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Adverse Childhood Experiences (ACEs)

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Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them.

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

  • experiencing violence, abuse, or neglect
  • witnessing violence in the home or community
  • having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

  • substance use problems
  • mental health problems
  • instability due to parental separation or household members being in jail or prison

Please note the examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and wellbeing, such as not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination.

ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. However, ACEs can be prevented.

 

ACEs are common. About 64% of U.S. adults reported they had experienced at least one type of ACE before age 18, and nearly 1 in 6 (17.3%) reported they had experienced four or more types of ACEs.

Preventing ACEs could potentially reduce many health conditions. For example, by preventing ACEs, up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided.

Some people are at greater risk of experiencing once or more ACEs than others. While all children are at risk of ACEs, numerous studies have shown inequities in such experiences linked to the historical, social, and economic environments in which some families live. ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work.

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States.

ACEs can have lasting, negative effects on health, wellbeing in childhood and life opportunities, such as education and job potential, well into adulthood. These experiences can increase the risks of injury, sexually transmitted infections, maternal and child health problems (including teen pregnancy, pregnancy complications, and fetal death), involvement in sex trafficking, and a wide range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide.

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress (extended or prolonged stress). Toxic stress from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning.

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. These effects can also be passed on to their own children. Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of poverty resulting from limited educational and economic opportunities.

ACEs are preventable. To prevent ACEs, we must understand and address the factors that put people at risk for or protect them from violence.

Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential. CDC has produced a resource, Adverse Childhood Experiences Prevention Resource for Action [4 MB, 38 Pages], to help states and communities use the best available evidence to prevent ACEs. It features six strategies from the CDC Resources for Action, formerly known as “Technical Packages to Prevent Violence.”

Lead Poisoning Prevention Training

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Lead is a naturally occurring metal that can cause health problems in children younger than 6 years of age.  At high levels, lead poisoning can be fatal. No safe blood lead level has been identified. Knowledge and awareness about lead as a public health concern is essential to prevention.

These videos provide a brief overview of what lead is, where it is found and why it is important to protect young children from its exposure and is designed for high school and general audiences.

Childhood Lead Poisoning Prevention: Information for the Community

Childhood Lead Exposure Prevention Education: Heads Up for High Schoolers

Make Shots Easier on Your Child

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For babies and younger children
  • Distract and comfort your child by cuddling, singing, or talking softly.
  • Smile and make eye contact with your child. Let your child know that everything is ok.
  • Comfort your child with a favorite toy or book. A blanket that smells familiar will help your child feel more comfortable.
  • Hold your child firmly on your lap, whenever possible.

Once your child has received all of the shots, be especially supportive. Hold and cuddle your child. A soothing voice, combined with praise and hugs will help reassure the child that everything is okay.

Additionally, babies can be soothed through swaddling, skin-to-skin contact, and breastfeeding. If older than 6 months, babies can also be given a sweet beverage.

For older children and adolescents
  • Point out interesting things in the room to help create distractions.
  • Tell or read stories.
  • Support your child if he or she cries.
  • Never scold a child for not “being brave.”
  • Take deep breaths with your child to help “blow out” the pain.

Fainting (syncope) can be common among adolescents immediately after getting shots. To help prevent any injuries that could occur from a fall while fainting, your preteen or teen should stay seated for 15 minutes after the shot.

Before you leave the appointment, ask your child’s doctor for advice on using non-aspirin pain reliever and other steps you can take at home to comfort your child.

After the shots

Sometimes children experience mild reactions from shots, such as pain at the injection site, a rash or a fever. These reactions are normal and will soon go away. These tips will help you identify and minimize mild side effects:

  • Read the Vaccine Information Sheet(s) your child’s doctor gave you to learn about side effects your child may experience.
  • Use a cool, damp cloth to help reduce redness, soreness and/or swelling at in the place where the shot was given.
  • Reduce fever with a lukewarm water sponge bath.
  • Offer liquids more often. It is normal for some children to eat less during the 24 hours after getting vaccines.
  • Ask your child’s doctor if you can give your child a non-aspirin pain reliever.
  • Pay extra attention to your child for a few days. If you see something that concerns you, call your child’s doctor.

