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This article provides an overview of attachment theory, developmental trauma and trauma‐informed care for paediatricians. The impact of difficult or impoverished parent–child relationships on brain development and long‐term health is now well known. Recent neuroscience research reveals the adverse neurological impacts of developmental trauma and supports the biological basis of attachment theory. There is also an increasing body of evidence that childhood adversity is common and impacts physical and mental health throughout the life‐span. Comprehensive paediatric assessment should include an understanding of attachment difficulties and developmental trauma. Viewing children and their families through a ‘trauma‐informed lens’ can provide critical insights into their clinical presentation and care needs. All paediatricians should be providing and practicing trauma‐informed care.

ObjectiveTo evaluate the impact of fetal alcohol spectrum disorder (FASD) on child and family functioning.DesignProspective survey.SettingMultidisciplinary FASD assessment service.PatientsCaregivers of 35 children with FASD.Main outcome measuresChild-health-related functioning (Royal Alexandra Hospital for Children Measure of Function (MOF)), family impact (Impact on Family (IOF) Scale), impact on siblings and caregiver stress.ResultsMost caregivers were foster carers (74%). Children with FASD (median age 8.7 years; 54% male) were a median of 7.0 years at diagnosis. Regarding child-health-related functioning, 43% reported moderate, severe or major problems in at least one area on the MOF. IOF was moderate (60%) or high (34%). Poorer child-health-related functioning was associated with greater impact on family. Unaffected siblings received less parental attention and displayed anger or frustration about the affected child’s needs. Caregivers reported frequent and high levels of stress.ConclusionsFASD impacts children’s health, and function of the family and unaffected siblings. These novel findings highlight the need for family-oriented service development.