As we close the door on April this week and welcome in May, we are also leaving National Child Abuse Prevention Month. But this is an issue that must not be talked about for only one month each year. It must be part of the discussion of healthy child development all year long. Dr. Jack P. Shonkoff, Director of the Center for the Developing Child at Harvard University, explains in this video why we all have a stake in the healthy development of every child.
Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness in San Francisco, wrote a truly informative commentary on the effects of toxic stress on children that I would like to share with you.
Chances are, you know someone whose child has been diagnosed with Attention Deficit Hyperactivity Disorder. Perhaps your own child has received this diagnosis. In many cases, it’s a legitimate issue, and can require medication, therapy or both.
But in my experience, ADHD is one of the diagnoses that can be given – precipitously – to children whose behavior issues are not really about inattention. Their behavior is just one outward sign of a much larger public health problem that we are still working to fully understand: toxic stress.
I observe its effects every day in the clinic where I practice as a pediatrician in Bayview, one of San Francisco’s poorest neighborhoods.
Babies have emotions, too
When we think of the emotional life of a baby, we often reduce the child’s feelings to the way he behaves around a few daily activities. We hear an infant cry when he needs to eat, or sleep, or when he feels uncomfortable. And most caretakers tune in and attend to those needs.
But an infant’s well-being is not just about food, rest and diapers. There’s a lot more going on inside a baby’s brain and heart that we can nurture and foster.
Babies and toddlers have a complex emotional life, just like adults. They are constantly observing their caregivers and the world around them to piece together their relationship to their environment.
During the critical developmental years, between birth and age four, some children experience high anxiety or fear because their home environment is unsafe. They’re subject or witness to physical or emotional abuse, or even extreme poverty. And this trauma can have a tremendous impact on their physical brain development, as well as their emotional development, at a stage when a child is forming the most important attachments in life.
“Toxic stress” is not typical stress
Every child experiences some stress growing up – and even some upsetting events. That’s normal. And learning to cope in those situations is actually necessary for the brain and the body, because it helps a child navigate a complex world and bounce back when trouble arises. Even in a crisis, when a caretaker is there to help a child cope in a healthy way, it strengthens the child’s ability to trust. Those kinds of experiences qualify as “positive” or “tolerable” stress.
But when a child endures something extremely stressful, especially if it is repeated or takes place over a long period of time– without adequate emotional support, this leads to prolonged activation of the body’s stress response system. That’s called “toxic” stress. And it can affect the way the brain and body grow and develop.
Some examples of those painful experiences, also called “ACEs,” or “adverse childhood experiences,” include physical and emotional abuse, neglect, having a caregiver who is mentally ill or substance-dependent, or being exposed to violence without enough support from a loving adult.
Pain in childhood can lead to illness in adulthood
Prolonged or extreme adversity in childhood can cause damage emotionally, socially and physically.
Caregivers, teachers and health providers often see the impact of toxic stress most clearly in a young child’s behavior. We’ll observe a child who is defiant, loses control a lot, has trouble paying attention or has developmental delays that we can’t attribute to an underlying physical problem.
And toxic stress affects more than outward behavior. Below the surface, it manifests itself in actual physical changes in the brain and the body.
Like several other researchers, I have studied the link between ACEs and health. The groundbreaking study in this area, published in 1998, found that a person with four or more adverse experiences in childhood had 2.6 times the risk of the lung disease COPD (chronic obstructive pulmonary disease) of someone with no adverse experiences.
ACEs can also heighten the chance of obesity, stroke, cancer, asthma and diabetes, as well as multiply the risk of hepatitis, depression and heart disease.
Stress sets off a chemical reaction
ACEs directly affect a child’s body by activating the same kind of “fight-or-flight” response you’d experience if, say, you came into contact with a bear. The heart pounds, and the body releases hormones that cause chemical reactions.
Chronic stress can mean frequent triggering of this chemical response, and that can be harmful to a child’s development long-term. It can lead to chronic inflammation, and affect the part of the brain that is implicated in addictive behavior.
The more adverse experiences a child has, the more likely s/he is to develop a host of risky behaviors and negative outcomes later in life, such as alcohol and drug abuse, teen pregnancy or even suicidal tendencies that can cause serious harm or greatly diminish the prospects of a healthy and successful adulthood.
A caregiver is a child’s best buffer
Even in an atmosphere where stress is frequent and not controllable, a young child’s parent or caregiver is the number one shield against the effects of toxic stress. Babies and toddlers are sponges. They absorb many emotions – and tensions – in the atmosphere and people around them. But when there’s a caregiver who can help the child manage these difficult feelings and develop resilience, it can prevent the development of toxic stress.
The quality of a caregiver’s interaction with a child is a key building block for healthy emotional, social and even physical development. Research has shown that something as subtle as a parent’s facial expression and tone of voice will affect even a young infant.
Some of the best ways to support a child’s health and development involve simple things like smiling and laughing, taking time to play with a child one-on-one, and just slowing down to spend time together. Read more here.
Last week Spidey and I spent vacation week together. We had a blast playing games, reading stories, singing silly songs in the car as we ran errands, baking cookies, going to the Discovery Center and a play at the Opera House, and just being together.
I love the times we spend together. And I hope that when he looks back on his childhood, it will be with a special fondness for his Grandma Peanut Butter, as he calls me. Playing with and spoiling our grandchildren is one of the special delights we have earned and they deserve. Right?
But did you know that grandparents also play a very functional role in today’s society? More than three million children in the United States are cared for every day by grandparents.
A number of factors are driving the increase in grandparents serving as the primary caregivers for grandchildren. Grandparents often step in to raise grandchildren when a parent is unavailable due to death, illness, incarceration, or abandonment. In other cases parents may have handed off children to grandparents when they went to serve in Iraq or Afghanistan.
Grandparents saddled with child-rearing responsibilities in these situations are faced with balancing the stress of the departure of their own child with the sudden shift in caretaking responsibilities at a time in life when retirement should be around the corner. A Pew report last year found that more than a fifth of grandparents who care for grandchildren live under the poverty line, more than twice the overall poverty rate among Americans ages 50 and over. And the financial challenges appear especially stark for grandparents raising grandchildren alone.
Even in situations where a family is intact, the need for two income-earners in a family often motivates parents to turn to grandparents for childcare responsibilities. For many children, grandparents are a source of stability and increasingly perform routine activities traditionally assigned to parents, such as day-to-day decision-making and providing for the children’s needs.
Very young children can benefit greatly from spending quality time with their grandparents. For example, several studies have shown that children whose grandparents talk, read and sing often to them show better vocabulary and emotional development, and are better able to manage stress. Simple things like singing traditional lullabies, telling family histories or playing games can strengthen bonds with young grandchildren, and help them prepare to learn.
Here are some resources and good reads on the topic:
“Tips for Sharing Child Care With Grandparents,” Seattle Times, December 11, 2011.