A Little-Known Way Your Own Childhood Trauma May Affect Your Toddler

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“My two-year-old keeps falling down when he tries to walk.”

“My son is almost 24 months old, but all he can say is “mama” and “dada.”

“She just turned two, and she still can’t follow the simplest instruction.”

When your toddler misses a developmental milestone, it’s natural to fret — after all, in rare cases such delays may be a sign of an underlying condition, such as autism spectrum disorder.

But recent research suggest that some delays may have a more surprising explanation, one that spans generations.

In a study headed by Alonzo Folger, PhD, of the Cincinnati Children’s Hospital Medical Center in Ohio, researchers found that children are more likely to miss developmental milestones by the age of two if their parents suffered traumatic events during their own childhood.

“We are just beginning to learn how these early life insults may have developmental health implications for the next generation,” Folger said.

To collect their data, Folger and his team screened toddlers’ parents for ACEs at their children’s four-month checkup. The completed study included a sample size of 311 mother-child pairs and 122 father-child pairs, plus 30 whose gender was not recorded. The ACEs 10-question screening included questions about childhood abuse, neglect, and household instability such as divorce or substance abuse.

When the researchers screened 363 toddlers of the parents for developmental delays at 24 months, the results were striking.

For each extra ACE experienced by a toddler’s mother, there was an 18% increase in the risk for a suspected developmental delay. For fathers, there was a similar trend. Three or more ACEs in a mother’s past? Her child was more than twice as likely to have a high risk for a developmental delay across many areas, including communication, problem-solving, and motor skills.

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The researchers suggest this may call for a “two-generation” approach to prevention and treatment, in which providers could tailor family-based interventions to lower the risk that parents’ trauma may have a ripple effect on their children.

The study, released in Pediatrics this April, helps underscore the value of parental ACEs screening.

Discussing the study, co-author Robert Shapiro, MD, said, “We believed that parental childhood adversity could likely carry over to the next generation’s health and development. If true, a measure of parental adversity could be used as a very early marker to identify infants who could benefit from prevention programs or early intervention.”

Their hypothesis proved correct. “We did find a significant association between parental ACE score and an increased risk for delayed child development measured at 24 months of age — an important finding for parents, pediatricians and family doctors,” Shapiro said.

The reason? The study adds evidence that screening for parental ACEs by a child’s doctor opens up opportunities to improve infant-child development in many children. “The ACE score identifies risk at birth earlier than conventional screening,” Shapiro noted. Earlier intervention is likely more effective than intervention after developmental delays and social/emotional problems are detected, he added.

Parenting with ACEs

What can parents with ACEs take away from this study?

“The main point of this study for parents is to be intentional with their parenting, especially if they have experienced many ACEs in their childhood,” said co-author Emily Eismann, MS. “It’s unclear how much risk is passed on through nature versus nurture, but regardless, we know that nurturing is healing.”

Eismann noted there are simple things that parents can do to protect, support, and heal their child’s development. “First, it’s important that parents take good care of themselves,” she wrote in an email. “They can do this by getting sleep and exercise, eating nutritious food, doing deep breathing, yoga, or other mindfulness practices, and building their network of healthy, supportive relationships. These things can help parents to calm themselves down when stressed so that they can respond to their child in a nurturing way. Children benefit from all of these things as well.”

“It’s important for parents with ACEs to know it’s not their fault and that healing is possible for them and beneficial for their child”

“Parents can also support their child’s development,” Eismann said, “by helping them to feel physically and emotionally safe, by creating consistent routines for their child, by making eye contact with them, by talking to them, by spending quality one-on-one time with them, by being attentive and responsive to their physical and emotional needs, and by encouraging them and praising them.”

More steps parents can take

If parents have a high ACE story and feel realize their childhood trauma is making it harder for them to parent in a calm and nurturing way, what other steps should they take?

“If a parent has a high ACE score, I think it’s important that they know that it’s not their fault and that healing is possible for them and beneficial for their child,” Eismann said. “They may find it helpful to reflect on what they did and did not like about the way they were parented and how that impacts the way that they are parenting their own child now. “

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“Parents may also want to learn more about healthy parenting practices that they may not have experienced themselves as well as what to expect of their child at different ages of development,” according to Eismann. Some potential resources often mentioned by doctors include peer-to-peer parent coaching, parenting classes or support groups, and even books on parenting and child development recommended by health providers.

Co-author RJ Gillespie, MD, agreed that an important step for parents with ACEs is to raise their concerns with their pediatrician, “but to be patient if their provider is less than familiar with ACEs and how that might impact parenting. A provider who is willing to partner with parents who have experienced trauma can be a great ally and can be a bridge to resources for families, whether that is just listening to a parent’s story, or connecting families with parenting resources and support.”

“That said, there is a lot of healing that happens just from being aware that ACEs might impact parenting,” Gillespie added.

“Sometimes the reactions that we experience to our toddlers are so automatic and visceral that we don’t take the time to understand where they are coming from,” she noted. “For example, if you were yelled at a lot as a kid, how would a baby with colic make you feel? “How do you respond to a toddler that hits or bites if physical abuse was a part of your history? While some of these reactions may feel hard-wired, parents are always in a position to learn and do things differently. Reaching out for support — connecting with friends, providers, or other people who ‘have your back’ — is an important first step for this.”

What’s next for the investigators

The study has attracted considerable attention — and for good reason. Although a large body of work has linked toxic stress related to ACEs in childhood to an increased risk of chronic illness in adulthood, the impact of parents’ childhood trauma on their offspring is largely unknown.

How is this risk transmitted? Folger says it may occur through multiple pathways. In a previous study, he and others identified symptoms of depression in mothers and low social support as possible mechanisms — findings underscored by other studies.

In subsequent studies, the researchers intend to investigate other pathways that may affect the children of parents with ACEs, including the home environment and parents’ additional mental health conditions.

Perhaps most intriguing pathway, Folger said, “are epigenetic changes [biological changes that may switch genes on or off] that may alter biology in response to the environment and increase a child’s vulnerability to negative social-emotional and behavioral health.” Epigenetics, he added, remains in the early stages of study.

“Most importantly,” Folger said, “we along with other researchers also seek to identify the protective factors that may interrupt these pathways and improve resilience and health.” Among those they’ll be looking at: Early childhood home visits, stable housing, and therapy for mothers who are depressed.

— Diana Hembree is a science reporter for the Center for Youth Wellness and its initiative Stress Health, which supported me in researching this story. She has written or edited for many other news outlets, including Time Inc., Hippocrates, HealthDay, Forbes.com, the Center for Investigative Reporting and the Times of London syndicate.

References

Assessing Developmental Delays. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/toddler/Pages/Assessing-Developmental-Delays.aspx

Folger AT, Eismann EA, Stephenson NB, et al. Parental Adverse Childhood Experiences and Offspring Development at 2 Years of Age. Pediatrics. 2018;141(4):e20172826

Folger, A. T., Putnam, K. T., Putnam, F. W., Peugh, J. L., Eismann, E. A., Sa, T., … & Ammerman, R. T. (2017). Maternal Interpersonal Trauma and Child Social‐Emotional Development: An Intergenerational Effect. Paediatric and perinatal epidemiology, 31(2), 99–107.

Learn the Signs, Act Early. Important Milestones: Your Child By Two Years. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html

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