiedad y el estrés
Learn more about CHOC’s Pediatric Mental Health Services
At CHOC, we specialize in providing a full continuum of pediatric mental healthcare, including inpatient, intensive outpatient and outpatient program services.
Trauma and ACEs recommended reading
Related guides
Trauma and ACEs can lead to other mental health conditions such as anxiety and depression. For more information on other mental health conditions that can be caused by traumatic events, please visit our other mental health guides.
Additional Resources
Trauma and ACEs books
- The PTSD Workbook for Teens: Simple, Effective Skills for Healing Trauma, Libbi Palmer
- How Little Coyote Found His Secret Strength: A Story About How to Get Through Hard Times, Alicia Hu and Ching-Pang Kuo
- A Terrible Thing Happened: A Story for Children who have Witnessed Violence or Trauma, Margaret M. Holmes
- Healing Days: A Guide for Kids Who have Experienced Trauma, Susan Farber Straus, PhD
- Jenny is Scared: When Sad Things Happen in the World, Carol Shuman
- The Hugging Tree, Jill Neimark
- The Invisible String, Patrice Karst
Videos and Webinars
- Stress Relief Video Series
- Serie de videos de técnicas para aliviar la ansiedad y el estrés
- Transitioning Back to School After A Trauma
- How To Talk To Kids About Race/Racism
- Why Youth Resort To Substance Use
- Educación de salud mental de CHOC – Padres/ Comunidad general | Porqué Los Jóvenes Usan Drogas
- Empowered Families
The guidance on this page has been clinically reviewed by CHOC pediatric experts.
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For more health information for your family visit health.choc.org