THIS ISSUE: Child Stress
Pediatricians can provide significant support to children and their families by recognizing and responding to excessive stress when it is present in clinical encounters. With the recent natural disasters of Hurricanes Katrina and Rita leading to the displacement of thousands of children and their families, and ongoing armed conflicts affecting military families as examples of extraordinary or excessive stress on the nation as a whole, pediatricians must be attuned to signs and symptoms of childhood stress. This includes the ability to proactively incorporate screening and assessment of stress in children and their families. There is strong evidence that excessive stress can interfere with critical caregiver/child relationships, carve the initial ruts that lead to future paths of unhealthy coping, and adversely affect the developing brain and overall health and well-being of the child. It is valuable to review the evolving literature on the spectrum of childhood stress, particularly where early identification and intervention can prevent adverse outcomes as children mature.
The impetus for this Pediatrie Annals issue addressing child stress began with a series of presentations given at a Department of Defense Military Family Support Summit convened in conjunction with the annual Zero to Three Training Institute in November 2005 in Washington, D.C. We would like to acknowledge Barbara Thompson, Director of the DoD Office of Family Policy, and the entire Zero to Three organization for their instrumental role in bringing together behavior and mental health experts to "sound the alarm" for a critical health and developmental threat to children: Child Stress. This journal serves as an excellent platform to disseminate new information on the important topic of Child Stress for "first responder" pediatricians.
The first article addresses the spectrum of stress in children, written by Joshua Sparrow, MD, a Harvard psychiatrist at the Brazelton Touchpoints Center. Dr. Sparrow introduces the provocative topic of "prenatal stress" further integrating the nature-nuture paradigm. Next, Patti L. Johnson, PhD, and Eric M. Flake, MD, present the effects of maternal depression on the parent-child relationship and the quality of the home environment. Mary Dozier, PhD's, article on the effects of changing caregivers focuses on foster caregivers but clearly can be generalized to caregiver experiences following natural disasters and terrorism. We are fortunate to have the contributions of Alicia F. Lieberman, PhD, President of Zero to Three, who summarized years of domestic violence research on the "Impact of Trauma" in children. Daniel S. Schechter, MD, brings both his personal experiences from the aftermath of 9/11, along with his expertise in parent-child relationships, to help readers understand not only the participants (parents, caregivers, children) who are affected, but the fact that excessive or extraordinary stress also leaves its mark on the process of parenting. The final article, written by Keith M. Lemmon, MD, and Dr. Stafford, two practicing pediatricians, uses the stress in military families to provide pediatricians with an example of practical applications for primary care stress "check-ups." It includes specific ways to recognize and respond to childhood stress, regardless of etiology. The issue concludes with T. Berry Brazelton, MD, possibly the world's best-known pediatrician from many years of advocacy and health care, providing a perspective on Caring for One's Self, as we care for others.
There is a spectrum of stress that affects children, from typical, to tolerable, to toxic. This spectrum is a paramount theme in a current text that all child serving providers need to read, From Neurons to Neighborhoods. The authors help us to appreciate how we all can play a part in understanding and supporting families with typical stress, and if need be, referring families with toxic stress to appropriate resources. Much remains to be done to ameliorate disabling childhood stress, especially in these times. The pediatrician can play a critical role in early stress recognition and response to help ensure complete care of each child's full developmental potential.
A note from the editors:
The opinions and views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States government.
1. Shonkoff J, Phillips D. From Neurons to Neighborhoods. Washington, DC: National Research Council Institute of Medicine, National Academy Press; 2000.