Toxic stress gobbledygook

February 23, 2013

John DiTraglia MD

Contributing Columnist

There is a story about an ancient King Leopold of somewhere in Italy who did an experiment to try to find out what language people spoke before the tower of Babel. He took a bunch of babies away from their mother’s at birth and wet nursed them and cared for them in silence. Nobody could talk to them. Well, the experiment was a failure in terms of the question about language because all the babies died. But it points out something that pediatricians still believe, even though this is probably not a true story, - that it takes more than just food and shelter to survive childhood.

I can wholeheartedly agree with this point of view, though it is not really scientific. But the American Academy of Pediatrics is taking this to a silly, television health guru, level with a review article in the February issue of Pediatrics (1) that references another policy statement from 2012. (2) They say that toxic stress in early childhood can have irreparable effects on the development and calibration of the neuroendocrine-immune network. And that we need to impact the ecobiodevelopmental framework of children to prevent later problems. They say that pediatricians should spend more time and get paid more for delving into these issues with families and then try to fix them.

By “toxic stress” they mean “the extreme, frequent, or extended activation of the stress response without the buffering presence of a supportive adult. Risk factors for toxic stress in childhood include neglect and abuse, extreme poverty, family violence, substance abuse, and parental mental health problems.” If that’s toxic stress then, hey, nobody wants that. Whether or not this will lead to permanent neuroendocrine-immune network damage, everybody is for trying to prevent or intervene in the ecobiodevelopmental framework of these stresses.

And it might be that stress affects immunity. For example, these authors report studies of immunity in monkeys who are taken away from their mothers (3) and studies in Romanian orphanage inmates who get more fever blisters than Romanian children who have a home,(4) and another study that showed children exposed to poverty, intimate partner violence and community violence are more likely to have asthma.(5) But again, even if that’s true, we already want to try to prevent abandonment and violence. I don’t think this stress business means having a Jewish mother and immunity is often extrapolated to something magical.

Finally, stress is good. Not “toxic stress,” but some stress. For most of the time that humans have existed on earth and in many places still today, they have huddled in very harsh, cold or hot, dark, smoky, vermin infested, hovels, with dirt floors and with all kinds of human on human inhumanity and natural catastrophe, without the benefits of safe water and lots of good food and immunizations. I’m old enough to remember how sick I was when I had the measles. While I hope we never have to go back to those bad old days I have a theory that the reason we are all getting too fat is because we don’t have enough stress in our lives.

1. Johnson SB et al. The science of early life toxic stress for pediatric practice and advocacy. Pediatrics 2013;131:319-27

2. Garner As, Shonkof JP aqnt Committee…Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1) Available

3. Lubach GR et al. Effects of early rearing environment on immune responses of infant rhesus monkeys. Brain Behav Immun 1995;9(1):31-46.

4. Coe CL, Lubach GR. Critical periods of special health relevance for psychoneuroimmunology Brain Behav Immun. 2003;17(1):3-12

5. Chen E et al. The role of the social environment in children and adolescents with asthma Am J Respir Crit Care Med. 2007;176(7):644-49.