Why Optometrists and Eye Care Professionals Play a Critical Role in Recognizing Childhood Trauma By Dr. Pamela J. Pine

Every day, optometrists and eye care professionals examine far more than vision.

They observe behavior, development, physical health indicators, family interactions, and signs that may point to concerns extending well beyond the eye exam itself.

For many children, an eye care appointment may be one of the few healthcare encounters they experience regularly. That creates a unique opportunity—and responsibility.

Understanding Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before age 18.

Examples include:

• Physical abuse
• Emotional abuse
• Sexual abuse
• Neglect
• Domestic violence
• Household substance misuse
• Household mental illness
• Parental incarceration
• Family instability

Research shows that nearly two-thirds of American adults report experiencing at least one ACE, and many experience multiple forms of adversity.

These experiences can affect physical health, mental health, learning, behavior, and long-term wellbeing.

Why Eye Care Professionals Should Pay Attention

Children affected by adversity may present with:

• Difficulty concentrating
• Delayed developmental milestones
• Behavioral concerns
• School performance challenges
• Elevated stress responses
• Difficulty engaging with healthcare providers

While these observations alone do not indicate abuse or trauma, they may provide important context when considered alongside other findings.

Eye care professionals are often trusted healthcare providers who may notice patterns others miss.

The Eye as a Window into Health

Researchers continue to explore the relationship between childhood adversity and biological changes throughout the body.

The retina is part of the central nervous system, making it an important area of scientific interest when studying the effects of stress and trauma.

Emerging research suggests that biological markers associated with adversity may someday help deepen our understanding of how trauma affects long-term health.

Recognizing Signs of Possible Abuse

One area where eye care professionals already play a critical role is the identification of injuries associated with abusive head trauma.

Clinical findings may include:

• Retinal hemorrhages
• Ocular injuries
• Unexplained trauma
• Findings inconsistent with reported history

These situations require careful documentation and adherence to professional and legal reporting obligations.

Understanding Mandatory Reporting Responsibilities

Healthcare professionals are often mandated reporters under state law.

Responsibilities may include:

• Recognizing signs of suspected abuse
• Documenting observations appropriately
• Following state-specific reporting requirements
• Collaborating with child protection authorities when necessary

Knowing what to do—and feeling confident doing it—can make a significant difference.

Closing the Knowledge-to-Action Gap

Many healthcare professionals report receiving limited training on:

• ACEs science
• Trauma-informed care
• Child abuse recognition
• Difficult conversations with families
• Reporting procedures

As awareness grows, increasing numbers of professional organizations are encouraging trauma-informed approaches across healthcare settings.

What Trauma-Informed Eye Care Looks Like

Trauma-informed practice does not require clinicians to become mental health professionals.

Instead, it involves:

• Creating a safe environment
• Building trust
• Using respectful communication
• Recognizing signs of stress and trauma
• Understanding reporting responsibilities
• Connecting families with appropriate resources

These practices support both patient care and professional confidence.

Why This Matters

A single healthcare encounter can change the course of a child’s life.

When clinicians recognize concerns, ask thoughtful questions, and understand how to respond appropriately, they create opportunities for protection, support, and intervention.

Eye care professionals have unique expertise in seeing what others may miss.

Sometimes that observation can extend beyond vision—and become the first step toward helping a child find safety and support.

The eye exam is about much more than eyesight.

It may be one of the most important opportunities a child has to be seen.