Toxic Stress: How the Body’s Response Can Harm a Child’s Development

Stress that occurs continually, or is triggered by multiple sources, can take a toll on a child’s health. Toxic stress that children suffer not only shapes their emotional lives as adults, but also affects their physical health and longevity.

Can stress be helpful or good?

Stress is a body’s reaction to situations things and situations that occur within and outside the body. Stress can be helpful and has been hard-wired into our human physiology for survival. For example, imagine you are hiking in the forest and are confronted with a bear. The body’s natural “fight-or-flight” response results in adrenaline and cortisol being pumped into your blood stream to help you fight harder and run faster.

The body’s stress response is beneficial to help you survive this potentially life-threatening encounter. However, this stress response is only appropriate and useful if you are actually in the woods with a bear. A problem occurs if the bear comes home with you every night, for example if you are a 5-year-old whose single working mother is struggling with alcoholism. This child experiences stress day after day and can become “toxic stress”. Stress goes from being helpful and life-saving to unhelpful and life-damaging. Children are especially vulnerable to this repeated stress activation, as their brains and bodies are in a critical and sensitive period of development.

What types of stress can my child have?

Stress can be subdivided into different categories: positive stress, tolerable stress and toxic stress. A positive stress response is a normal and essential part of healthy development. Positive stress is characterized by brief increases in heart rate and hormone levels. Examples of positive stress include the first day of school or the first piano recital, particularly if that stress motivates you to prepare more or try harder.

Tolerable stress response activates the body’s alert systems to a greater degree. Examples of tolerable stress include a frightening car accident or being admitted to the hospital. If the activation is time-limited and buffered by relationships with adults who help the child adapt, the brain and other organs recover from what might otherwise be damaging effects.

Toxic stress response can occur when a child experiences strong, frequent and/or prolonged adversity which results in changes to their baseline state. Examples of toxic stress include physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence or the accumulated burdens of family economic hardship. This prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years. The presence of social-emotional buffering such as a healthy relationship support from an adult determines whether the resulting stress response will be tolerable or toxic.

What is the body’s chemical response to toxic stress and how does it affect my child’s short and long-term health?

Toxic stress has the potential to change your child’s brain chemistry, brain anatomy and even gene expression. Toxic stress weakens the architecture of the developing brain, which can lead to lifelong problems in learning, behavior, and physical and mental health. When a child experiences toxic stress, the Hypothalamic Pituitary and Adrenal (HPA) hormone axis is over-activated. This results in blood levels of the stress hormone cortisol being higher which can result in long term changes in inflammation and immunity. Studies have shown associations between toxic stress and changes in brain structure.

The consequences of this can include more anxiety as well as impaired memory and mood control. Toxic stress responses can also include changes in gene expression, meaning which genes in your DNA are turned on or off. The Adverse Childhood Experiences (ACE) study created an awareness of the association between adverse childhood experiences and diseases and conditions affecting adult health. The ACE study showed that adverse childhood experiences in categories of abuse, household challenges and neglect are not only associated with worse mental health outcomes, but also with chronic health conditions such as diabetes, heart disease, chronic obstructive pulmonary disease, liver disease, and cancer (among many other adult health conditions).

For more information on toxic stress, listen to our PediaCast.

Kari Phang, MD
Kari Geronilla Phang is a 2017 graduate of Nationwide Children’s Pediatric Residency Program. She is currently an academic pediatric fellow at the Medical University of South Carolina Children’s Hospital, practicing both inpatient and outpatient pediatrics. She has an interest in pediatric advocacy through the American Academy of Pediatrics Section on Pediatric Trainees. Follow Dr. Phang on Twitter at @DrKariPhang.

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