The Role of Pediatric Providers

M ANY CHILDREN EXPERIence or are exposed to potentially traumatic events (PTEs) (those likely to lead to posttraumatic stress disorder [PTSD], ie, potentially threatening to life or physical safety and with responses involving intense fear, horror, or helplessness) such as child abuse, domestic violence, community violence, or deaths of a traumatic nature prior to reaching adulthood. Recent studies have found that up to 68% of all children experience serious PTEs, with more than half of these children experiencing multiple PTEs. At least 1 study documented that more than 90% of youth seen in a pediatric primary care clinic reported trauma exposure; of these, 25% met full or partial criteria for PTSD. The Adverse Childhood Experiences Study demonstrated that child abuse and other traumatic experiences during childhood confer significantly increased risk for many of the leading causes of early death in adulthood. Graham-Bermann and Seng documented the association between child trauma and increased prevalence of many common health problems such as asthma, allergy, headaches, and gastrointestinal tract disturbance. Seng et al also found associations of PTSD and significantly increased odds of a range of adverse health conditions in children from birth to age 18 years. Several other studies have confirmed the association of childhood trauma with negative outcomes, including increased risk for poor school performance, high health care use, substance abuse, suicide attempts, PTSD, and depression. Primary care pediatric providers can serve several critical roles in preventing these negative long-term sequelae. First, children exposed to traumatic events are often reticent to discuss or disclose these experiences to others, particularly if the events are associated with secrecy or shame (for example, child abuse or domestic violence). Pediatric providers are trusted adults who most typically see children for routine and nonjudgmental reasons and present with calm, reassuring deAuthor Affiliations: Department of Psychiatry, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania (Drs Cohen and Mannarino); and Departments of Pediatrics and Public Health, The Ohio State University, Columbus (Dr Kelleher).