Earlier this year the American Academy of Paediatrics (AAP) issued a policy statement warning of ‘Toxic Stress’ and the long-term effects it has on children. It’s the first time I’ve heard this expression and it’s certainly a powerful term, a recent article in the New York Times brought this issue to a wider audience.
Toxic Stress can be caused by a number of situations ranging from neglect, being witness to negative, destructive behaviour and most importantly and the subject of much study, stress whilst still in the womb.
Stress causes production of Cortisol, a hormone with both positive and negative impact. Important element in the maturing of fetal lungs, however the negatives are too powerful to ignore. A shopping list of concerns, when in excess, Cortisol suppresses the immune system, decreases bone formation, is associated with impaired learning and is quoted as having the potential to affect the ‘architecture of the brain’.
Joining the dots – production of excess Cortisol is triggered by stressful situations, they in turn change the body’s metabolism and if the body is carrying a fetus, then the fetus may be affected.
Highly stressful situations for a pregnant mother has potentially far reaching effects on the child and stays with that child to adulthood. Of course we know countless stories of children from complex backgrounds who despite adversity ‘made-good’, however the studies are clearly beginning to show that the numbers of people who have suffered and continue to suffer as a result of Toxic Stress are too high to ignore. Links to increased heart disease, diabetes, behavioural problems and academic under-performance to name some of the areas affected.
Harvard paediatrician , Jack P. Shonkoff states ‘ You can modify behavior later, but you can’t rewire disrupted brain circuits’. ‘We’re beginning to get a pretty compelling biological model of why kids who have experienced adversity have trouble learning’. Dr. Shonkoff believes ‘Early experiences are literally built into our bodies.’
These findings must lead us to re-thinking how we approach pre-natel care and support.
The AAP’s policy statement states ‘Protecting young children from adversity is a promising, science-based strategy to address many of the most persistant and costly problems facing contemporary society, including limited educational achievement, diminished economic productivity, criminality and disparities in health.
In the US a very good example of early intervention is the Nurse-Family Partnership. Nurses visit vulnerable women who are pregnant for the first time. Supporting them emotionally and teaching them about the value of breast-feeding and caring for their bodies. Basically being their as a positive influence and giving the vulnerable person the real sense that they are not in a lone struggle.
Evidence already available serves to support the AAP’s findings – two examples noted in the New York Times stretch back decades. Children severely neglected in Roumanian orphanages had changes in their chromosomes which accelerated aging and their brain scans looked different. Going further back, Dutch adults who had be in utero during a brief WW11 famine later in life had problems concentrating and a higher level of heart disease.
If the findings of these groundbreaking studies then translate into meaningful changes in policy for our most vulnerable in the long-term we really can stretch a welcoming hand to future generations. If however the findings are consigned to a filing cabinet somewhere and we continue to react only to the symptoms without addressing properly the real causes of Toxic Stress, then we will all suffer the consequences, none more so than the new born baby who really does starts life on a back-foot.
Link to some further reading on this topic http://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/