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What specific adverse childhood experiences (ACEs) confer the greatest risk of chronic gastrointestinal (GI) symptoms and how do psychosocial or contextual factors modify these associations? Martin SL et al (J Pediatr Gastroenterol Nutr. 2026;82(5):1162–1170. doi: 10.1002/jpn3.70385. Epub 2026 Feb 23. PMID: 41 730 772) have presented this interesting study aiming to identify which ACE was most strongly associated with GI symptoms in children and adolescents living in the USA. They also evaluated emotional, behavioural and environmental pathways that may affect these relationships. They analysed nationally representative data from over 73 000 children aged 6–17 year from the 2021–2023 National Survey of Children’s Health. Using the interesting statistical analysis approach of Least Absolute Shrinkage and Selection Operator regression (https://www.ibm.com/think/topics/lasso-regression) they identified ACEs most predictive of GI symptoms with co‐occurring GI symptoms and chronic pain examined secondarily. GI symptoms were reported in 6% of children. Five ACEs were retained for the primary outcome; the strongest associations were observed for household mental illness (adjusted OR (aOR) 1.56; 95% CI 1.44 to 1.70) and economic insecurity (aOR 1.38; 95% CI 1.26 to 1.50), followed by neighbourhood violence (aOR 1.34; 95% CI 1.19 to 1.52) and racial discrimination (aOR 1.31; 95% CI 1.16 to 1.47). Emotional and behavioural difficulties mediated 20%–35% of these effects; food insecurity mediated 26% for economic insecurity. As might be expected, school and neighbourhood safety and community support attenuated several of these ACE–GI associations.