Pediatricians are a resilient group. With changes in populations and pediatric infirmities over time, we have continuously adapted our routines to optimally serve children and families. It’s not easy to change practice, but often critically important that we do so. Years ago, pediatricians complained bitterly when they were asked to add H. Influenzae vaccine to the original DPT/OPV regimen, even though they regularly witnessed H. influenzae infections. BMI calculations were seen as an unnecessary burden until we realized the extraordinarily high rates of obesity in our clinic populations. Similarly, many of us are reluctant to empathetically ask families about their traumas and stresses, for fear that we won’t know what to say when those traumas are revealed, and we’ll never get to the car seat questions we intended to ask during the visit.
The sequelae from COVID-19 (especially isolation and stress) and the ACEs Aware initiative have convinced many of us that we need to adopt changes to our practice, and implement trauma-informed practices including ACEs screening. In a recent JAMA Network Open article, Tali Raviv et. al summarized the impact of the COVID-19 pandemic as reported by a racially diverse population of over 32,000 caregivers of Chicago school children and families. Widespread increases in mental health concerns and decreases in well-being and positive coping skills were reported for children in all grades. Examples included an increase in reported anger from 4.2% to 23.9% and an increase in depressive symptoms from 3.4% to 14%. If we use the science of the impact of trauma on children, we recognize that these symptoms reflect basic brain science- the children and teens are reacting to perceived threats with behavioral adaptations expressing fear, trauma and a lack of the sense of safety. So how do we adapt our practices to address this?