“All our phrasing – race relations, racial chasm, racial justice, racial profiling, white privilege, even white supremacy – serves to obscure that racism is a visceral experience, that it dislodges brains, blocks airway, rips muscle, extracts organs, cracks bones, breaks teeth. You must never look away from this. You must always remember that the sociology, the history, the economics, the graphs, the charts, the regressions all land, with great violence on the body.” Ta-Nehisi Coates For children who have family members who can relate to this quote, or worst, have experienced it themselves, there are consequences detrimental to their health as adults. Extant literature has well established that adverse childhood experiences (ACEs) are contributory to such public health outcomes as emotional and cognitive impairment, adoption of high-risk behaviors, and premature death. A person with four or more adverse childhood experiences is 2•4 times more likely to have a stroke and 2•2 times more likely to have ischemic heart disease [[1]Durham Board of County commissioners Passes ACEs Community Resilience Plan.The Chicago Reporter. August 22. 2016; (Accessed online 9/12/21)https://www.exchangefamilycenter.org/exchange-family-center-blog/2019/2/26/durham-board-of-county-commissioners-passes-aces-community-resilience-planGoogle Scholar]. While there is abundant research on the original ACEs: child abuse, neglect, parental mental illness and witnessed domestic violence, there is less on specific effects of recurrent childhood exposure to events such as the death of George Floyd [[2]Bailey ZD et al.Structural Racism and Health Inequities in the USA: Evidence and Interventions.Lancet. 2017; 389: 1453-1463Summary Full Text Full Text PDF PubMed Scopus (1279) Google Scholar]. We now know Black children have higher ACE scores than White, age-matched counterparts. The Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition defines trauma as (a) witnessing a traumatic event, (b) witnessing trauma in others, (c) indirect exposure to a traumatic experience of a family member or close associate [[3]Pai A Sukis A North CS Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. 9/30/2021; (Accessed online)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371751/Google Scholar]. Trauma increases with increased frequency of police contact [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Black youth disproportionately meet these criteria through exposure to violence experienced in interactions with police [[5]Boyd RW Police Equity Health Child Pediatrics. 9/29/2021; (Accessed online)https://pediatrics.aappublications.org/content/137/3/e20152711Google Scholar]. They are also more likely to be seen as adults, more responsible for their behavior and at increase of being treated more harshly by police [[6]Dudley RG Childhood Trauma and Its Effects: Implications for Police, New Perspectives in Policing.National Institute of Justice. July 2015; (Accessed online 10/21/21)https://www.ojp.gov/pdffiles1/nij/248686.pdfGoogle Scholar]. Imprisonment of Black males, at all ages, is 3.8 to 10.5 times higher than for White males [[5]Boyd RW Police Equity Health Child Pediatrics. 9/29/2021; (Accessed online)https://pediatrics.aappublications.org/content/137/3/e20152711Google Scholar]. Youth exposed to police violence are at increased risk of arrest and incarceration which can result in post-traumatic stress disorder, depression, poor school attendance and performance [[5]Boyd RW Police Equity Health Child Pediatrics. 9/29/2021; (Accessed online)https://pediatrics.aappublications.org/content/137/3/e20152711Google Scholar]. Shouldering more blame for trauma due to police violence separates this from other forms of trauma. Police violence is one component of structuralized racism contributing to health inequities in Black youth [[7]Duarte CDP Salas-Hernandez L Griffin J Policy determinants of inequitable exposure to the criminal legal system and their health consequences among young people.Am J Public Health. 2020; 110 (Accessed online 10/11/21): S43-S49https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987944/Crossref PubMed Scopus (7) Google Scholar]. Between January 2005 and December 2017, 15, 967 youth were treated in California hospitals for injuries sustained during police intervention. The percentage of youth who have been arrested between ages 8-23 ranges from 15•9% to 26•8% [[8]Brame R Turner MG Paternoster R Bushway SD Cumulative prevalence of arrest from ages 8 to 23 in a national sample.Pediatrics. 2012; 129: 21-27Crossref PubMed Scopus (146) Google Scholar]. Black boys aged 15-19 had the highest rate, with 143.2 additional injuries per 100,000 person-years as compared to age-matched White boys [[9]Farkas K Duarte CD Ahern J. Injuries to Children and Adolescents by Law Enforcement: An Analysis of California Emergency Department Visits and Hospitalizations, 2005-2017.JAMA Pediatr. 10/11/2021; (Accessed online)https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783641Crossref PubMed Scopus (2) Google Scholar]. And, compared to White boys, they were 5.3 times more likely to be injured. Black boys experience more frequent vehicular stops than White boys (45% vs. 26%, respectively) [[7]Duarte CDP Salas-Hernandez L Griffin J Policy determinants of inequitable exposure to the criminal legal system and their health consequences among young people.Am J Public Health. 2020; 110 (Accessed online 10/11/21): S43-S49https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987944/Crossref PubMed Scopus (7) Google Scholar]. Of those stopped by police, Black boys have more of the following interactions as compared to White boys: frisked (43% vs. 7%); searched (46% vs. 19%); received racial slurs (16% vs. <1%) or threatened force (19% vs. 4%) [[10]Geller A Policing America's Children: Police Contact and Consequences Among Teens in Fragile Families.Workng Papers wp18-02-ff, Princeton University, School of Public and International Affairs, Center for Research on Child Wellbeing. 2017; https://fragilefamilies.princeton.edu/sites/fragilefamilies/files/wp18-02-ff.pdfGoogle Scholar]. With the increase in school shootings over the years has come an increase in the percentage of schools with school resource officers (SROs) from 1%, in 1975, to 58% in 2018 [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Schools with over 75% Black students have more SROs than schools with over 75% White (54•1% vs. 32%) [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Over forty states have laws permitting subjective (and therefore potentially bias) assessment, by SROs, of defiant or disruptive behavior. SROs are associated with increased school arrests and increase the school-to-prison pipeline [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Arresting students doubles their risk of dropping out, decreases access to higher education, and increases chance of future interaction with law enforcement [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Suspension and expulsion rates are 2-3 times higher for Black students [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Even exposure to police can have immediate effects of anxiety, helplessness, and retraumatization [[4]Connery C The Prevalence and the Price of Police in Schools. October 27, 2020; (Accessed online 9/27/21)https://education.uconn.edu/2020/10/27/the-prevalence-and-the-price-of-police-in-schools/#Google Scholar]. Traditionally, protective factors against ACEs include schools, family and community. Solutions to consider include, 1) Improving diagnostic tools for ACEs occurring in Black youth such as expansion of the ACE score to include police violence and adding this to the criterion for trauma in DSM-5. This could increase awareness about issues of Black children, as professionals manage mental health conditions resulting from youth experiences. 2) Increasing police training on ACEs in minoritize children. 3) Being intentional in the placement of SROs by ensuring there are programs supporting a healthy interface between SROs and Black students. Until physicians can accurately document and measure what we see in our young patients’ lives, we are likely to continue to underreport and undertreat minorized children affected by exposure to police violence. Dr. Edje is the Associate Dean for Graduate Medical Education at the University of Cincinnati Medical Center and College of Medicine; board member of Center for Closing the Health Gap, LLC.; member of the Council on Medical Education of the American Medical Association; and member of the Family Medicine Review committee for the Accreditation Council for Graduate Medical Education.