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ACEs Risk Factor #3: Early Hospitalization

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Born Prematurely (Preterm); Low Birth Weight

Preterm birth (birth prior to 37 weeks gestation) remains more prevalent in the United States than in many developed countries and continues to be a prime reason for infant death (mortality) and illness (morbidity) Moore (2002).

There are four main reasons some women begin labor early:

  • Multiple pregnancies; infection; no obvious reason
  • Ruptured membranes
  • The health of the mother or the fetus
  • Infants born after 37 weeks but are low birth weight <5.8lbs

Major risk factors for prematurity include:

  • Physical violence; Maternal smoking
  • Lack of experience with the onset of preterm labor
  • Treatment strategies after the identification of preterm labor

Physical violence victims were more likely to experience placental abruption, preterm labor, kidney infections, cesarean births, and fetal distress. Risk of preterm birth significantly increased with maternal smoking in any trimester but a noticeable reduction in birth weight and body length in infants were found to be the result of smoking during the third trimester.

Women who experienced symptoms of preterm labor were confused initially and waited two days to two weeks before seeking care Moore (2002). Magnesium sulfate or other tocolytic medications have been the main treatment for preterm labor, however, these infants were more likely to have intraventricular hemorrhaging and cerebral palsy at 18 months of age.

Received Lifesaving Surgeries

Premature birth and low birth weight are developmental problems considered to be related to birth defects Mekdeci (2004). An increased risk of developmental disabilities, such as, cerebral palsy (20%) and mental retardation (50%), are found to have structural birth defects that require lifesaving surgery and include:

  • Heart
  • Spina Bifida
  • Oral Cleft
  • Limbs
  • Respiratory
  • Nervous system
  • Multiple abnormalities
ACE Risk Factor #3: Early Hospitalization

Medical Neglect

Neglect is the most common form of maltreatment and the deadliest Hornor (2014). Common medical neglect includes:

  • Failure/delay in seeking medical care
  • Noncompliance with plan of care
  • Failure to seek care for dental caries, tooth decay

For example, repeated admission to the hospital for a dehydrated child would be considered medical neglect, which could lead to negative intrinsic feelings towards the parent(s) by the child and not understanding why. If a child is cared for properly, they should receive the necessities (food, shelter, clothing), as well as love and attention to their needs.

Children who develop decay as infants and toddlers have a greater probability of decay development in "baby" and permanent teeth. There is more to oral health than just healthy teeth and poor hygiene could lead to a decreased quality of life Colak (2013). The effects of oral health are both physical/psychological and can influence how children:

  • Grow
  • Look
  • Speak
  • Chew
  • Taste food
  • Socialize
  • Feel about their social well-being, Self Esteem

Quality of life for children is affected by pain/discomfort, chronic infections, altered eating/sleeping habits, failure to thrive, impaired speech, risk of hospitalization, high treatment costs, repeated absence from school for the child and work for the parent due to appointments or recovery time. Reduced growth and weight gain are due to the malnourishment caused by the inability to eat enough to feed the child's growing body needs Colak (2013).


The assumption that neonatal male circumcision had no effects psychologically or emotionally has long existed in medical circles. It was believed that circumcision could not traumatize the child because newborns could not feel pain and if they did feel the pain, they would not remember it later in life CIRP (2012). Perinatal (birth) trauma, such as circumcision, can lead to altered pain sensitivity, stress disorders (PTSD), ADD/hyperactivity, and self-destructive disorders (suicidal behavior). Grieving the traumatic loss of a body part, males may experience distress and emotional dysfunction.

Medical Trauma

The physical or emotional response a child has to a severe illness, injury, or surgery is called medical trauma. The response can range from mild to severe and 25-30% of medically ill children are affected. Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity NCTSN (2020). Parents and siblings can experience traumatic stress reactions that disrupt their daily functioning.

For example, a severe illness may include asthma/cancer, a severe injury may include being hit by a car/broken bones, and surgery may include open heart/other lifesaving surgeries. When hospitalized, children are stuck with needles, connected to heart monitors/other machines with lights, beeping/buzzing sounds, alarms, and can be painful. Many times, they cannot receive the touch, nurture, cradling, rocking, and singing needed due to being in the NICU (Neonatal Intensive Care Unit).


Circumcision Information and Resources Pages. (2012, May 26). Psychological impacts of male circumcision.

Colak, H., Dülgergil, C. T., Dalli, M., & Hamidi, M. M. (2013). Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of natural science, biology, and medicine, 4(1), 29–38.

National Child Traumatic Stress Network (NCTSN). (2020, May 9). Effects.

Horner, G. (2014). Child Neglect: Assessment and Intervention. Journal of Pediatric Health Care. 28(2), 186-192.

Mekdeci, B. & Schettler, T. (2004, May). Birth Defects and the Environment. BirthDefects.

Moore M. L. (2002). Preterm birth: a continuing challenge. The Journal of Perinatal Education, 11(4), 37–40.

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