Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

Toxic Stress at the Border

Toxic Stress at the Border

If you’re a parent like me, you’re probably crushed by what’s going on at our border. Every day there are more stories about kids being taken away from mothers who have crossed the border illegally or who are seeking asylum. Infants being taken away during breastfeeding, older kids warehoused by the hundreds in old retail stores, mothers not knowing how to get in touch with their children for weeks. Regardless of politics, it’s an utter moral failure - but as a pediatrician I worry even more about the long-term effects on these kids. In recent years we’ve realized that traumatic experiences during early childhood can have a massive effect on that child’s entire life. We call this phenomenon toxic stress, and understanding it is key to our kids’ future.

Cortisol can be thought of as a stress hormone. When humans are stressed, whether through fear, anger, pain, or illness, our adrenal glands pour cortisol into our blood. This can make us alert, speed up our hearts, and get muscles ready to move (think of how you’d feel if a grizzly bear stepped onto the trail 50 feet ahead of you). This can be a lifesaving response that lets you run away from lions and lift cars off people. But those are pretty rare occasions.

Now we know that children can have the same response to stress in their environments. They churn out cortisol if they see their mom get hurt, or if they don’t know where they are going to sleep tonight, or when they are hungry. When you argue angrily with your spouse, your child is stressed by the volume of your voices and your body language. If you’re depressed or distracted, she can be stressed by getting less eye contact and fewer touches.

No child lives in a perfect environment, but the kids exposed to a greater number and severity of these “adverse childhood experiences” plunge into a constant state of “fight or flight.” Their little cortisol systems become twitchy and erratic, and these changes can become permanent. Young brains are super flexible and therefore super vulnerable. The amygdala is important for responding to emotions, especially fear. It’s kind of like your body’s alarm. The hippocampus, on the other hand, helps in memory and controlling emotions so that the amygdala doesn’t run out of control. Toxic stress supersizes the amygdala and handicaps the hippocampus. (1)

The fallout of these changes is hard to overestimate. Kids exposed to toxic stress have difficulty regulating their emotions and responding to stress. They struggle with attention and relationships. They do more poorly in school or at almost anything else you can measure. (2) They are set up to fail as adults as well, with a 4- to 12-fold increased risk for alcoholism, drug abuse, depression, and suicide. (3) They are more likely to have heart disease, cancer, and even fractures. You can imagine the huge ripple effects on society and how affected kids are more likely to eventually pass that stress on to their own children.

What can we do about toxic stress? It’s becoming clear that building resilience is the answer. Researchers have been busy trying to find the best ways to do this at a child, family, and community level. An excellent review just published this month looked at 40 studies over the past decade that attempted to increase resilience in a variety of setting from families to foster care. (4) The results were encouraging. The interventions included in-home visits to help parents be more nurturing, therapy, and help with transitioning to school. Kids in the intervention groups tended to have healthier cortisol responses, fewer changes to the amygdala and hippocampus, and even lower rates of prediabetes.

I can’t imagine a more perfect storm of toxic stress than taking a young child away from his mother in an unfamiliar country, especially when a lifetime of adverse events is precisely why that child made the journey in the first place. His mom is the only resilience factor he has. You take care of kids. I don’t care if a parent can’t afford food because she’s too lazy to work. You take care of the kid. I don’t care if a dad failed to sign his kid up for health insurance because he’s more concerned about getting high. You take care of the kid. I don’t care if a kid’s in this country illegally because his mom committed a crime. You take care of kids, always.

1. Stress- and allostasis-induced brain plasticity. McEwen BS, Gianaros PJ. Annu Rev Med. 2011; 62:431-445.

2. The lifelong effects of early childhood adversity and toxic stress. Shonkoff JP et al. Pediatrics. 2012; 129(1):e232-46. doi: 10.1542/peds.2011-2663.

3. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Felitti VJ et al. American Journal of Preventative Medicine. 1998; 14(4) 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8.

4. Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Purewal Boparai SK. Child Abuse and Neglect. 2018; 81:82-105. https://doi.org/10.1016/j.chiabu.2018.04.014

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