Adverse babyhood experiences (ABEs) are a new construct derived from large bodies of evidence that identify a different group of risk factors from adverse childhood experiences (ACEs). ABEs influence infant and maternal morbidity and mortality as well as risk for chronic illnesses and other chronic conditions in the child as well as symptoms in fathers.
Like ACEs, the effects of ABEs add up to increase risk over time. I've developed the construct of ABEs to address the need for understanding and recognizing the impact of unique, additional adverse events occurring before a child’s 3rd birthday that offer new and powerful opportunities for prevention, repair and treatment.
This journal article on ABEs was published in July 2020 with the Journal for Prenatal & Perinatal Psychology and Health (JOPPPAH). The Association for Prenatal and Perinatal Psychology and Health (APPPAH) has graciously given me permission to make my article freely available. The pdf can be downloaded at the bottom of this post.
Adverse babyhood experiences (ABEs) identify 10 categories of negative events for parents before they conceive and for parents and babies from conception until a child’s third birthday.
ABEs identify preventable and reducible non-genetic factors that increase risk for infant morbidity and mortality, chronic illness, mental health conditions, and other symptoms in a child’s life; morbidity and mortality in mothers; PTSD and depression in fathers, and more.
Understanding, repairing and reversing effects of ABEs decreases risk for adverse childhood experiences (ACEs), and for poor health outcomes in parents and children.
The 10 ABEs
The 10 ABEs build on psychologist Antonio Madrid’s Maternal Infant Bonding Survey 14, a questionnaire listing events that increase maternal emotional and physical separation, interrupt parent-infant bonding and coregulation, and increase risk for asthma and other symptoms.
ABEs categorize adverse events into general areas rather than specific questions or types of trauma. The categories offer examples and are not all-inclusive. This is because what constitutes trauma is more common than recognized and is different for everyone.
The following categories of ABEs provide examples of risk factors and are based on the literature.
1. Maternal loss or trauma increases risk for all other ABEs and consequently, for all potential negative outcomes. This category includes events in a mother’s life from before she conceives until her child’s third birthday. ABE #1 includes maternal experiences of trauma throughout her life, such as adverse childhood experiences; discrimination based on race, religion, sexual orientation, gender and for other reasons; adverse events from previous pregnancies, such as stillbirth or miscarriage, preterm birth, preeclampsia, and other events and poor outcomes. Other examples of trauma or loss include accidents, violence and other sources of trauma such as poverty; loss or death of a partner, parent, child or other family member; difficulty conceiving; and more.
2. Low support or loss of support beginning two years before conception until the baby’s third birthday reduces resiliency and the ability to cope with adversity. Low support for the mother increases risk for birth complications, bonding disruptions and other ABEs. Examples include a partner who becomes ill or leaves, disapproval of the pregnancy, having low family support such as for being very young or single, and more.
3. Maternal physical stress is a risk factor for low birth weight, premature birth, chronic illness and other effects in the baby; and for complications and other ABEs in the mother. Examples of physical stress include being sick through much of the pregnancy, worrisome bleeding, gestational diabetes, excessive alcohol, smoking, illegal drugs, toxemia, getting hurt, significant vomiting, having to be medicated, getting too little or poor nutrition, and more.
4. Maternal emotional stress is a risk factor for outcomes similar to physical stress. Examples of emotional stress include feeling seriously depressed or scared. Emotional stress can also come from having a physical or mental illness, feeling unsafe, marital problems, conflict, financial worries, experiencing serious loss other than in ABE #1, and more. The common worries about pregnancy and the baby are not considered ABEs 4 5.
5. Complications in mothers during pregnancy, labor, birth and beyond are risk factors for both baby and mother, as well as for bonding disruptions, difficulty breastfeeding, and other effects. Examples of maternal complications include hemorrhage, being put to sleep for delivery, toxemia, long labor, forceps extraction, vacuum extraction, induction, cesarean, and more. Maternal “near misses,” in which mothers experience serious difficulties and complications just short of death, are ABEs.
