Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health

Abstract

By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.

Impact of Social and Relational Adversity on Access to Services among US Children with Autism Spectrum Disorder 2016–2019

“…For example, such screening may allow health care providers to identify those parents who would benefit from the provision of additional psychosocial supports [ 26 ] or enrollment in parenting interventions that would expand their set of tools to manage challenging behaviors [ 27 , 28 ]. This finding is also consistent with emerging literature affirming that safe stable nurturing relationships are essential for promoting resilience and adaptive skills across the lifespan [ 5 ].…”

“…Nevertheless, a robust emerging literature also conclusively demonstrates that history is not destiny: formation of safe stable nurturing relationships can buffer youth with ACEs against toxic stress [ 4 ]. Indeed, a recent policy statement from the American Academy of Pediatrics calls on health care providers to buffer all children against toxic stress through timely provision of both preventive and therapeutic services aimed at promoting relational health [ 5 ].…”

Childhood obesity within the lens of racism

“…Grounded in resilience theory, counter‐ACE interventions promote healthy development when children are exposed to risk, adversity, and toxic stress 54 . Research suggests that proactive use of counter‐ACE interventions reduces health risks and improves relational skills instrumental in mitigating the effects of toxic stress 55,56 …”

Gene-Environment Pathways to Cognitive Intelligence and Psychotic-Like Experiences in Children

“…We believe this finding will lead to consideration of policies and programs to promote cognitive development and mental health in children. Wholistic and quantitative approaches considering the comprehensive ecosystem of family, school, and residential environments may ensure maximum effectiveness and efficient use of resources 39, 40, 64, 65 . One exemplary application is from the Health Impact in 5 Years (HI-5) Initiative of the US Centers for Disease Control (https://www.cdc.gov/policy/hst/hi5).…”

“…Nevertheless, previous research on early intervention discovered limited effect sizes 35,36 . One possible explanation for the ineffectiveness is that policies only focused on clinical approaches, neglecting the role of family, school, and neighborhood environment in children's intelligence and mental health [37][38][39][40] . Thus, evaluating the effects of positive parenting behavior and benign school environments and neighborhood socioeconomic conditions should provide practical policy implications.…”