AAPCA1 & ACEs Aware
ACEs Aware January Initiative: Intergenerational Trauma
The ACEs Screening tool and initiative to address childhood trauma is a small step in a long history of pediatric research and programs on understanding how children thrive, and how we can support them. 

This month, we look at how intergenerational trauma and epigenetics impacts our children and how we can best support them.
Pediatric Perspectives: ACEs Screening
"We know the focus on ACEs helps our patients. Every day in my work, screening for ACEs in children and parents gives us the opportunity to break the cycle of abuse and trauma. Most often, the parents have high ACEs scores and the children usually have low or no ACEs and that's our window of opportunity right there."
- Dr. Deirdre Bernard-Pearl, Medical Director at Santa Rosa Community Health, Pediatric and Teen Campuses
Screening for Parental ACEs: An Opportunity to Make A Difference
Dr. Deirdre Bernard-Pearl discusses the benefits of screening children for ACEs at the right time.
Pediatricians are experts in prevention and working with families. Yet for generations, pediatricians haven’t asked parents in detail about their ongoing stresses and past adversities. With many families, when significant concerns suddenly appeared, such as child sexual abuse, severe depression in a teen, or unexplained school truancy, we discovered that the family was in a storm of worry and stress, such as domestic violence, or mental illness. If we screen parents for ACEs, we can find out about toxic stress that can commonly disrupt the family support system and help address it before a child manifests their own problems.
Just like screening for post-partum depression, as pediatricians, we can screen for parental ACEs. Deirdre Bernard-Pearl MD, FAAP, one of the Think Tank members for the Chapter 1 ACEs Aware grant, notes that the Adult ACEs Questionnaire is a useful tool in starting the critically important conversations about family stresses and strengths. The Questionnaire, which is available on the ACEs Aware website, asks about the parent’s experiences with the 10 categories of ACEs.  
ALSO NOTE: Medi-Cal payment of $29 is available for ACEs-certified providers when the Questionnaire is completed once per lifetime by patients 21 of years and old per managed care plan.
Intergenerational Transmission of Adversity: Epigenetics
Intergenerational transmission of adversity and protective factors may occur through biological, cultural, psychological, or socioeconomic mechanisms. Epigenetic research shows that trauma and toxic stress can modify gene expression without changing the genotype or it can shorten the telomere, resulting in a shorter lifespan. Examples of these impacts include:

  • The Dutch famine, or Hunger Winter of 1944-45 which occurred in the western Netherlands after a Nazi food embargo reduced daily caloric intake to as low as 580 calories a day. The infants born to women who had experienced starvation during their third trimester had higher rates of low birth weight and smaller head circumferences. As adults, these famine-exposed infants had significantly increased rates of obesity, cardiovascular disease, and Type 2 Diabetes.

  • In a study of children born to Civil War survivors of Confederate POW camps, researchers found that the dire conditions of the camps during certain years resulted in significantly shortened lifespans for the subsequent children of these POWS. Children born after the end of the Civil War to POWs with improved diets and treatment during internment had normal life expectancies.
Free Upcoming Events
AAPCA1 Chapter Chat on Staff Preparedness and Resilience
February 10, 2021
7-8:30 PM
Join us for a discussion on preparing to deliver trauma informed care for incorporating ACEs screening into your practice.
Catalyst Center: ACEs Aware Provider Training
Trainings in February and March, 2021
ACEs Aware Webinar: Network of Care
January 27, 2021
12 PM-1 PM
This webinar will include a discussion and concrete example of a trauma-informed network of care, a group of interdisciplinary health, education, and human service professionals, community members, and organizations that support adults, children, and families by providing access to evidence-based “buffering” resources and supports that help to prevent, treat, and heal the harmful consequences of toxic stress.

Parental and Provider Resources for ACEs
All in For Kids Healthcare Provider Toolkit Graphics
Using Relational Health During the Pandemic to Help Prevent Toxic Stress in Your Child, Patients and Clients

The informational sheet below encourages you to recognize toxic stress in your patients and how to improve relational health and child maltreatment.
ACEs Aware Self-Care Tool for Adults

This is an ACEs Aware-developed tool for patients to use in developing a self-care plan to enhance well-being and decrease stress – for adults.
We look forward to communicating future ACEs initiatives with you and your practice! For more information on the ACEs initiative, visit our website here or contact projectcoordinator@aapca1.org.

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.


President: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer: Nivedita More • Past President: John Takayama
Executive Director: Isra Uz-Zaman

California Chapter 1, American Academy of Pediatrics | www.aapca1.org | info@aapca1.org| 916-274-4173