Detection & Identification

Pediatricians and other pediatric health care professionals are often among the first to respond when children and families experience a traumatic event.  This places them in a key position to partner with families to identify symptoms early and promote healing. For this reason, it is essential that pediatric care is delivered through a trauma-informed framework that includes primary prevention, secondary detection, and tertiary treatment, often beginning with the recognition of trauma-related symptoms.  

Secondary care (detection) focuses on identifying and supporting children who are experiencing symptoms related to trauma. This includes history-taking, on-going surveillance, assessment, screening (both universal and targeted), and when appropriate, diagnosing. Pediatricians are encouraged to screen not only for exposure to adversity, but, more importantly, for its impact on the child.   

Trauma-informed care (TIC) uses screening approaches that combine open-ended questions about experiences of adversity with specific questions about trauma-related symptoms. The goal is not to generate a cumulative “score” of exposures, but to understand the child’s symptoms, supports, and strengths to guide treatment and healing.  

Surveillance 

Surveillance refers to the ongoing, relationship-based process of observing, listening, and asking open-ended questions during clinical encounters. Pediatricians can recognize early warning signs of trauma and use this information to guide discussions and care. It can be the first step in a TIC framework, allowing pediatricians to: 

• Build trust and psychological safety with families. Safety is the foundation of TIC.
• Observe interactions between caregivers and children for signs of stress or resilience.
• Identify family strengths, stressors, and contextual factors that may be impacting their health.
• Encourage families to share concerns related to stress, adversity, or trauma.

Two questions that might be useful for surveillance are: 

• Has anything bad or scary happened since we last met?
• Has anyone come or gone from the home recently?

Screening 

Validated traumatic stress screening tools assess a child’s current functioning, symptoms of post-traumatic stress, and need for further evaluation or intervention. When used within a trauma-informed and culturally sensitive approach, these toolsy can: 

• Identify children exhibiting trauma-related symptoms or behavioral concerns.
• Guide appropriate clinical responses and referrals.
• Complement developmental, behavioral, and social determinants of health (SDOH) screening. 

Using Trauma Screening Tools in Practice 

When a child exhibits emotional, behavioral, or physical symptoms that may be related to trauma, validated screening tools can help determine whether trauma is a contributing factor. Evidence supports screening for both trauma exposure and symptoms, alongside screening tools for conditions with overlapping symptoms, including to better identify specific needs and guide treatment.  This approach is more effective and avoids limitations of Adverse Childhood Experiences ( ACEs) screening alone.  Screening results should be interpreted in context, alongside developmental, behavioral, and family information. Trauma screening tools can also be incorporated into primary care or specialty care visits. 

Key considerations for use: 

• Conduct screening within a safe, trusting relationship, clearly explaining its purpose to caregivers.
• Integrate trauma screening with assessments of social needs (eg., SEEK or WE CARE).
• Use screening findings to inform individualized care rather than to assign diagnostic labels.
• Confirm that referral pathways and follow‑up supports are established and accessible. 

To learn more about identification and support, check out the Practical Strategies for Implementing Trauma-Informed Care PediaLink course and this Engagement, Surveillance, and Screening session of the AAP Trauma-Informed Care and Resilience Promotion ECHO.