What every child needs: Addressing toxic stress

Commentary published in Feb. 23, 2016 St. Louis Post-Dispatch

Link to article

By Kenneth Haller, MD, SSM Cardinal Glennon Children’s Hospital and Saint Louis University School of Medicine

“If we pray, we won’t get shot.”

These seven words, spoken by a 9-year-old St. Louis girl named Destiny, convey the impact of toxic stress on the lives of children better than all the reports of policy makers, teachers, doctors, social workers and legislators ever could.

These words and the words of so many other children and parents quoted in Nancy Cambria’s monumental series “The Crisis Within” that appeared with photos by Laurie Skrivan in Sunday’s Post-Dispatch must stand as a challenge to all of us in the St. Louis community to assure that all kids can live in environments and communities that will give them the best chance of growing up healthy — and of growing up, period.

Unfortunately, those living in poverty have often been demonized and blamed for their own problems. Quotes like “Well, if they would just stay in school, get a job, and quit having so many kids, they’d be fine,” are quite common in the comments section of articles like “The Crisis Within.” And it does make sense that many people believe that it as simple as that because, for them, that’s how it worked.

They have probably never attended crumbling schools with impossibly large class sizes, or worked 18-hour days at three part-time, minimum-wage jobs because their education was so poor that that was all they were qualified for, or been in relationships where refusing sex was unthinkable and access to contraception was impossible. Even if someone accepts all that, it is still easy to think that these problems are not my problems if I live far enough away in an affluent or even middle-class community.

However, what those of us in pediatrics have known for years and what Cambria’s article demonstrated so powerfully is that the scientific evidence is overwhelming that children who grow up in communities where they realistically feel under constant threat for their very lives and are living in households stressed by job, housing, and food insecurity are vastly more likely to have lifelong problems with such devastating diseases and syndromes as asthma, allergies, attention problems, cognitive difficulties, obesity, stroke, kidney problems, heart disease, diabetes and even cancer.

This is because being under constant stress affects kids on a genetic level. We are born with more genes than we will ever use, and our environment and our experience tell our body which genes to turn “On” and which to turn “Off.” This is called epigenetics, and when kids live in a loving, supportive home, genes for secure attachment to others are turned on while genes that are designed for high alert are dialed down. However, when a child perceives constant danger, stress genes that may view even normal parts of the body as a threat are turned on, leading to much higher rates of all the diseases listed above, as well as causing disruptions in sleep, a reduced ability to think clearly, and even a diminished ability to give and receive love.

From this very practical standpoint then, regardless of how we view the motivation or even the morality of people living in impoverished communities, creating public policy to effectively reduce toxic stress in children is the only viable option we have if we are to be serious about addressing the long-term health and productivity in the St. Louis region and the state of Missouri in a fiscally responsible manner. A broad public policy focus on job, housing, education and food security, as well as neighborhood safety, promises to save Missourians millions of dollars in reduced health care costs, fewer special education programs, lower court and incarceration costs, all while increasing worker productivity and incomes.

The American Academy of Pediatrics Agenda for Children has focused on child poverty for the past two years. In the United States in 2012, 22 percent of all children under 18 lived in poverty (16 million children), and 45 percent of all children under 18 lived in low‐income households (32.7 million children). This is simply unacceptable in the richest nation on earth. Let’s hope we can all agree that every child deserves to live in a loving, secure home, and that no child should ever have to wonder if she will make it home from school alive.

Dr. Kenneth Haller is president of the Missouri chapter of the American Academy of Pediatrics and an associate professor of pediatrics at Saint Louis University School of Medicine and SSM Cardinal Glennon Children’s Hospital.