Reducing Toxic Stress in Childhood

The link between trauma or other adversities during childhood and the risk of developing mental and/or substance use disorders, and other hardships later in life is increasingly recognized. Now a growing body of scientific evidence is revealing how physiological changes that occur in children who endure severe, prolonged stress contribute to both mental and physical health conditions later in life.

Andrew Garner, M.D., Ph.D., former chair of the American Academy of Pediatrics (AAP) leadership workgroup on early brain and child development, explained that when a child endures severe, unmitigated stress for a long period of time, the body and brain are bathed in cortisol, a hormone that triggers that fight-or-flight response. Normally, this hormone is helpful, allowing individuals to respond quickly in an emergency, but when cortisol levels are chronically elevated it can cause permanent changes in the brain and gene expression.

The good news is that support from nurturing adults can mitigate the harmful effects of toxic stress by helping children feel safer and allowing their bodies to turn off the stress response.

“The antidote to toxic stress is safe, stable, and nurturing relationships,” Dr. Garner said. He explained that a comforting adult can help young children to turn off this stress response, and older children can be taught healthy strategies for managing stress and their emotions.

The data, along with policy changes associated with health reform that promote wellness, have prompted the AAP to launch a multipronged effort to combat toxic stress during childhood. The AAP is calling on pediatricians to take a multigenerational approach to child health and help parents to better support children in crisis.

“It’s tough for pediatricians, because we think of the child as our patient,” Dr. Garner explained. “But science tells us we need to consider the family and the community.”

For example, if a physician is seeing a child with asthma whose condition is not improving, the physician may assume the family is not following the treatment plan. But a social worker might tell the physician that the family is experiencing homelessness and has been staying in an abandoned house. They lack the transportation and funds to get the child’s medications.

“You are not going to address this child’s asthma with medications without linking that family with the services they need,” Dr. Garner said. Pediatricians may also be afraid to ask families about such hardships because they are not confident they will be able to link them to services.

Building Safety Nets for Families

To help physicians do this, AAP is working to build stronger community safety nets for families experiencing hardships by working with policymakers and social service providers. A newly formed Center for Healthy, Resilient Children at AAP will work to translate the data on toxic stress into medical practice and policy and to build collaborations with early childhood educators and social services, Dr. Garner said.

“There are multiple ways to start bridging,” he said. “We really need to have a web that’s catching these kids."

He noted that some programs are already working to help pediatricians and social service organizations work together. For example, an organization called HealthLeads works with medical clinics where physicians “prescribe” interventions for families like job training, legal advice, housing, or food, alongside traditional medical care. A cadre of about 1,000 college students help to fill those prescriptions by linking the families to appropriate services. Another example is Head Start–Trauma Smart, an early childhood education program that works to meet the needs of children who have experienced trauma or hardships and helps link these youth and their families to medical care and other services.

The foundation of this effort will require more information for parents and caregivers about the health effects of toxic stress on children. Physicians and other medical professionals working with children will have to ramp up efforts to screen families for homelessness and other risk factors. Finally, treatment and services must be in place to help children in need.

A key goal of the AAP’s efforts is to empower parents and help them meet their children’s basic needs. “I’ve never met a parent who doesn’t want to do a good job,” Dr. Garner said. “But it is hard to do when you don’t know where you are going to sleep at night, or you are a victim of abuse, or you don’t have a job.”

Publications and Resources

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This article was originally published to highlight the May 2015 theme of Children and Families.

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Last Updated: 04/29/2020