Peer-reviewed article
Systematic review of pediatric health outcomes associated with childhood adversity
Debora Lee Oh, Petra Jerman, Sara Silvério Marques, Kadiatou Koita, Sukhdip K. Purewal et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined 35 longitudinal studies to understand how childhood adversity affects children's physical health. The review found that children exposed to adversity such as maltreatment and household dysfunction show delays in cognitive development, increased asthma and infections, sleep problems, and changes in stress hormones and immune function. The researchers recommend that healthcare providers consider childhood adversity when diagnosing developmental delays, recurring infections, and other health conditions in children.
Key points
- Childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption
- Household dysfunction affected weight during early childhood, while maltreatment affected weight during adolescence
- Maternal mental health issues were associated with elevated cortisol levels; maltreatment was associated with blunted cortisol levels
- Childhood adversity caused alterations in immune and inflammatory response and accelerated telomere erosion
- Children show variable responses to adversity, suggesting complex underlying mechanisms
Limitations
This review examined only physical health outcomes and excluded mental and behavioral health outcomes, so it does not capture the full range of adversity's effects on children. The review does not provide information on which interventions are most effective at preventing or mitigating these health outcomes.
Abstract
BACKGROUND: Early detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. A systematic review was conducted to better understand the pediatric health outcomes associated with childhood adversity. METHODS: PubMed, PsycArticles, and CINAHL were searched for relevant articles. Longitudinal studies examining various adverse childhood experiences and biological health outcomes occurring prior to age 20 were selected. Mental and behavioral health outcomes were excluded, as were physical health outcomes that were a direct result of adversity (i.e. abusive head trauma). Data were extracted and risk of bias was assessed by 2 independent reviewers. RESULTS: After identifying 15940 records, 35 studies were included in this review. Selected studies indicated that exposure to childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption. Studies on household dysfunction reported an effect on weight during early childhood, and studies on maltreatment reported an effect on weight during adolescence. Maternal mental health issues were associated with elevated cortisol levels, and maltreatment was associated with blunted cortisol levels in childhood. Furthermore, exposure to childhood adversity was associated with alterations of immune and inflammatory response and stress-related accelerated telomere erosion. CONCLUSION: Childhood adversity affects brain development and multiple body systems, and the physiologic manifestations can be detectable in childhood. A history of childhood adversity should be considered in the differential diagnosis of developmental delay, asthma, recurrent infections requiring hospitalization, somatic complaints, and sleep disruption. The variability in children's response to adversity suggests complex underlying mechanisms and poses a challenge in the development of uniform diagnostic guidelines. More large longitudinal studies are needed to better understand how adversity, its timing and severity, and the presence of individual genetic, epigenetic, and protective factors affects children's health and development.