|Nadine Burke Harris, M.D., M.P.H., FAAP, speaks with Johns Hopkins All Children's physicians.
There’s a public health crisis hidden in plain sight throughout the United States.
Though it seldom gets the headlines given to topics such as Zika virus and “superbugs,” toxic stress is a health crisis for millions of children and can dramatically impact their future health, education and lifespan.
Toxic stress is the normal response of the body and brain to adverse childhood experiences (ACEs). A child with four ACEs has a dramatically increased risk for health, behavior and learning problems in childhood and for 7 of the 10 leading causes of death in adults.
The pediatric residents at Johns Hopkins All Children’s Hospital are working to help health care professionals, families and communities learn more about ACEs, toxic stress and resilience. Advocating to improve children’s health is a key part of their training. This year they launched Partnering for Resilience Week, hosting screenings of the documentary film Resilience as well as forums with educators and city officials. They will be at the St. Petersburg Saturday Morning Market on April 29 to share this vital information.
The residents kicked off the week’s events with a special presentation by a national expert on ACEs and toxic stress. More than 175 physicians and health care professionals had the opportunity to learn from Nadine Burke Harris, M.D., a pediatrician whose TED talk about toxic stress in children has been viewed more than 2 million times. She is the founder and CEO of the Center for Youth Wellness in San Francisco and received the 2015 American Academy of Pediatrics Humanism in Medicine Award.
Nearly 20 years ago, a study of 17,500 adults by researchers at the Centers for Disease Control and Kaiser Permanente showed an important link between adversity in childhood and serious health problems in adulthood. Burke Harris reminded her audience that even today, pediatricians receive little education about ACEs and don’t routinely ask families to complete a screening tool for ACEs. She is working to change that practice through widespread education thanks to the documentary Resilience and an upcoming book.
Some types of stress are relatively easy to handle. Taking a test at school may cause temporary stress that quickly goes away. ACEs are different, and the stress they cause is different, too.
ACEs may include: physical or emotional neglect; physical, emotional or sexual abuse; divorce or loss of a parent, a household member with mental illness or substance abuse; or domestic violence. ACEs produce toxic stress because the body’s fight-or-flight response remains activated, flooding the brain and body with stress hormones that can damage organs, change brain structure, behavior and cognitive development, and even change how a cell’s DNA reads and sends messages.
Toxic stress can lead to asthma and lung disease; excess weight or obesity; cardiovascular disease and stroke; behavior and learning problems; diabetes; cancer; depression, suicide and risk-taking behaviors. Health care providers can use an ACE screening tool that assigns one point per ACE. As a child is exposed to more ACEs, his or her ACE score rises and toxic stress has a greater impact on health. Burke Harris shared the science behind ACEs and toxic stress, plus some startling statistics:
- 34.8 million children in the United States have at least two or more ACEs, and the rate in Florida is higher.
- An ACE score of four or more makes kids twice as likely to have asthma, early infections, learning and behavior problems.
- Young women with an ACE score of four or more have a 42 percent teen pregnancy rate.
- Without an intervention, youth with an ACE score of six or more have a 20-year difference in life expectancy.
ACEs impact children of every race, ethnic group and socioeconomic group, in every region of the country. Although children in communities with the highest levels of violence and discrimination are at higher risk, toxic stress is a problem in every community.
But there is cause for hope. Resilience can make a difference. Early intervention to reduce adversity and help caregivers serve as a buffer for stress can make a big difference.
“Science doesn’t help just sitting in journals,” Burke Harris said, stressing the need to develop clinical and diagnostic tools to go along with the current ACE screening questionnaire, and for pediatricians, schools and communities to do more to recognize ACEs and connect children and families with resources that can help. The residents are doing their part through education, outreach and advocacy.
Sarah Marsicek, M.D., a co-chair of the committee of residents that coordinated Partnering for Resilience Week, plans to put these powerful lessons into action. “Dr. Burke Harris caused me to pause and think about opportunities I may have missed to talk about ACEs with families. I believe that stressors are an important part to a child's overall health and should be a factor in the treatment plan. Using this knowledge and asking families about adversities they may face will help me be a better physician.”
Families, educators and communities can also work to prevent or reduce toxic stress by reducing childhood ACEs. The public is invited to learn more at these events:
Thursday, April 27, 7 – 8:30 p.m. Community screening of the documentary Resilience at Campbell Park Elementary School, 1051 Seventh Ave. S, St. Petersburg
Saturday, April 29, 9 a.m. – 2 p.m. Saturday Morning Market, “Toxic Stress Booth.” Meet Johns Hopkins All Children’s Hospital residents to learn more about toxic stress in childhood and what communities can do to promote resilience.