The impact of parental adverse childhood experiences on children’s healthcare utilisation: a systematic review

Background

Adverse childhood experiences (ACEs) are potentially traumatic events occurring before the age of 18 and are linked to a range of health, cognitive, and socioeconomic challenges – effects that can extend into the next generation. While the association between ACEs and disease risk has been extensively studied, the impact of parental ACEs on children’s healthcare utilisation is not yet systematically evaluated. The aim of this study was to systematically gather the available evidence on the influence of parental ACEs on the use of healthcare services used by their children.

Methods

Original studies on parental ACEs and other types of childhood adversity and preventive, primary, or secondary healthcare utilisation before December 2024 were sought in PubMed, Embase and PsycINFO. Title and abstract screening was conducted using ASReview. To assess quality across multiple domains (study design, participant selection, outcome selection and measurement, and statistical analysis), we applied a combination of three existing frameworks.

Results

In total, 8494 papers were found, of which 16 included. While the results from these publications were mixed, a modest positive effect of parental ACEs on healthcare utilisation was found. Especially in secondary care utilisation, the majority of the evidence pointed towards a positive association. No associations were found for primary care utilisation.

Conclusions

The findings do not provide strong evidence that children of parents with ACEs use more healthcare services, but this group seems to use more specialised care that may increase future healthcare burden.

What is already known on this topic

• Adverse childhood experiences (ACEs) can have adverse effects on both mental and physical health. The last decade, more has become known about their intergenerational effects and developmental and health effects have been observed in children of parents exposed to ACEs. Also, previous reviews have demonstrated the effects of ACEs on healthcare utilisation in adults. However, evidence for the effects of parental ACEs on healthcare utilisation of their children has not been systematically reviewed.

What this study adds

• No association was found between parental ACEs and primary care utilisation, and mixed results were found for preventive care. However, a general trend suggests that parental ACEs increase secondary healthcare utilisation in children.

How this study might affect research, practice or policy

• Higher secondary care utilisation in children of parents with ACEs implicates an increased burden of disease and added stress on healthcare systems. Addressing ACE-related healthcare challenges requires an integrated care approach that incorporates recognition and prevention of ACEs. In practice, this calls for early identification and coordinated family support. Future research should explore which care strategies best meet the needs of these families and how to effectively target upstream risk.