January 30, 2025 • 36 mins
What is toxic stress? What effects can it have on a child’s body and development, and how can those effects be prevented? What does it mean to build resilience? This episode of The Brain Architects explores what “toxic stress” means, and what we can do about it.
Host Sally Pfitzer is once again joined by Center Director Dr. Jack Shonkoff as they dive into the different types of stress, including what makes certain stress “toxic,” while other stress can be tolerable or even positive for children. They discuss the effects that toxic stress can have on developing brains, as well as what it means to be resilient to sources of stress, and how parents and caregivers can help encourage that resilience in children. Dr. Shonkoff also emphasizes the point that, even for those who may have experienced toxic stress, “it’s never too late to make things better.”
Then, listen to a panel discussion featuring Pediatrician Dr. Kathleen Conroy, Community Mental Health Worker Cerella Craig, Professor and Researcher Dr. Megan Gunnar, and Training Director for Rise Magazine Jeanette Vega, as they discuss the various ways in which they encounter toxic stress and its effects in their work. The panelists speak openly about how toxic stress can affect families and children—including ways in which the systems set up to help can be the cause of further stress—and how to talk about toxic stress in a way that doesn’t make things feel hopeless to those who have experienced it. They also dig into strategies they employ in their various fields to help children and families deal with stress, and move what might be toxic stress back to tolerable levels.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to The Brain Architects, a new podcast from the Center on the Developing Child at
(00:05):
Harvard University.
I'm your host, Sally Fitzer.
Our center believes that advances in science can provide a powerful source of new ideas
that can improve outcomes for children and families.
We want to help you apply the science of early childhood development to your everyday interactions
with children and take what you're hearing from our experts and panels and apply it to
your everyday work.
(00:27):
So in today's episode, we're going to explore this concept called toxic stress, which is
actually a buzzword you may have heard and potentially used incorrectly.
So we're going to discuss what toxic stress is and what it can do to a child's body and
development and we'll learn a little bit more about what we can do to counteract its effects.
Here to discuss this topic of toxic stress with us is Professor of Child Health and Development
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and the Director of the Center on the Developing Child, Dr. Jack Shonkoff.
Hey, Jack.
Hey, Sally.
So glad to have you back with us today.
Great to be here.
Today, we're digging into a topic that has quite a bit of research around it and a lot
of different ideas out there in terms of what it actually is and how it affects children's
brains.
And this is the topic of toxic stress.
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So from your perspective, could you just give us a little bit of background on what is toxic
stress and how did the term come to be?
This is a really important one to talk about.
The story starts with a group of scientists working together to figure out how to make
biological aspects of stress understandable for the public.
When we talk about stress, we're talking about not the thing that causes stress, but the
(01:33):
body's response to stress.
What's going on inside of our bodies biologically?
And in the culture in the United States, there's no sympathy for stress.
To think about the impacts of stress on children as something we should worry about.
It's a roadblock of people saying, you know, let them just suck it up and get over it.
But, you know, you can't ask babies to pull themselves up by their bootstraps, right?
(01:55):
So the stress response can save our lives.
But it's only meant to be up long enough to deal with the threat and then go back.
So the first thing we did was come up with a very simple three category way of thinking
about stress.
The first level we called positive stress.
What's positive stress for a very young child?
It's the stress of the first day in a child care center where people are all strangers.
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It triggers the stress response, but it doesn't last very long.
When they're adults who kind of help you deal with the stress and you deal with the strangeness
of the child care center and the stress system comes back down and you're back to baseline.
The next level we call tolerable stress.
Tolerable stress is there's a serious illness in a family or you've just survived a natural
disaster.
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Again, it's the same stress system getting activated.
The question is how do you get it back down?
And when it's a really serious threat, that's where serve and return interactions and supportive
relationships are critical.
It first creates a sense of safety for the child.
You'll be okay.
I'm here.
I'm taking care of you.
And so is modeling and helping children build their own coping skills to deal with stress,
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which is critical for a healthy life.
The third level is what we call toxic stress.
And by that, it's the same elevation of all of these biological responses.
The system doesn't go back to baseline quickly and it stays elevated for days or weeks or
months.
What causes toxic stress?
It's not so much what causes the stress.
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It's whether there are people there who will help you deal with it and feel more comfortable.
So toxic stress is when there is no reliable adult to help you through.
It's the stress from severe chronic neglect.
It's the stress from being in deep poverty or in a violent environment where you don't
feel like anybody is helping you feel safe.
Toxic stress is about the absence of adult support to get through.
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And we've learned to talk about that always connected to the idea of resilience because
kids can do well in horrible circumstances if there's an adult to help them through.
It's usually a parent, but it doesn't have to be a parent.
It could be another family member.
It could be a neighbor.
It could be a preschool teacher.
It could be a child care provider.
We don't talk about toxic stress anymore without talking about how you build resilience to
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make sure that any potential toxic stress gets converted into tolerable stress.
Could you talk a little bit more about what you mean by resilience?
And is there a way that we know how to actively build that in brains?
Resilience is learning coping skills.
It's learning adaptive skills.
It's being able to feel a sense of control over what's going on.
But when children are very young and they feel less control, the resilience is built
(04:29):
by adults creating a sense of safety and protection and then modeling for children.