6. Complications in babies from conception until the third birthday are risk factors for bonding disruptions, difficulty breastfeeding and other ABEs, chronic illness, mental illness and more. Examples include fetal illness or poor growth in the womb, events around birth such as a tight cord around the neck, shoulder dystocia, being injured during birth, premature birth, breech birth, trouble breathing; needing resuscitation, oxygen, a blood transfusion, incubator care, intensive care; jaundice, having an infection or other illness, being a twin or other multiple birth, forceps extraction, vacuum extraction, cesarean, having a circumcision or other medical procedure, and later events such as accidents and more. Infant “near misses,” in which babies experience serious difficulties and complications just short of death, are ABEs.
7. Separation of baby from mother in particular, or of baby from either parent increases risk for symptoms in babies such as physiological and emotional dysregulation, poor growth, chronic illness, and mental illness. Separation also increases risk for maternal symptoms such as postpartum depression. Examples of separation include maternal emotional separation due to trauma for the mother, father or baby; physical separation such as if the mother is given general anesthesia or has a cesarean, the baby is in newborn intensive care (NICU), or the baby stays in the hospital after the mother goes home. Other examples include foster care, adoption, being hospitalized for illness, surgery or other adverse event in first two years, being separated for other reasons such as a parent being hospitalized, parent travel, and more.
8. Birth weight is a reflection of experiences in the womb. Low birth weight (below 5.5 pounds for many illnesses and below 7 pounds for some) is a risk factor for chronic illnesses and other symptoms later in life. Weighing 10 pounds or more at birth is also associated with increased risk in some studies.
9. Breastfeeding Concerns. Difficulty breastfeeding is a common symptom of ABEs and bonding disruptions. It indicates a need for greater support.
10. Early signs and symptoms in mother, baby or father indicate a need for more support and repair. Many are indicators of exposure to other ABEs. Examples include parental feelings of disconnection or lack of affection for their infant, postpartum depression or PTSD, and other symptoms in either parent. Examples of symptoms in the baby include being sickly, easily upset, irritable or demanding, not growing well, not affectionate, not liking to be held, difficult to calm or comfort, difficulty feeding, frequent respiratory infections, colic, trouble sleeping, coughing a lot, gagging often, wheezing, and more. Chronic illnesses in children or adults may also be indicators of ABEs experienced before the third birthday.
Other adverse events that do not fit in the above list or in previous categories can be included as ABEs, such as unwanted pregnancy, a father’s experience of PTSD from his partner’s birth experience, ABEs similar to #1-#5 occurring for the father, and more.
Many ABEs are already part of the routine history gathered by obstetricians, midwives, family physicians, pediatricians and others involved in prenatal and perinatal care. A more detailed list of ABEs can be obtained elsewhere 15.
Identifying and understanding ABEs can:
- Inform parents, health care professionals, teachers, and adults with chronic illness and other symptoms about identifiable, preventable, reversible and treatable risk factors.
- Educate about common, underestimated risk factors for poor physical and emotional health in babies and parents, and other effects.
- Delineate the many symptoms and other effects of early adversity.
- Emphasize the potential for reversibility or reduction of symptoms and other effects of adversity.
- Identify interventions and treatment approaches.
- Reduce infant morbidity, mortality, near misses and other complications.
- Reduce maternal morbidity, mortality, near misses and other complications.
- Reduce symptoms in fathers related to ABEs.
- Change the common perspective of blame to an understanding that emotional, behavioral and physical symptoms reflect underacknowledged physiological effects of trauma.
Keywords: Critical periods, fetal origins of adult disease, adverse babyhood experiences, adverse childhood experiences, trauma, postpartum depression, maternal morbidity, maternal mortality, maternal infant bonding, asthma, type 1 diabetes, type 2 diabetes, heart disease, stroke, cancer
- A Comprehensive Guide to ABEs (includes free ABEs Fact Sheet)
- A Compilation of Resources for Healing ABEs
- Class: Opportunities for Prevention, Repair and Treatment of ABEs June 1 (Offered week 4 of a 7 week Course “The Impacts of Adverse Prenatal and Birth Events: A Transdisciplinary Approach.” Paid course May 11 to June 22 with recordings available)
- ABEs References with freely downloadable references for the construct of ABEs