Early Brain Development and Health

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The early years of a child’s life are very important for later health and development. One of the main reasons is how fast the brain grows starting before birth and continuing into early childhood. Although the brain continues to develop and change into adulthood, the first 8 years can build a foundation for future learning, health and life success.

Brain of baby x-ray graphic 3D rendering

How well a brain develops depends on many factors in addition to genes, such as:

  • Proper nutrition starting in pregnancy
  • Exposure to toxins or infections
  • The child’s experiences with other people and the world

Nurturing and responsive care for the child’s body and mind is the key to supporting healthy brain development. Positive or negative experiences can add up to shape a child’s development and can have lifelong effects. To nurture their child’s body and mind, parents and caregivers need support and the right resources. The right care for children, starting before birth and continuing through childhood, ensures that the child’s brain grows well and reaches its full potential. CDC is working to protect children so that their brains have a healthy start.

The importance of early childhood experiences for brain development

Children are born ready to learn, and have many skills to learn over many years. They depend on parents, family members, and other caregivers as their first teachers to develop the right skills to become independent and lead healthy and successful lives. How the brain grows is strongly affected by the child’s experiences with other people and the world. Nurturing care for the mind is critical for brain growth. Children grow and learn best in a safe environment where they are protected from neglect and from extreme or chronic stress with plenty of opportunities to play and explore.

Parents and other caregivers can support healthy brain growth by speaking to, playing with, and caring for their child. Children learn best when parents take turns when talking and playing, and build on their child’s skills and interests. Nurturing a child by understanding their needs and responding sensitively helps to protect children’s brains from stress. Speaking with children and exposing them to books, stories, and songs helps strengthen children’s language and communication, which puts them on a path towards learning and succeeding in school.

Exposure to stress and trauma can have long-term negative consequences for the child’s brain, whereas talking, reading, and playing can stimulate brain growth. Ensuring that parents, caregivers, and early childhood care providers have the resources and skills to provide safe, stable, nurturing, and stimulating care is an important public health goal.

When children are at risk, tracking children’s development and making sure they reach developmental milestones can help ensure that any problems are detected early and children can receive the intervention they may need.

Learn more about supporting early childhood experiences:

A healthy start for the brain

To learn and grow appropriately, a baby’s brain has to be healthy and protected from diseases and other risks. Promoting the development of a healthy brain can start even before pregnancy. For example, a healthy diet and the right nutrients like sufficient folic acid will promote a healthy pregnancy and a healthy nervous system in the growing baby. Vaccinations can protect pregnant women from infections that can harm the brain of the unborn baby.

During pregnancy, the brain can be affected by many types of risks, such as by infectious diseases like Cytomegalovirus  or Zika virus, by exposure to toxins, including from smoking or alcohol, or when pregnant mothers experience stress, trauma, or mental health conditions like depression. Regular health care during pregnancy can help prevent complications, including premature birth, which can affect the baby’s brain. Newborn screening can detect conditions that are potentially dangerous to the child’s brain, like phenylketonuria (PKU).

Healthy brain growth in infancy continues to depend on the right care and nutrition. Because children’s brains are still growing, they are especially vulnerable to traumatic head injuries, infections, or toxins, such as lead. Childhood vaccines, such as the measles vaccine, can protect children from dangerous complications like swelling of the brain. Ensuring that parents and caregivers have access to healthy foods and places to live and play that are healthy and safe for their child can help them provide more nurturing care.

Learn more about the recommended care:

Prevent Type 2 Diabetes in Kids

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There’s a growing type 2 diabetes problem in our young people. But parents can help turn the tide with healthy changes that are good for the whole family.

Until recently, young children and teens almost never got type 2 diabetes, which is why it used to be called adult-onset diabetes. Now, about one-third of American youth are overweight, a problem closely related to the increase in kids with type 2 diabetes, some as young as 10 years old.

