We are fortunate to be in a time in pediatrics when the neuroscience is catching up with what we have long known about social determinants of health affecting children's development. The original study on Adverse Child Experiences (ACEs) was published almost 20 years ago in a collaboration between the CDC and Kaiser. But recently, growing understanding of the science behind toxic stress outcomes is generating renewed interest and investment, such as here in King Co with the recent passing of the Best Starts for Kids levy-the first of its kind!
There has been much interest recently in this topic both nationally at the AAP and locally in our program. Colleen Gutman did a wonderful RCP, residents and Dr. Ivor Horn hosted a terrific journal club, and Dr. Abby Grant gave a great talk to the REACH residents, all in the past month. So, naturally, we need to do a TOW, too. A big thanks to the fantastic advocacy of Colleen and Abby to help prepare these great resources to disseminate to everyone for informing their clinic practices.
Resources for this week:
- Case and discussion by Drs. Gutman and Grant
- AAP Technical Report on Early Childhood Adversity and Toxic Stress 2012
- Videos on toxic stress and promoting resilience from the recent national AAP conference
Take-home points on ACEs/Trauma-informed care:
- Ecobiodevelopmental framework (EBD) – As reviewed in the 2012 AAP Technical Report, "an emerging, multidisciplinary science of development supports an EBD framework for understanding the evolution of human health and disease across the life span." That is, science has shown significant associations between the "ecology of childhood" and many developmental outcomes and life course trajectories.
- ACEs definition: Adverse childhood experiences (ACEs) are experiences in early life that have detrimental effects on child development and adult health outcomes including abuse, neglect, being exposed to intimate partner violence, mental illness, drug addiction, poverty and racism.
- Toxic stress definition: Adversity and maltreatment in childhood are thought to affect development and health through chronic exposure to stress. This repeated and ongoing activation of stress response pathways is termed “toxic stress”, in contrast with normal, healthy, physiologic stress response mechanisms. Children experiencing adversity and maltreatment have been shown to have elevations in inflammatory cytokines and dysregulation of their HPA axis, and their brains may develop differently.
- Protective factors: The presence of a positive, nurturing adult is powerful in protecting against the negative effects of toxic stress. While there is great variability in genetic susceptibility to stress reactivity, nurturance mediates and protects against the negative effects of toxic stress and adversity.
- Pediatricians' role in addressing ACEs/toxic stress: we are being called upon to take more active roles in developing and implementing science-based strategies to reduce toxic stress in early childhood, and hopefully thereby tackle some of the pressing disparities in learning, behavior, and health. Inform yourselves about the resources on trauma-informed care (as above). Take a "universal precautions" approach and treat everyone with respect. Give special attention to care provided to those who are affected by trauma to help build nurturing and resilience, and avoid retraumatizing children and/or caregivers.