A Unique Child

How to support children with ACEs in early years settings

  • How to support children with ACEs in early years settings

Your actions could make the difference for a child between a future of happiness and a future of chaos, says Lorraine Jenkin…

Most people feel anecdotally that people who have had a tough childhood tend to have a tough adulthood: things that happen to us as children shape us – positively and negatively – and affect our future choices and behaviours.

However, it is only recently being appreciated how tight the correlation is between the number of Adverse Childhood Experiences (ACEs) and the health and wellbeing of adults.

What are ACEs?

ACEs are listed as children experiencing physical, sexual or emotional abuse, or growing up in a household in which there is alcohol or drug abuse, mental illness, criminality (particularly incarceration), domestic violence or parental separation.

Each one of these things is counted as a single ACE. Some children will obviously have multiple ACEs.

Certain levels – and periods – of stress are considered to be normal and indeed good for us. They teach children to cope with uncomfortable situations and build long-term resilience. However, extreme or prolonged stress changes a child at a cellular level.

Constant heightened awareness raises cortisol and adrenaline and so body chemistry becomes different compared to a child who has the occasional isolated incident to contend with.

The original ACEs research (at Kaiser Permanente, 1995–97) recognised this and found that adults who have four or more ACEs are much more likely to have poor adult health – debilitating conditions such as cancer, heart disease or diabetes.

Those with six or more ACEs have life expectancies 20 years less than their peers with none.

They are also less likely to be able to cope with everyday life without resorting to activities that inflicted the ACEs on them in the first instance: substance abuse, violence, criminality, domestic abuse, mental illness and abusive behaviours, thus continuing the cycle for their own families.

The correlation is so strong that the government is seeking to not only tackle the ACEs happening in the first place, but also educate professionals who work with children to spot those suffering and seek assistance for them – both to buffer against the ACEs and build resilience within them.

This will be multifaceted: health visitors, early years practitioners and teachers, police, fire fighters, doctors and nurses.

If you consider that the death of a woman through domestic abuse costs the government £1.8 million (Home Office statistics), then you can see the financial (let alone moral) worth of investing to prevent it.

Professional support

As professionals who work with children, you will be aware of your requirements to report to social services instances of abuse, for example.

However, many children’s problems are long-running and would not necessarily be considered a reportable offence: having a parent with a mental illness, would not (necessarily) be considered a dangerous situation for a child.

However, couple that with the other parent not coping and so self-medicating with prescription pills, and endless abusive arguments between the parents that eventually ends in parental separation, and suddenly you have a child with four ACEs.

These problems are compounded for the child due to the chaos that often surrounds such behaviours: the family budget spent on alcohol rather than food, an over-medicated parent slumped on the sofa instead of reading stories for bedtime, neglect regarding the washing of clothes and bodies, and certainly no energy left for introducing exciting vegetable dishes.

A child could very quickly feel isolated or shunned by peers and so the problems are multiplied.

Constantly alert to danger, a child (and then adult) loses the ability to rationalise the severity of the threat, and so everything can be seen as a problem needing a serious reaction: this makes a child unpopular and someone to be avoided.

Fortunately, there are actions that can buffer a child against the impact of ACEs and build resilience within them. Children who have many interests outside of the home (if it is the home that is affecting them) can lessen the consequences of their ACEs.

It’s not only that time spent away from the source of pain and fear lessens the occurrence, but the mind being occupied with pleasurable things can allow the brain respite from the adrenaline and cortisol, and so lessen the cellular changes.

If a child can have at least one available adult who is ‘on their side’, then they can weather the storm much better.

Therefore, even if there are problems within the home, if at least one parent is maintaining structures, continuity and support, then the impact of ACEs can be reduced.

Some children, sadly, won’t have this and their home is a place of fear or chaos. That means that their supportive adults in, for example, their nursery or school, become even more crucial.

What you can do

Assign the identified children a stable key person, rather than likely shorter-term placements. Persist in encouraging and giving the skills for friendships – for those children, no one else may be doing this.

Children with high numbers of ACEs need to be independent much more than their peers will. Singing or engaging in crafts lifts the soul and the ability to spend hours with mates kicking a football around will provide a place for that child to go, so start it young.

Educate parents about ACEs if you can: hand out leaflets from health visitors and be more urgent with the stable relatives of the children who might be suffering.

If Granny understands that the role she needs to play is far greater than expected, then she can be the buffer between the child and the ACEs and make the difference to not only her grandchild, but her future generations.

Alert health visitors if confidentiality allows it, or urge the stable adult to do so. For those children moving up to school, inform teachers of their ACE scores to ensure no break in pressure to build resilience and to get help.

Working with children is always an important job, but for those children who have four or more ACEs, your actions could be making the difference between a future of happiness and a future of chaos.


Lorraine Jenkin is an author who has been involved in childcare for several years.

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