More and more research studies show adverse childhood experiences (ACEs), also known as toxic stress, affect children long into adulthood. ACEs include abuse, neglect, and family dysfunction.  Studies show ACEs can increase the risk of many types of disease, such as  cancer, heart disease, and diabetes.  

What do ACEs have to do with pediatric medical traumatic stress? Besides affecting future health, when children (or their parents) experience ACEs, their behavior in a medical setting and ability to cope with injury and illness may be shaped by those experiences. While ACEs can lead to future physical or mental health concerns, not all children will experience long term effects.  

So what are you supposed to do as a doctor or nurse?  As Dr. Wade from Children's Hospital of Philadelphia explains, by "asking every patient (or their parents) about adversity in their lives, Wade says, could help identify the kids who are at higher risk. If a patient has a high adversity score, Wade says, he's likely to track the child's development more closely. "That'll be the kid where I'll say, 'Come back to me in three months, or two months,' " he says. " 'Let's see how you're doing. Let's check in.' "

Screening patients for ACEs and for traumatic stress reactions is important and simple. The DEF Protocol can be incorporated seamlessly into daily practice. The DEF Protocol helps doctors and nurses identify what they can do, as they take care of ill or injured children, to address and prevent traumatic stress responses: 



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