Abstract
BackgroundEarly detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. A systematic review was conducted to better understand the pediatric health outcomes associated with childhood adversity.MethodsPubMed, PsycArticles, and CINAHL were searched for relevant articles. Longitudinal studies examining various adverse childhood experiences and biological health outcomes occurring prior to age 20 were selected. Mental and behavioral health outcomes were excluded, as were physical health outcomes that were a direct result of adversity (i.e. abusive head trauma). Data were extracted and risk of bias was assessed by 2 independent reviewers.ResultsAfter identifying 15940 records, 35 studies were included in this review. Selected studies indicated that exposure to childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption. Studies on household dysfunction reported an effect on weight during early childhood, and studies on maltreatment reported an effect on weight during adolescence. Maternal mental health issues were associated with elevated cortisol levels, and maltreatment was associated with blunted cortisol levels in childhood. Furthermore, exposure to childhood adversity was associated with alterations of immune and inflammatory response and stress-related accelerated telomere erosion.ConclusionChildhood adversity affects brain development and multiple body systems, and the physiologic manifestations can be detectable in childhood. A history of childhood adversity should be considered in the differential diagnosis of developmental delay, asthma, recurrent infections requiring hospitalization, somatic complaints, and sleep disruption. The variability in children’s response to adversity suggests complex underlying mechanisms and poses a challenge in the development of uniform diagnostic guidelines. More large longitudinal studies are needed to better understand how adversity, its timing and severity, and the presence of individual genetic, epigenetic, and protective factors affects children’s health and development.
Highlights
Detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children
Studies on childhood adversity with pediatric health outcomes have pointed to an increased likelihood of physical and developmental health issues in children exposed to adversity [18,19,20], but these studies have been primarily cross-sectional, making it difficult to determine the temporal relationship between exposure and outcome
Exposure to childhood adversity was defined as exposure to 1 or more of the experiences shown in Table 1, which were derived from the Center for Youth Wellness Adverse Childhood Experiences (ACE) Questionnaire (CYW ACE-Q) [22]
Summary
Detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. Evidence has shown that adversities such as abuse or neglect experienced during childhood can have lifelong consequences by affecting the foundations of health [1,2,3,4]. This body of evidence has generated growing attention to the concept of toxic stress, the chronic or frequent activation of the stress response from exposure to serious childhood adversity in the absence of adequate support or protection from adults [5]. The present systematic review, was focused on longitudinal studies in children to better understand the biological mechanisms linking exposure to childhood adversity with pediatric health outcomes
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