Adverse Childhood Experiences and Growth Outcomes in Childhood: A Longitudinal EHR-Based Study

Area of Science:

• Pediatric Health
• Developmental Biology
• Clinical Informatics

Background:

• Adverse childhood experiences (ACEs) are potent risk factors for adverse health outcomes.
• The biological impact of ACEs on childhood development, particularly growth, is not fully understood.

Purpose of the Study:

• To investigate the association between documented ACEs and growth trajectories in a large pediatric cohort.
• To determine if growth alterations precede clinical recognition of ACEs.

Main Methods:

• Utilized longitudinal electronic health record (EHR) data from over 400,000 pediatric patients.
• Employed a Natural Language Processing (NLP) algorithm to identify clinical ACE documentation.
• Analyzed height Z-scores, final attained height, and peak growth velocity in relation to ACE documentation timing.

Main Results:

• ACE documentation was linked to lower height Z-scores and reduced final height.
• Children with ACEs exhibited earlier peak growth velocity timing.
• Height differences emerged approximately two years prior to ACE documentation.
• Earlier ACE exposure correlated with more significant growth alterations.

Conclusions:

• Early life stress, as indicated by ACEs, disrupts childhood growth during sensitive developmental periods.
• Growth trajectory changes associated with ACEs may serve as an early, clinically accessible biomarker.
• These findings underscore the profound and early biological impact of adverse childhood experiences.