Pediatricians Report on Toxic Stress and Human Development

The American Academy on Pediatrics has recently released a report on the lifelong effects of experiencing early childhood toxic stress, a disrupting developmental response to extremely stressful events such as abuse and neglect.  It is proposed that a new framework for healthy human development and the consideration of many adult diseases as developmental disorders could provide new opportunities for eliminating health disparities associated with maltreatment as well as poverty and discrimination. For example, the pediatric community could partner with the child welfare system to improve outcomes for maltreated children. Because abuse and neglect can cause developmentally harmful toxic stress, cross-disciplinary practices should go beyond the current focus of identification of maltreatment and documentation and treatment of injuries. It should include medical homes and regular referrals to early intervention for children with developmental delays or disabilities. This would be a shift from focusing on safety to more broadly addressing emotional, social and cognitive well-being and a public health model of prevention.

The brief proposes an ecobiodevelopmental (EBD) framework incorporating current understandings of the interplay between genetic predispositions (biology) and environmental influences on their expression (ecology). The report identifies toxic stress as both a risk factor for health-threatening behaviors—that is, the way individuals adapt to cope with the stress—and as a means for causing stress-related disease—in the way toxic stress experiences can imprint brain and body functioning. Further societal implications are considered including the robustness of civic participation, the quality of community life, the strength of the workforce in global economic competition, and reduced health care expenditures on health problems like cardiovascular disease, hypertension, diabetes, and depression.

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