Pupils widen. The heart pounds. Stress hormones flood the body. Lungs expand, and every muscle sits on the verge of action. This describes the stress response, a normal reaction to a normal emotion. But when a child experiences strong, frequent or prolonged adversity, without adequate adult support, it's referred to as toxic stress, and there can be long-term health consequences.
As a pediatric resident physician at Johns Hopkins All Children's Hospital in St. Petersburg, helping children grow and develop into happy, healthy, productive adults is my priority. Childhood toxic stress can be categorized as abuse, neglect or household dysfunction and can occur in many different forms, including:
• Exposure to physical or emotional abuse
• Chronic neglect
• Caregiver substance abuse
• Mental illness
• Exposure to violence
• Parental divorce
• Accumulated burdens of family economic hardship
These stressors, called adverse childhood experiences, or ACEs, can have a serious effect on children. The more ACEs a child has, the more likely they are to develop a wide array of chronic conditions derailing healthy development. Prolonged exposure can affect the ability to learn and reason. Chronic conditions such as asthma could also worsen. As ACEs increase and children age, they are at an elevated risk of obesity, smoking, substance abuse, depression and missed work and lost wages. Additionally, the risk of diabetes, heart disease, stroke, cancer and broken bones also increases.
So how do you know if a child is experiencing toxic stress? If your child has conditions such as ADHD, obesity, sleeping problems or aggression, ask your pediatrician if toxic stress could be a contributing factor. You may see behavioral changes that include hyperactivity, depression, insomnia, developmental delay or overeating. In these cases, a pediatrician may refer your child to an expert who can help with processing and managing emotions. Additionally, you should speak with your child's pediatrician to calculate an ACE score for you and your child. If you've experienced toxic stress, consider sharing with your teenage children ways you were able to overcome those stressors.
In Florida, the four most common ACEs are divorce, poverty, incarceration and caregivers with substance use disorders. Care for people with mental illness is lacking, so it's important that we talk to our legislators about the need for increased mental health care funding — both to create additional facilities as well as to recruit expert providers who can treat and reduce Floridians' exposure to toxic stress. Locally, organizations such as 2-1-1 Tampa Bay Cares may help with financial hardships. Additionally, your child's pediatrician can direct you to mental health and counseling resources in your community.
To address toxic stress we must emphasize and teach resilience. Children can be taught coping skills and methods to be resilient in the face of hardship by having a stable, constant, caring and involved adult in their lives. Be that adult for children or help your child find a mentor. Together we can counteract toxic stress and support families, as well as develop resilient children and communities.
Dr. Zach Spoehr-Labutta is a pediatric resident at Johns Hopkins All Children's Hospital in St. Petersburg.