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What to Ask

The AAP recommends surveillance for risk factors related to social determinants of health during all patient encounters. Practices can use a written screener or verbally ask family members questions about basic needs such as food, housing, and heat. Find resources here.

What to Know

Healthy People 2020 organizes SDOH into 5 key domains:

  • economic stability (eg, poverty and food insufficiency)
  • education (eg, high school graduate and early childhood education)
  • social and community context (eg, concerns about immigration status and social support)
  • health and health care (eg, health insurance status and access toa health care provider)
  • neighborhood and built environment(eg, neighborhood crime and quality of housing)

Positive and Adverse Childhood Experiences

  • Research shows many health and well-being disparities are rooted in early childhood. Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes.
  • Safe, stable, nurturing relationships and supportive community and health care environments protect against childhood stressors such as adverse childhood experiences and their prolong exposure called toxic stress. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories.
  • Pediatricians play a pivotal role in a comprehensive well-child care in intervening to promote, identify, and treat safe, stable, and nurturing relationships for lifelong health. Find resources on the public health approach to early relational health

Moving Beyond ACE Scores Infographic

How to Support

Use the Getting Started Guide to plan workflows and create a resource directory

Identify coordinated intake and referral systems in your community like Help Me Grow, United Way 2-1-1, Unite Us, and others

Build community partnerships and ask families for input on high-quality referral resources in your community

Identify additional well-being supports networks Circles of Security, Postpartum Support International, Prevent Child Abuse America Chapters, and brief visit interventions Resilience University, Elmo Belly Breathing, and Sesame Street Monster Meditation

Use the Screening Tool Finder

Use visit planning resources like the Well Visit Planner and CHADIS

Learn and Practice Asking SDOH Questions and Practice Role Play Scenarios for Difficult SDOH Conversations

Engage Families As Change Leaders

Improve Office Systems for Practice Transformation

Last Updated



American Academy of Pediatrics