Impact of parental adverse childhood experiences on children's healthcare utilisation: a systematic review.

backgroundAdverse childhood experiences (ACEs) are linked to poor health and social outcomes, with growing interest in their intergenerational effects. Socioeconomic context strongly shapes both exposure to ACEs and their transmission across generations, yet is often under-represented in research. While many studies have explored how ACEs affect adult health, the impact of parental ACEs on children's healthcare utilisation has not yet been systematically reviewed.

methodsWe systematically reviewed studies examining associations between parental ACEs or related adversity and children's use of preventive, primary or secondary healthcare. We searched PubMed, Embase and PsycINFO databases up to December 2024. Title and abstract screening were conducted using an AI-assisted screening tool called Active Learning for Systematic Reviews. Study quality was assessed across design, participant selection, measurement and analysis. Findings were synthesised narratively and visualised with harvest plots, grouped by healthcare level and exposure type.

resultsOut of 8494 records, 15 studies were included. Designs, populations, ACE measures and outcome definitions were heterogeneous. No consistent associations were found in preventive or primary care domains. In secondary care, 11 of 12 analyses found a positive or no association; four high-quality studies showed increased use of emergency, inpatient or psychiatric services among children of parents with ACEs. Methodological variability limited comparability between studies, particularly in ACE definitions.

conclusionsParental ACEs may contribute to increased use of secondary healthcare in offspring, though evidence across care levels remains inconclusive. Future studies should aim for more consistent measurement of ACEs and standardised outcome definitions to clarify intergenerational effects on healthcare utilisation.