1 in 8 Children Exposed to Violence 5 or More Times in a Year

1 in 8 Children Exposed to Violence 5 or More Times in a Year 150 150 Tiasha Letostak, PhD

The average pediatric subspecialist sees two to four child polyvictims each day. What can physicians do to help these children and their families?

According to the National Survey of Children’s Exposure to Violence (NatSCEV), 60 percent of children have directly experienced or indirectly witnessed at least one act of violence in the previous year. Nearly half experienced a physical assault and one in eight were exposed to violence five or more times in a year. These children are known as polyvictims — children exposed to victimization from multiple sources or contexts.

This exposure to violence can come in many forms, including child abuse, bullying by peers or siblings, sexual assault or witnessing violence toward others. Research shows that chronic exposure to these types of stressful, adverse events can cause significant physical, mental and emotional harm and is linked to devastating long-term effects in adolescence and adulthood.

NatSCEV was the first comprehensive national survey to examine the spectrum of childhood exposure to violence, crime and abuse across all ages, settings and timeframes. Findings revealed that with each exposure to violence, a child’s risk of future victimization was increased. For instance, a child who was physically assaulted in the past year also was five times as likely to have been sexually victimized and more than four times as likely to have been maltreated during that same period.

Pediatricians and pediatric subspecialists play a critical role in identifying child and adolescent violence victims and coordinating the referral and follow up for necessary services, says Denise Dowd, MD, chair of the American Academy of Pediatrics’ Medical Home for Children Exposed to Violence Project Advisory Committee. Polyvictimization is characterized by a lifetime of multiple exposures, and pediatric practitioners come into contact with child polyvictims at numerous touchpoints in the health care setting, from annual well visits to ICU admissions.

That awareness is integral to identifying children exposed to violence and ensuring that these children receive appropriate services, says Dr. Dowd, who also is an emergency medicine physician at Children’s Mercy Hospital in Kansas City, Missouri.

Dr. Dowd recently presented a Pediatric Grand Rounds seminar at Nationwide Children’s Hospital in Columbus, Ohio, on the implications that exposure to violence and other early adversity have for pediatricians. “The number one recommendation I would have for pediatricians is to be aware and ask about exposures to violence,” she says. “You can start the conversation with a simple question: Has your child been exposed to anything scary?

“Trauma or exposure to violence often masquerades as other things — chronic headaches, chronic stomachaches, ADHD, oppositional defiance disorder or other diagnoses that warrant further investigation,” Dr. Dowd adds. “Pediatricians are reluctant to begin the conversation with a family or parent regarding exposure to violence, but it is necessary, because some problems are outside of the standard kit of medical diagnostics.”

Addressing a parent’s toxic stress or adversity is important, she emphasizes, because these experiences shape a parent’s ability to cope with stressors and be supportive of their child. “In practice, we have to be really cognizant of the parents’ exposures to adversity and ask the parent about their own experiences with violence.”

The Medical Home for Children Exposed to Violence recommends that pediatricians establish context and express general concern to reassure families that they are not being singled out for these questions. One approach they recommend is to say, “We hear so much about violence these days that I have begun to talk to all of my families about exposure to violence.”

Children’s exposure to violence is pervasive and affects all age groups, and pediatricians can make a difference by routinely asking parents about violence in the lives of children.



Finkelhor D, Turner H, Hamby S, Ormrod R. Polyvictimization: Children’s Exposure to Multiple Types of Violence, Crime, and AbuseNational Survey of Children’s Exposure to Violence, Office of Juvenile Justice and Delinquency Prevention (OJJDP), U.S. Department of Justice. 2011 Oct.

About the author

Tiasha is the senior strategist for Clinical & Research Communications at Nationwide Children's Hospital. She provides assistance to investigators in The Research Institute and clinician-scientists at Nationwide Children’s for internal and external communication of clinical studies, peer-reviewed journal articles, grant awards and research news. She is also the editor-in-chief for Research Now, Nationwide Children's monthly, all-employee e-newsletter for research, as well as a writer for Pediatrics Nationwide.