Monday, January 9, 2012

“It is easier to build strong children than to repair broken men.” Frederick Douglass (1817–1895)

A portion of a New York Times Editorial followed by 
the abstract of the American Academy of Pediatrics position paper, 
with links to the full report.
January 7, 2012

A Poverty Solution That Starts With a 


PERHAPS the most widespread peril children face isn’t guns, swimming pools or speeding cars. Rather, scientists are suggesting that it may be “toxic stress” early in life, or even before birth.
This month, the American Academy of Pediatrics is issuing a landmark warning that this toxic stress can harm children for life. I’m as skeptical as anyone of headlines from new medical studies (Coffee is good for you! Coffee is bad for you!), but that’s not what this is.
Rather, this is a “policy statement” from the premier association of pediatricians, based on two decades of scientific research. This has revolutionary implications for medicine and for how we can more effectively chip away at poverty and crime.
Toxic stress might arise from parental abuse of alcohol or drugs. It could occur in a home where children are threatened and beaten. It might derive from chronic neglect — a child cries without being cuddled. Affection seems to defuse toxic stress — keep those hugs and lullabies coming! — suggesting that the stress emerges when a child senses persistent threats but no protector.
Cues of a hostile or indifferent environment flood an infant, or even a fetus, with stress hormones like cortisol in ways that can disrupt the body’s metabolism or the architecture of the brain.
The upshot is that children are sometimes permanently undermined. Even many years later, as adults, they are more likely to suffer heart disease, obesity, diabetes and other physical ailments. They are also more likely to struggle in school, have short tempers and tangle with the law.
The crucial period seems to be from conception through early childhood. After that, the brain is less pliable and has trouble being remolded.
“You can modify behavior later, but you can’t rewire disrupted brain circuits,” notes Jack P. Shonkoff, a Harvard pediatrician who has been a leader in this field. “We’re beginning to get a pretty compelling biological model of why kids who have experienced adversity have trouble learning.”

A policy statement of the American Academy of Pediatricians, 2012

Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating developmental Science Into Lifelong Health

Advances in a wide range of biological, behavioral, and social sciences are expanding our understanding of how early environmental influences (the ecology) and genetic predispositions (the biologic program) affect learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity. A supporting technical report from the American Academy of Pediatrics (AAP) presents an integrated eco-bio-developmental framework to assist in translating these dramatic advances in developmental science into improved health across the life span.  Pediatricians are now armed with new information about the adverse effects of toxic stress on brain development, as well as a deeper understanding of the early life origins of many adult diseases. As trusted authorities in child health and development, pediatric providers must now
complement the early identification of developmental concerns with a greater focus on those interventions and community investments that reduce external threats to healthy brain growth. To this end, AAP endorses a developing leadership role for the entire pediatric community—one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters—to catalyze fundamental change in early childhood policy and services.

AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span. Pediatrics 2012;129:e224–e231

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