Weight Matters

People who are overweight—especially if they have excess belly fat—are more likely to have insulin resistance, kids included. Insulin resistance is a major risk factor for type 2 diabetes.boy eating an apple

Insulin is a hormone made by the pancreas that acts like a key to let blood sugar into cells for use as energy. Because of heredity (traits inherited from family members) or lifestyle (eating too much and moving too little), cells can stop responding normally to insulin. That causes the pancreas to make more insulin to try to get cells to respond and take in blood sugar.

As long as enough insulin is produced, blood sugar levels remain normal. This can go on for several years, but eventually the pancreas can’t keep up. Blood sugar starts to rise, first after meals and then all the time. Now the stage is set for type 2 diabetes.

Insulin resistance usually doesn’t have any symptoms, though some kids develop patches of thickened, dark, velvety skin called acanthosis nigricans, usually in body creases and folds such as the back of the neck or armpits. They may also have other conditions related to insulin resistance, including:

Activity Matters

Being physically active lowers the risk for type 2 diabetes because it helps the body use insulin better, decreasing insulin resistance. Physical activity improves health in lots of other ways, too, from controlling blood pressure to boosting mental health.

Age Matters

Kids who get type 2 diabetes are usually diagnosed in their early teens. One reason is that hormones present during puberty make it harder for the body use insulin, especially for girls, who are more likely than boys to develop type 2 diabetes. That’s an important reason to help your kids take charge of their health while they’re young.

More Risk Factors

These factors also increase kids’ risk for type 2 diabetes:

  • Having a family member with type 2 diabetes.
  • Being born to a mom with gestational diabetes (diabetes while pregnant).
  • Being African American, Hispanic/Latino, Native American/Alaska Native, Asian American, or Pacific Islander.
  • Having one or more conditions related to insulin resistance.

If your child is overweight and has any two of the risk factors listed above, talk to your doctor about getting his or her blood sugar tested. Testing typically begins at 10 years old or when puberty starts, whichever is first, and is repeated every 3 years.

Take Charge, Family Style

Parents can do a lot to help their kids prevent type 2 diabetes. Set a new normal as a family—healthy changes become habits more easily when everyone does them together. Here are some tips to get started:

Mealtime Makeover

  • Drink more water and fewer sugary drinks.
  • Eat more fruits and vegetables.
  • Make favorite foods healthier.
  • Get kids involved in making healthier meals.
  • Eat slowly—it takes at least 20 minutes to start feeling full.
  • Eat at the dinner table only, not in front of the TV or computer.
  • Shop for food together.
  • Shop on a full stomach so you’re not tempted to buy unhealthy food.
  • Teach your kids to read food labels to understand which foods are healthiest.
  • Have meals together as a family as often as you can.
  • Don’t insist kids clean their plates.
  • Don’t put serving dishes on the table.
  • Serve small portions; let kids ask for seconds.
  • Reward kids with praise instead of food.

Getting Physical

  • Aim for your child to get 60 minutes of physical activity a day, in several 10- or 15-minute sessions or all at once.
  • Start slow and build up.
  • Keep it positive—focus on progress.
  • Take parent and kid fitness classes together.
  • Make physical activity more fun; try new things.
  • Ask kids what activities they like best—everyone is different.
  • Encourage kids to join a sports team.
  • Have a “fit kit” available—a jump rope, hand weights, resistance bands.
  • Limit screen time to 2 hours a day.
  • Plan active outings, like hiking or biking.
  • Take walks together.
  • Move more in and out of the house—vacuuming, raking leaves, gardening.
  • Turn chores into games, like racing to see how fast you can clean the house.
Want to Limit Overeating? Limit TV Time

A recent study showed that when the amount of TV kids watched was limited, they lost weight—but not because they were more active when they weren’t watching. The difference was snacking: kids ate more when they were watching TV than when doing other activities, even sedentary (not physically active) ones.

boy eating an apple

Encourage your kids to reach for fruit, the original fast food.

Young kids and teens are still growing, so if they’re overweight the goal is to slow down weight gain while allowing normal growth and development. Don’t put them on a weight loss diet without talking to their doctor.