Cumulative adverse childhood experiences and children's health

Adverse childhood experiences (ACE), potentially stressful or traumatic experiences that are concentrated among already vulnerable populations such as children of color and economically disadvantaged children, can accumulate throughout childhood. The stress process perspective suggests that ACEs, such as parental incarceration or violence exposure, can have deleterious implications for childhood health. This analysis used data from the 2016 and 2017 National Survey of Children's Health (NSCH), a nationally representative sample of non-institutionalized children ages 0 to 17 in the United States (N = 71,811), to estimate the association between number of ACEs and children's health (including three general and 12 specific health indicators). ACEs are common, with nearly half (45.3%) of children exposed to at least one ACE. Exposure to three or more ACEs, compared to no ACE exposure, is positively associated with fair or poor overall health, activity limitations, and recurring school absence, adjusting for an array of child and parent characteristics. Exposure to three or more ACEs is also positively associated with specific indicators of children's mental (such as depression, anxiety, behavioral or conduct problems) and physical (such as asthma, allergies, headaches) health conditions. These associations exist when restricting the sample to children with similar risks of ACE exposure based on their age. These associations are also similar across child race/ethnicity and gender. Given that ACE exposure is concentrated among already vulnerable children, ACEs may exacerbate existing social disparities in children's health.