Percentage of infants/toddlers who have experienced one adverse childhood experiences; two or more adverse childhood experiences

Percentage of infants/toddlers who have experienced one adverse childhood experiences; two or more adverse childhood experiences

Exposure to unmanageable stress can interfere with the normal development of the body’s neurological, endocrine, and immune systems, leading to increased susceptibility to disease. Because their brains are developing rapidly, infants and toddlers are especially vulnerable, and the damage may be long-lasting. Survey items asked parents to indicate whether their child had ever experienced one or more of the following: economic hardship, divorce/separation of parent, death of a parent, a parent who served time in jail, being a witness to domestic violence, being a victim of or witness to neighborhood violence, living with someone who was mentally ill or suicidal, living with someone with an alcohol/drug problem, or being treated or judged unfairly due to race/ethnicity.
The denominator is children ages 0-2. The numerators are all children ages 0-2 whose parent reports one adverse experience or two or more adverse childhood experiences (ACEs), respectively. There are nine ACE items: hard to get by on family’s income; parent or guardian divorced or separated; parent or guardian died; parent or guardian served time in jail; saw or heard parents or adults slap, hit, kick, or punch one another in the home; was a victim of violence or witnessed violence in neighborhood; lived with anyone who was mentally ill, suicidal, or severely depressed; lived with anyone who had a problem with alcohol or drugs; and treated or judged unfairly due to race/ethnicity. A response of “somewhat often” or “very often” to the question “How often has it been very hard to get by on your family’s income?” was coded as an adverse childhood experience. The remaining survey items are dichotomous Yes/No response options, with “Yes” coded as an ACE. The wording of the economic hardship item was changed in the 2018 National Survey of Children’s Health (NSCH). Data for that item are no longer comparable to earlier version of the NSCH, however, the composite measure may continue to be compared. Estimates in the State of Babies Yearbook: 2022 are based on a four-year (2016-2019) combined sample of the NSCH. These results are more reliable than the results presented in the 2021 report, which were based on three years of NSCH data (2016 – 2018), the 2020 report, which were based on two years of NSCH data (2016-2017), or the 2019 report, which were based on 2016 data. They should be considered improved estimates, not new estimates that can be compared directly to the 2021, 2020 or 2019 yearbook estimates.
This indicator can be disaggregated by race/ethnicity and household income. Race/ethnicity: The child’s race/ethnicity is reported by their caregiver, and the included subgroups are Hispanic of all races, non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian. The US Census Bureau recommends against using state or national population estimates for the following groups with the NSCH since these categories are not controlled independently since these categories are not controlled independently: American Indian or Alaska Native, Hawaiian or Pacific Islander, and some “other” and “two or more races” categories, so those estimates are not presented. In 2019, the “some other race” race category was removed from the questionnaire. Missing responses were imputed and categorized into existing race groups. Household income: NSCH derives household income-to-poverty ratios based on family income and household size. Missing values were imputed by the Census Bureau, and the single imputation version provided in the 2016-2019 data files is used. Households with incomes less than 200 percent of the federal poverty line are classified as low-income. Households with incomes at or above 200 percent of the federal poverty line are classified as “not low-income.”

Shonkoff, J. P., Garner, A. S., The Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood Adoption and Dependent Care & Section on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246. https://doi.org/10.1542/peds.2011-2663
Child and Adolescent Health Measurement Initiative (CAHMI) (2019). 2017-208 National Survey of Children’s Health (2 years combined data set): Child and family health measures, national performance and outcome measures, and subgroups, STATA codebook, Version 1.0. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). https://www.childhealthdata.org/learn-about-the-nsch/nsch-codebooks

Sources:
Child and Adolescent Health Measurement Initiative. (2017). 2016 National Survey of Children’s Health (NSCH) Stata Constructed Data Set. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org
Child and Adolescent Health Measurement Initiative. (2018). 2017 National Survey of Children’s Health (NSCH) Stata Constructed Data Set. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org
Child and Adolescent Health Measurement Initiative. (2019). 2018 National Survey of Children’s Health (NSCH) Stata Constructed Data Set. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org
Child and Adolescent Health Measurement Initiative. (2020). 2019 National Survey of Children’s Health (NSCH) Stata Constructed Data Set. Data Resource Center for Child and Adolescent Health supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org

Not Ranked
This indicator does not factor into the category's GROW ranking.