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Combating Toxic Stress in St. Petersburg

Johns Hopkins All Children’s Hospital leads effort to raise awareness about adverse childhood experiences and their damaging impact.

By Linell Smith

Date: 10/03/2017

Combating Toxic Stress in St. Petersburg
Johns Hopkins All Children’s pediatric resident Anna Meyer holds a toddler near the community education booth staffed by fellow residents.

Toxic stress, a response of the body and brain to adverse childhood experiences (ACEs), affects millions of children and can dramatically impact their future health, their education and their life span.

Pediatric residents at Johns Hopkins All Children’s Hospital (JHACH) in St. Petersburg, Florida, recently helped health care professionals, families and community members learn more about ACEs, toxic stress and resilience through the special program Partnering for Resilience Week, held in collaboration with the American Academy of Pediatrics.

The effort featured presentations by a national expert on toxic stress as well as forums with health professionals, educators and city officials. The All Children’s residents also set up a table at St. Petersburg’s popular Saturday Morning Market to inform parents in the community about the condition, how to recognize it and where to find help.

“Broadening the education of residents to include an understanding of the role of toxic stress is essential to prepare them as future providers, leaders and advocates for children,” says Jonathan Ellen, president, CEO and physician-in-chief at JHACH.

Adverse childhood experiences 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.

Unlike the temporary stress that may be created by taking a test at school, these experiences can produce long-lasting stress as the body’s fight-or-flight response remains activated, flooding the brain and body with stress hormones that can damage organs and change brain processing, behavior and cognitive development. Toxic stress can even alter a cell’s DNA structure, changing how a cell reads and sends messages.

Such chronic 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. The risk for suicide increases 1,200 times over the course of a lifetime for children with four or more ACEs, according to a study in the American Journal of Preventive Medicine.

Although children in communities with the highest levels of violence and discrimination are at higher risk, toxic stress is a problem everywhere. Early intervention to reduce adversity and to help caregivers serve as a buffer can make a big difference, however.

During the Partnering for Resilience Week, a group of residents visited a local elementary school to teach fourth grade students how to identify and express their emotions. The clinicians then made sure that teachers were informed of any serious issues.

“The reason toxic stress perpetuates the stress response is because there is no counterbalancing measure,” says Zach Spoehr-Labutta, a second year resident who helped lead the outreach program. “When the child does not have a stable, caring adult in their life, it is challenging for them to develop good coping skills, and thus there is nothing turning the stress ‘off.’”

Residents at All Children’s will continue to educate members of the community about toxic stress with help from St. Petersburg’s City Council, which has pledged $30,000 toward their efforts, according to Spoehr-Labutta. Additionally, the young physicians are distributing an ACE evaluation form to parents and caregivers who bring children to the general pediatric and adolescent medicine clinic at All Children’s. They hope this pilot program will help identify and address problems early on.

“The goal is for residents to screen for these events just as they might for high blood pressure, anemia, lead exposure and developmental problems,” Spoehr-Labutta says.

Ellen Arky contributed to this article.