According to the 2025 National Child Abuse and Neglect Data System report, there are over half a million children who have experienced abuse in the United States.1 The harm extends beyond the duration of the abuse, as survivors face the risk of lasting impacts on their physical and psychological well-being throughout their lives.2 Despite the magnitude of this issue, the lived experiences of children are strikingly absent in the child abuse literature.3 There are many reasons why children are excluded from research; chief among them are the ethical and regulatory hurdles involved in gaining approval to include children in research and the importance of shielding children from psychological harm.4 However, when the authentic voices of children who experience abuse are omitted from the conversation, opportunities to learn about their views on how to promote healing may also be missed. That is why our research team collaborated with the National Children’s Alliance to conduct a study to understand children’s journeys toward healing in their own words.4 This piece brings visibility and voice to children who experience abuse and shares insights regarding how child perspectives can inform trauma-informed care (TIC) following abuse.We invited Child Advocacy Centers (CACs) nationwide to join our initiative. CACs are child-friendly facilities that use a multidisciplinary team approach to lead investigative efforts and coordinate key services for children who have experienced abuse and their non-offending family members.5 Participating CACs distributed 3 carefully crafted open-response questions to children in their care. The questions asked children to convey what healing after child abuse meant to them, what was most important to their healing, and how CACs could best help them heal. This study was reviewed and deemed exempt by our institutional review board. To access this study in its entirety, please see the reference below.4This study generated quotes from over 3000 children who interacted with CACs between 2021 and 2023. The children described that their healing was rooted in regaining a sense of happiness, or simply feeling better or good again. While the breadth of responses to the question of what is most important to promote healing illuminated the individual nature of each child’s healing journey, several important themes emerged that offer a lens into how pediatric clinicians can help children heal after abuse.Children who had experienced abuse shared that the most vital element promoting their healing was speaking about their experiences, paired with having someone truly listen. As one young person said: “The most important thing to help me heal and feel better is talking about it and even being healed enough to joke about it, as well as being able to get emotional and vulnerable about it. Healing is important and it is part of the process of life, because healing helps you grow.” That “someone” to listen could be a trusted professional such as a physician, nurse, teacher, or counselor.Many children emphasized that strong social connections enhance healing following abuse. The children highlighted the critical role of supportive relationships with family and friends. As one child said: “My family and my best friend. They help me feel better and let me know I’m not alone.”Children stressed the importance of feeling safe in their pursuit of healing. This included feeling that their body is safe (as one child said: “Check if I am safe in my private parts”) as well as feeling safe in their environment (as one child said: “Give a safe space to communicate efficiently, and effectively without getting disrupted, or distracted”).Children also described sources of comfort and diversion to support healing that aligned with their developmental stages. For example, young children spoke about the comfort they derived from pets—as one child simply said: “Laying with my animals.” Teenagers tended to lean on music as a healing tool—as one adolescent said: “Music, just listening to music and blocking out the world and just focus on myself.” Across all developmental stages, children mentioned toys and games, ranging from stuffed animals to fidget items. One young child said: “Grab a squishy and squeeze it and smile.”These diverse responses illustrate that the process of healing is deeply personal, and children themselves are the most reliable guides to understanding what they need after abuse. Nevertheless, pediatric clinicians can meet each child where they are by making space for children to speak and be heard, being a source of support, promoting a sense of safety, and providing tools for diversion as part of efforts to meaningfully integrate TIC into their practice.The landmark Adverse Childhood Experiences Study revealed the way early adversity shapes health trajectories throughout the lifespan.2 Since then, numerous models of TIC have been developed to guide pediatric health care professionals in navigating the complex terrain of caring for children that have experienced abuse. The American Academy of Pediatrics’ TIC framework defines 5 key action areas: awareness (understanding trauma’s impact), readiness (preparing systems and staff), detection and assessment (identifying trauma exposure), management (providing appropriate interventions), and integration (embedding trauma-informed practices throughout care).6To make space for children who have experienced abuse to speak about those experiences and feel heard, pediatric clinicians should be particularly attentive to the awareness, readiness, and detection/assessment elements of the TIC framework. Fragmentation of communication between systems, shorter health care visits, larger visit volumes, a rise in telehealth, and emergence of artificial intelligence influence primary care clinicians’ ability to ask challenging questions and make space for complicated answers.7 Children healing from abuse are seeking room to express themselves and be listened to. By maintaining awareness of the impact of trauma and preparedness to navigate these challenging conversations with empathy and support, pediatric clinicians can foster nurturing relationships with children who have experienced abuse, model such approaches for family members, and promote healing. Pediatric primary care clinicians in particular have a unique opportunity to support children’s healing over time. This support may be needed months or even years after the initial experience, as children recontextualize what happened to them as their developmental capacities and understanding grow.To promote comfort and distraction, pediatric clinicians can leverage management and integration strategies from the TIC framework, for example, by ensuring that trauma-informed resources are accessible in clinical spaces through simple interventions like animals (eg, pet therapy), toys, games, and music. Children who experienced abuse shared that to feel safe and comfortable in clinical settings, it was important that non-offending family members be permitted to stay with them, that staff were approachable, and that spaces were child-friendly. While these are hallmarks of pediatric care generally, CACs are intentionally designed to meet these standards. When needs for support and services exceed the capacity of the primary care practice, pediatric clinicians can refer families to CACs.It is essential to remember that children are the experts in their own healing journey after abuse. Our role as pediatric clinicians is to listen, learn from their wisdom, and become more prepared to support their recovery. As one child concluded, “Do what is best for the child, but also consider what the child wants.”Erin Casey, Program Evaluation Manager for the National Children’s AllianceThe National Children’s AllianceDr Kurt Stange, The Center for Community Health Integration, Case Western Reserve University School of MedicineMarie Masotya at the UH Center for Child Health and PolicyKaitlin Lounsbury, Previous NCA Program Evaluation ManagerThe Canopy Child Advocacy Center in Cleveland, Ohio
Stats et al. (Thu,) studied this question.