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

Background

Adverse childhood experiences (ACEs) are linked to poor health and social outcomes, with growing interest in their intergenerational effects. While many studies have explored how ACEs affect adult health, the impact of parental ACEs on children’s healthcare utilisation has not yet been systematically reviewed.

Methods

We conducted a systematic review of original studies examining associations between parental ACEs or related adversity and children’s use of preventive, primary, or secondary healthcare. We searched PubMed, Embase, and PsycINFO up to December 2024. Title and abstract screening were conducted using ASReview. Quality of the studies was assessed using a composite framework evaluating study design, sampling, exposure and outcome measurement, and analysis strategy. Findings were synthesised narratively and visualised with harvest plots, grouped by healthcare level and exposure type.

Results

Out of 8494 records, 15 studies were included. Studies were heterogeneous in design, population, ACE measurement, and outcome definitions. No consistent associations were found in preventive or primary care domains. In secondary care, 11 of 12 associations were either positive or neutral; four high-quality studies showed increased use of emergency, inpatient, or psychiatric services among children of parents with ACEs. Methodological variability limited comparability between studies, particularly in how ACEs were operationalised.

Conclusions

Parental ACEs may contribute to increased use of secondary healthcare in offspring, though evidence across care levels remains inconclusive. Future studies should aim for more consistent measurement of ACEs and standardised outcome definitions to clarify intergenerational effects on healthcare utilisation.

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. For example, developmental and health effects have been observed in children of parents exposed to ACEs. Also, previous research has 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.