Much of recent pediatric research highlights the health and development issues stemming from adverse childhood experiences, or ACEs. ACEs, also known as toxic stress, can include physical and emotional abuse, neglect, exposure to violence, food insecurity, and economic hardship.All of which can have lasting physical and emotional consequences affecting children well into adulthood. According to the AAP, who just last week held a daylong conference devoted to this issue, "toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease".

So what is a nurse or doctor supposed do to? How can you make an impact on such large issues in the short time period you spend with patients? James M. Perrin, MD, president of the AAP, suggests pediatricians ask a few leading questions to parents about the health of the child as well as what's happening in the home. Questions like: “Has he had any fevers recently and how well is he walking...How are you doing, mom? What’s going on with you? What’s going on in the family?”

While questions like these seem simple, what do you with the answers? Perrin advises that someone else in your practice follows up with the family, ensuring they're receiving the assistance they need. In your practice or department, what questions do you ask your patients and families to assess toxic stress?