Trauma-Informed Care in Pediatrics: A Developmental Perspective in Twelve Cases with Narratives.

introductionThe dose-response relationship of adverse childhood experiences (ACEs) with chronic morbidities is recognized as prevalent. However, screening for ACEs and implementing trauma-informed care (TIC) have yet to become a standard of care in pediatrics.

objectivesTo document impactful developmental experiences of implementing TIC and universal screening of ACEs in the pediatric setting, elucidate the relationship between ACEs and their common presentation of developmental and behavioral health problems in pediatric patients, and propose feasible system changes to promote evidence-based professional expertise.

methodsDuring pediatric residency training, I implemented routine universal screening of pediatric patients using ACE questionnaires. Research-based trauma-informed practices, such as patient-centered communication regarding adverse health outcomes associated with prevalent ACEs, were used. Clinical vignettes describe 12 cases.

resultsMost patients and their families were receptive to counsel on recognizing, preventing, and mitigating the effects of toxic stress resulting from ACEs. Behavior in a patient, and sometimes a parent, was addressed from a developmentally sensitive lens of TIC, and appropriate therapeutic interventions were discussed. Addressing ACEs opened crucial conversations with some patients, which promoted efficacious, developmentally sensitive care. DISCUSSION: Implementing TIC in the pediatric setting, especially in training, is not only feasible but also vital to adequately understand the patient population. Equipped with clinical knowledge and experience in addressing ACEs, practitioners will more readily empower patients and their families to improve health outcomes.

conclusionWhen pediatric practitioners discover, intervene, and address the adverse effects of ACEs, their care becomes more efficacious and evidence based.