Beyond ACEs and PCEs: Relational Epidemiology and the Childhood Wellness Framework

Background/Objectives: Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs) have fundamentally advanced child health research by demonstrating that early life experiences shape health across the life course. While these frameworks have transformed understanding of trauma, resilience, and child development, they primarily focus on measuring children's experiences rather than the relationships, systems, and collective responsibilities that create the conditions in which childhood unfolds. This paper proposes Relational Epidemiology as an accountability-oriented expansion of epidemiology and introduces a Childhood Wellness Framework that shifts the scientific gaze from measuring children's experiences to evaluating the conditions that enable children to thrive. Methods: This conceptual paper integrates epidemiological theory, Indigenous ways of knowing, feminist ethics of care, child development, decolonizing methodologies, and Indigenous rights frameworks to examine the assumptions underlying child-centered approaches to measurement and to develop a relational model of childhood wellness. Results: Relational Epidemiology is presented as a theoretical orientation that expands epidemiological inquiry beyond describing adversity and resilience toward evaluating the relationships, systems, institutions, and policies that shape childhood. The Childhood Wellness Framework operationalizes this approach by organizing childhood around collective responsibilities and the relational conditions necessary for children to flourish. Grounded in Indigenous knowledge systems and illustrated through the experiences of First Nations, Métis, and Inuit children, the framework demonstrates how accountability can become a measurable focus of child health research. Conclusions: Relational Epidemiology extends, rather than replaces, ACEs and PCEs frameworks by shifting the unit of analysis from children's experiences to the fulfillment of collective responsibilities. The Childhood Wellness Framework offers a conceptual foundation for advancing research, clinical practice, public health, and policy by evaluating not only child outcomes, but also whether societies are creating the conditions necessary for all children to flourish.