Traumatogenic Potential of Federal Policy in the Lives of Children.

Decades of epidemiological and clinical research have demonstrated that adverse childhood experiences (ACEs) have long-lasting, harmful effects on health across the life span. Studies of adults and children find high rates of ACEs and strong evidence for their link to poor mental health, physical health, behavior, and social development. There is a higher burden of ACEs among populations that are already vulnerable, such as racial/ ethnic minorities, low-income or underemployed families, and sexual minorities. ACEs can lead to poor health and social outcomes (e.g., chronic illness, substance use, homelessness, violence victimization, and poverty) by producing toxic stress and dysregulating child development. ACEs classically include abuse, neglect, and other kinds of within-household dysfunction; however, in recent years, there has been growing recognition of adverse experiences outside the home (such as bullying, racism, and community violence) that can also produce deleterious outcomes. Adverse community environments often co-occur with—or are the foundation for— within-household ACEs, creating a “pair of ACEs” inside and outside the home that compound risk. Experiences of adverse community environments are now often included in contemporary conceptualizations of ACEs in both research and practice. When ACEs of either kind are severe, repetitive, or prolonged and produce a sustained toxic stress response—especially in the absence of loving caregiver relationships that buffer toxic stress —they can have profound, harmful effects. Childhood adversity has been studied in the context of immediate family and community environments in the existing ACE literature, but there is a need to consider a more upstream question: What creates the conditions necessary for childhood adversity to thrive in families and communities? Social determinants of health (e.g., inequality, racism, poverty, neighborhood safety, and access to social or health resources) and policy (i.e., local, state, and federal law) can play a central role in creating these conditions. To fully understand childhood adversity, we must understand the broader, upstream context in which ACEs develop and consider upstream interventions. This includes consideration for social determinants and policies that shape a child’s lived environment and lead to increased risk of ACEs both inside and outside the home. In the United States, we contend that federal policy actions—or, in some cases, inactions—have introduced new pathways for experiences of adversity into the lives of children. We note 5 particular areas of policy in the current US political context that have potential to expose children to adversity and warrant a policy advocacy response from pediatric professionals: