Screening for adverse childhood experiences in pediatric clinical settings: a scoping review of tools, implementation strategies, and evidence gaps

Adverse childhood experiences (ACE) are highly prevalent and associated with short and long-term negative health outcomes. As interest grows in integrating ACE screening into pediatric practice, questions remain about its feasibility, usefulness, and considerations. This scoping review aimed to map existing tools, implementation strategies, and gaps regarding ACE screening in pediatric clinical care. We conducted a scoping review following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the PRISMA-ScR checklist. The protocol was prospectively registered on the Open Science Framework. We searched MEDLINE, EMBASE, Cochrane Library, LiLACS, PsycArticles, CINAHL, and gray literature from January 2012 to September 2025. We included quantitative, qualitative, and mixed-methods studies, reviews, clinical guidelines, and policy statements addressing ACE screening among children aged 3–17 years in pediatric clinical settings. Two reviewers independently screened records, extracted data, and synthesized findings using descriptive mapping and narrative synthesis. Of 8,173 records identified, 32 met eligibility criteria. Most studies were conducted in the United States and showed substantial heterogeneity in screening tools, informants, scoring methods, and implementation processes. We identified 15 ACE screening tools used in pediatric clinical practice, with completion times ranging from approximately 2 to 60 min, most commonly between 5 and 20 min. Perceived benefits included earlier identification of adversity, improved clinician–caregiver communication, and opportunities for timely referral and preventive care. Key implementation strategies involved clinician training, integration into electronic health records, and linkage to mental health or social services. Major barriers included limited provider training, time constraints, unclear follow-up pathways, insufficient community resources, concerns about stigmatization, risks of labeling children without adequate support, and poor cultural fit—particularly in low- and middle-income countries. Evidence that ACE screening leads to improved long-term health outcomes was scarce and inconsistent. OSF, https//doi.org/10.17605/OSF.IO/FS5PE. ACE screening in pediatric settings shows potential value for early identification and trauma-informed care, but current evidence is insufficient to support routine universal screening or firm conclusions about long-term effectiveness. Implementation requires standardized, culturally adapted tools, clear care pathways, and adequate resources to respond to positive screens. Future research should evaluate effectiveness, assess potential harms, and develop context-appropriate screening models for settings with constrained resources and high social inequity.