Parents often bring children in for medication to treat attention-deficit/hyperactivity disorder. The children often have difficulty focusing at school and at home, which can be distressing for parents and teachers.

One young boy I saw looked quite withdrawn, so I put down the evaluation forms from his school and asked him what was going on in his life. He told me that his dad had left their family six months earlier, and shortly after that he started having trouble focusing in school.

Therapy, not medication, helped this young boy, but dealing with him changed my life and my practice as a pediatrician.

I didn’t know it at the time, but I had used one of the basic practices of trauma-informed care. Instead of asking “What’s wrong with this child?” we ask “What happened to this child?”

In 1998, the Centers for Disease Control and Prevention and Kaiser Permanente published a study in the American Journal of Preventive Medicine that surveyed more than 17,000 adults about their history of exposure to childhood traumas, including sexual and physical abuse, emotional and physical neglect and family dysfunction. They labeled these as adverse childhood experiences (ACE), and developed a scoring system.

The results showed a definite connection between high ACE scores and poor adult health outcomes. Clearly, emotional traumas in childhood can translate into physical health ailments in adults.

Compared with a person with an ACE score of 0 (no exposure to trauma), someone who scored 4 or higher had more than twice the risk of developing liver and chronic lung disease. A score topping 7 tripled your lifetime risk of having lung cancer and heart disease.

Several subsequent studies showed how different types of childhood traumas can rewire a child’s brain. Children who have experienced toxic stress live a majority of their lives in the body’s activated “fight or flight” mode. Because of this, their brains are overloaded with stress hormones, which makes it difficult to focus on learning, causing them to fall behind in school.

If you have a child who’s struggling with focus, ask your pediatrician to screen your child for exposure to traumatic experiences. But remember, a high score on this screening does not have to dictate their destiny.

Just as chronic toxic stress can rewire a child’s brain, the exposure to interventions that promote resilience (including trauma-focused therapy, proper nutrition, yoga and mindfulness) can help the brain to form new connections, a phenomenon called neuroplasticity.

With the right tools, children can thrive despite having experienced trauma.

Now in my work as a pediatrician, a child’s ACE score is as important to me as their pulse or respiratory rate. I understand that in my work-up for a child’s abdominal pain, I must also look at social and emotional determinants of health.

I also do my best to educate parents about tools to help build resilience, and the importance of having a compassionate and available adult in a child’s life. And I counsel parents about how their own childhood experiences and traumas can affect their parenting.

When children break an ankle, we are quick to get them in for treatment. But emotional wounds, if left untreated, can scar quickly, as well. And those scars can live with our children for a lifetime.


Dr. Malhotra is a mother, pediatrician and writer.