Toxic Stress Affects Children's Long-Term Health; Support Programs May Help


Children who grow up in stressful settings are at higher risk of developmental problems that may later manifest as chronic disease. Fortunately, support programs may help reduce stress and improve outcomes.

Children who grow up in stressful settings are at higher risk of developmental problems that may later manifest as chronic disease. Fortunately, support programs may help reduce stress and improve outcomes.

According to the American Academy of Pediatrics (AAP), children in distress may need help from health care professionals to reduce the long-term dangers of chronic, unmitigated stress, which is also known as toxic stress.1

According to Robert W. Block, MD, who served as a past president of the AAP, “We are now recognizing in medical science and practice that there are real and significant effects when children grow up with toxic and persistent stress.”1

Chronic stress affects not only learning potential but also gene expression, and stress changes the way children’s brains develop. Stress induced by sexual abuse, neglect, and malnutrition may contribute to these developmental problems, which may manifest later in life as chronic disease or mental illness.1

According to Jack P. Shonkoff, MD, who serves as director of the Harvard Center on the Developing Child, “When bad things happen early in life, the brain and other parts of the body don’t forget.”1

Managing stress and finding outlets for relieving stress, as well as intervening to reduce stressful stimuli, may help reduce health care burdens later in life. In one study, the Nurse Family Partnership study, new parents were educated about child development. A psychosocial intervention improved the children’s cognition, and, later in life, children of families who received the intervention enjoyed higher rates of graduation and economic self-sufficiency than children of families who did not receive the intervention.1,2

Scientists have studied interventions for reducing stress levels among children. In a metaanalysis of 19 eligible articles, investigators Slopen et al measured the effect of several interventions on levels of the stress hormone cortisol in children.3

Psychosocial interventions included parenting classes, drug rehabilitation interventions for parents with substance abuse problems, and day care programs for the children of mothers attending school. Other interventions included home-based training in appropriate child discipline techniques, and stress management courses. According to researchers, these types of interventions led to objectively lower levels of cortisol among children, indicating lower stress levels.3

Improving the health of children may require interventions that reduce stress levels in parents, as well. Pediatricians have an important role in intervening when home stress levels are high, and can help parents develop positive parenting techniques by referring parents to support programs. One such program, Reach Out and Read, encourages positive stress-relieving interactions between children and parents, such as reading books to children.1

By engaging parents in the process of childhood learning, the Reach Out and Read program also encourages children to develop a love of learning.1

According to James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, encouraging a solid educational foundation is an important public health goal. A lack of early childhood education is associated with a 25% higher likelihood of dropping out of school early, a 40% higher likelihood of becoming a teen parent, and a 50% higher likelihood of requiring special education services. Perhaps most importantly, children who do not receive early childhood education are at increased risk of being involved in violent crime later in life.1

According to Marks, “[I]t’s in society’s best interest to focus resources on early development.”

Recognizing the need for help and supporting parents through stress management classes, child care programs, and interventions that promote a positive perception of learning may help improve the lives and the overall health of at-risk children and families.1


1. Kuehn BM. AAP: toxic stress threatens kids’ long-term health [published online July 30, 2014]. JAMA. 2014.

2. O’Brien RA. Translating a research intervention into community practice: the nurse family partnership. J Prim Prev. 2005;26(3):241-257.

3. Slopen N, McLaughlin KA, Shonkoff JP. Interventions to improve cortisol regulation in children: a systematic review. Pediatrics. 2014;133(2):312-326.

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