Adverse Childhood Experiences and Growth Outcomes in Childhood: A Longitudinal EHR-Based Study.

Adverse childhood experiences (ACEs) are among the strongest risk factors for long-term mental and physical health complications, yet their impact on childhood biological development remains incompletely understood. In this study, we leverage longitudinal electronic health record (EHR) data from over 400,000 pediatric patients to examine the relationship between clinical ACE documentation identified from a Natural Language Processing (NLP) algorithm and growth trajectories across childhood and adolescence. In this cohort, ACE documentation was associated with consistently lower height Z-scores, reduced final attained height, and earlier timing of peak growth velocity. Differences in height became significant approximately two years before ACE documentation, suggesting that growth disruption precedes formal clinical recognition. Importantly, the magnitude of growth disruption depended on the child's age at ACE documentation, with earlier ACE associated with the largest alterations in height and growth timing. These findings support a model in which early stress impacts childhood growth during sensitive periods and may represent a clinically accessible biomarker of the negative health consequences of ACEs.