When C. Henry Kempe brought the plight of child abuse to the national forefront in the 1960s, he knew that infants who didn’t bond with mothers as neonates were at risk for abuse1. But despite his scientific background as a renowned virologist, he likely had no idea how childhood adversity could affect the developing brains of children. In this month’s Pediatrics, Shonkoff et al present, in two linked articles, the most state-of-the-art thinking of the biology of adversity, and its important corollary – how pediatricians can help create resilience and improved outcomes in children with environmental challenges. The first article on “Genes, Environment, and Time” (10.1542/peds.2020-1651) lays out the neurobiology of the interaction between adverse childhood and other environmental stressors (like racism, community violence, and poverty) on the genes of children during critical times of development. The amount of accumulated knowledge over the past few decades is astounding and lays out clear biological pathways relaying how toxic stress and adversity have direct and long-lasting impacts on genes and brain development (please, read the article to learn more about these pathways!). But what can we as pediatricians do about it?
Fortunately, in the second article entitled “Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice” Shonkoff et al describe how to utilize our practices to address adversity (10.1542/peds.2019-3845) and many opportunities are offered for consideration. First, we need to reconsider how we look at evidence-based interventions to influence and change child outcomes and consider using a more iterative approach rather than await proof of long-term outcomes from these interventions. Next, we need to transform pediatric practice to implement these more effective interventions that protect children from the long-term effects of adversity. This will include strengthening our parent interventions as well as utilizing and monitoring potential biomarkers as a proxy for toxic stress. Finally, we need to implement more measures that improve the health of populations of children and not just our individual patients in the office by leveraging the use of enhanced screening for social determinants of health and coupling such screening with additional interventions to reduce the disparities that exist in the communities we serve.
To create this new world of infant brain protection we truly need a transformation of all the sectors of child health. From basic science research to individual interventions to health system payment transformation and, in turn, the dismantling of systemic racist systems to improve the health of populations – we must align all of these changes and innovations with the sole purpose of supporting the developing brain of every child. Doing so will maximize our ability to meet the challenge of truly putting every child first and in turn helping them achieve their full potential.
References
- Gray J.D., Cutler C.A., Dean J.G., Kempe C.H. Prediction and Prevention of Child Abuse and Neglect. Journal of Social Issues 1979;35:127-139
