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Nadine Burke Harris is an American pediatrician who is the 1st and current Surgeon General of California since 2019. She is known for linking adverse childhood experiences and toxic stress with harmful effects to health later on in life. She opened the Center for Youth Wellness in 2010, to support and screen children for Adverse Childhood Experiences. The clinic is funded entirely by private donations and is free to patients.

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This book is about the journey of Dr. Nadine Burke Harris proving her hypothesis that adverse childhood experiences create life long effects to not only our social development but also our biology. She uses examples of past patients and their health conditions in order to further prove how toxic stress has shaped their health conditions. She often refers back to a boy in the book named Diego, who was seven years old but had the bone growth of a 4 year old. After discussing with his mother, Harris was informed that Diego was sexually assaulted at 4 years old by a man staying in their home. Harris quickly made the connection that his bone growth was representative of the age he was assaulted. Throughout the book she discussed various patients and the the biological effects of toxic stress on the body. She also goes into detail about the ACE assessment and how it should be improved due to the effects of trauma being unconsidered. A child experiencing a parent divorce cannot be under the same scale as a child that experienced sexual assault.

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The title was given to Harris when she reflected on his fist day of public health school when she was told of a story about the Cholera outbreak in 1854. A physician canvassed the residents of the neighborhood and found that the incidences were all clustered around the public well with a hand pump. He convinced the locals to stop using the well and the outbreak subsided. The well in this story represents the reason as to why everyone is sick. Instead of trying to cure the individual people, it's important to focus on the source of what is making everyone ill. In this case, ACE is the well.

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responses that can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support.

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The author uses her past experiences from her education path to argue her hypothesis that ACE causes long term effects for children. One of the experiences she uses is working in the frog lab and analyzing the effects of toxic stress on the tadpoles. She explained how when the tadpoles experienced high levels of toxic stress, cortisol levels heightened and some of the tadpoles were able to jump start the process of metamorphosis enacting the fight or flight response but only if the tadpole was at a certain time in development. For the tadpoles that experienced this toxic stress over a prolonged amount of time, their growth was inhibited they became maladaptive.
The author also discussed how not only does ACE affects an individuals behavioral patterns and make them more susceptible to drinking, smoking, etc. it can also lead to life long effects and make an individual more susceptible to strokes, heart disease, cancer, etc. The author notes how engaging in healthy behaviors even after experincing ACE, can still make a person likely to become ill of these diseases and take years from their life span.

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This book provides useful information as a way to understand and advocate for students experiencing trauma. When children are struggling academically or experiencing symptoms of asthma, eczema, or various other health conditions, this could be an indicator of ACE. Healthcare providers and educators should work together, depending on the severity of trauma, to best find specified supports and accommodations that aid the students learning. For example, Diego was significantly under the percentile of what his height should be for a 7 year old. In order to best accommodate his learning without putting emphasis on his ACE, educators could rearrange his seating in the classroom and place him closer to the teacher. Diego could also be referred to the schools guidance counselor in order to maintain a healthy relationship while also supporting his emotional growth. Educators should provide a safe setting for their students.

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I enjoyed reading this book because the author did a great job making medical terms understandable for someone who doesn't have a strong background in science. The text was also extremely informative about psychological and biological effects of ACE as children grow into adults. The author was able to use her personal experiences in order to tell a great story and relate her previous knowledge to what she was seeing in her patients. She also did a great job making the story enjoyable to read with witty humor and heartfelt touches. I would highly recommend this book for any individual that experienced trauma as a child, a foster parent, parents in general, teachers, individuals involved in government, etc. Becoming informed and making this topic a discussion has the ability to change the future and recognize the importance of childhood adversity.

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How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED