Thursday, 18 May 2017 23:21

Exposure to toxic stress has long-term effects on children

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by William Cogsgrove, MD

We all worry about toxic exposures in our environment. Will air pollutants damage our lungs? Will radon in our homes increase our cancer risks? Is there lead in the water our children drink?

Well, the most common toxic exposure affects two out of three of us, and increases our risks of seven out of ten of the leading causes of death in the United States. This exposure can affect our immune system, hormonal system, our brain development and even the manner in which our DNA is transcribed.

The toxic exposure that I am describing is often labeled “toxic stress” from Adverse Childhood Experiences or ACEs. Data collected over the past two decades shows the damaging outcomes of stressful experiences that occur during childhood. The original study of 17,500 middle class adults in San Diego in 1997 correlated physical, emotional, and sexual abuse or neglect of a child, or living in a family strained by mental illness, addiction, violence, parental separation or parental incarceration, with resulting lifelong damage for the child involved. These studies have also demonstrated a dose-response relationship – the more stressors that the child endures, the greater risk of later troubles.

These stressful experiences are unfortunately very common. 67% had one ACE, 40% had two, and 12.6% had four or more of these childhood toxic experiences. Those adults who had four or more ACEs, had more than double the risks of COPD or hepatitis as adults, and four times the risk of depression. They also had a 12-fold increased risk of attempted suicide, a 7-fold risk of alcoholism, and double the risk of cancer.

While it is hard to believe that traumatic occurrences in childhood lead to lifelong maladies, these correlations have been replicated in multiple studies across our country and across the world. Just how does it work? How do emotional scars in childhood result in such long-lasting troubles?

First, we need to realize just how vulnerable the child is during the early years. The brain doubles in size, and billions of neurons and trillions of synapses are being formed in the first three years. The toxic effects of stress hormones (adrenalin and cortisol) can damage that emerging brain. The chronic exposure to stress hormones (from constant fear or simply neglect) can lead to chronic changes in the child’s immune responsiveness, and hormonal balance. Stress even results in epi-genetic changes, in which individual genes of our DNA are switched on or off, up-regulated or down-regulated.

The results of these childhood experiences can be devastating to that individual’s life, and increase the likelihood of most of society’s ills, from teen pregnancy, drug addiction, PTSD, to chronic health problems. They have both an individual and a community-wide cost.

So what can be done? Is this hopeless? Do we have to just wait to see if we or our loved ones will have to suffer these awful consequences from something that happened to us years ago? No.

There is hope. The effects can be mitigated and lessened with trauma-informed therapy, in which a specially trained therapist helps us to unravel and disconnect our repeated reliving of the stress, fear, and shame that lingers from our past experiences. A trauma-informed community can lessen the consequences by shedding some light on why an adult with a history of such trauma seems to continually make bad choices. Having family and friends see that addictions may be an attempt to fulfill an unmet childhood need can bring some understanding and healing.

Probably the most important result of these 20 years of research is our understanding of just how critically important it is for every child to be nurtured in a safe, loving, and responsive relationship with at least one caring, stable adult.

William E. Cosgrove, MD is a pediatrician and past-president of the Utah Chapter of the American Academy of Pediatrics, serves on the Salt Lake County Board of Health, the Utah Medicaid Medical Care Advisory Committee, and is a member of the Trauma-Resiliency Collaborative.