There isn't a day that goes by for any child at any age where there aren't challenges.
And what parents are doing in terms of building resilience without calling it resilience is
they're helping the child develop a sense of what scientists call agency.
A sense that you have some control over your own life.
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It's things like what you eat and whether you will only eat candy or will eat some reasonably
healthy foods, whether you learn to share your toys.
The critical issue for children is are the adults who care for them able to provide a
sense of safety?
Sometimes the adults are so traumatized themselves that they can't without help.
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This is why when you're on an airplane and they say if the oxygen mask come down, put
your own mask on first before you assist your child.
That's based on good scientific understanding.
Adults have to be capable of providing that.
If you have at least one secure relationship that gives you a sense of safety and security,
you are on your way to building resilience because it's those relationships that provide
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safety and help model coping behavior that are the active ingredient in building resilience.
As challenging as it can be to talk about and as uncomfortable as it can be to really
think through, could you tell us a little bit about what does actually happen to a brain
of a child who's experiencing toxic stress?
I think it's really important for listeners to understand the biological implications
(06:02):
of what this trauma can really be doing for children.
Yeah, I'm really glad you asked that question because different parts of the body that are
dimensions of the stress response system have different effects in different ways.
So for example, very high levels of stress hormones, particularly one that's called cortisol,
which in the acute situation is very protective.
It helps make you more alert and it helps you deal with stress.
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If that stress hormone stays up for a long period of time, it actually starts to have
a negative wear and tear effect on parts of the brain.
So the parts that are most vulnerable to chronically elevated stress hormones are parts of the brain
that affect your memory, affect your ability to regulate your emotions and behaviors.
There are other parts of the stress system, for example, elevated inflammation.
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If that stays very high, that can affect parts of the brain that make you more at risk for
serious cognitive thinking problems and actually later in your life, increase your risk for
dementia.
At the same time, it's affecting other parts of the body.
Inflammation creates heart disease.
It increases the risk for a lot of chronic illnesses like arthritis.
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It's the wear and tear effect on the body of this stress activation, which actually
accelerates aging.
But remember, every time we talk about this, this is not a doomsday scenario because stress
is normal.
Stress is part of our everyday life.
It's not about whether you're experiencing stress.
It's about whether there are adults to help you learn how to deal with it and help you
feel safe.
(07:28):
Yeah, if a child experiences toxic stress or if a listener is thinking about the toxic
stress they experienced in their childhood, what would you sort of say to them about these
outcomes that you've described?
Anytime I give a lecture anywhere or a presentation, there are always people in the audience who
are sitting there saying, oh my goodness, this is me.
I know that because they come up to you after you've given a presentation and people will
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say I'm really understanding what's been going on in my life in a different way.
For some people, it's very frightening.
For some people, it's a relief to say this isn't my fault.
I'm not a weak character.
Now I understand.
But what's most important is that none of us is perfect.
None of us has a life without challenges.
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But the brain and the rest of the body is always trying to get back on track.
That's the other thing about biology.
If you're weighted down with risk factors and problems in your life and you find supports
and you find ways to build better skills to cope, the brain can't wait to get back on
track.
It is always trying to do that.
We know this is something that we don't have to passively sit by and accept.
(08:34):
We can always do something.
We can always make things better.
Always.
Better to get it right early the first time.
Better to prevent problems than try to figure out how to treat them later.
But it's never too late to make things better.
It's never too late to improve outcomes.
Jack, as we wrap up here, I wanted to think a little bit more with you about how parents
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or caregivers or anyone who's really interacting with these children who might be experiencing
stress can make sure that these stress responses are more tolerable as opposed to more toxic.
That's a really important question because there are so many times when we oversimplify
this story.
I think the key difference between tolerable and toxic stress at any age is not the cause
(09:18):
of the stress but how your body is dealing with the stress.
The younger you are, the more you depend upon adults to kind of provide that protection
although there's no age at which we do it by ourselves.
We're always looking for support.
I think what's really important, particularly for parents to understand and providers of
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early care and education who spend lots of time with kids, is that very often the challenges
facing the children may be more than a parent or a child care provider alone can deal with.
There's no shame in saying, I need help.
I need help to protect my child.
(10:02):
I need help to make sure that my child is protected in the face of these circumstances
we're dealing with.
Or I need help to be able to help my child develop better skills to cope and to be more
resilient.
I think one of the most dangerous things and one of the most harmful things that we do
(10:25):
is to basically send a message to parents and child care providers and others who are
facing serious challenges and tough circumstances to kind of say to them, you know, this is
all on you and if you don't do a good job, you know, X things are going to happen.
I think one of the healthiest and most promising ways for any of us to deal with threat and
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challenge is to be able to say when we need help.
And so it's not just the help that children need from adults can only best be given when
adults who need help themselves to do that are comfortable enough and we make it easy
enough to provide that help for the adults.
The relationship between the young child and the adult is critical.
(11:13):
Adults thrive in their own environment of relationships.
None of us can do everything by ourselves.
And if we understand that importance, then we will minimize if not eliminate toxic stress
in the lives of everybody.
Thank you, Doc, for being here and for talking with us about this really important concept.
I think it's especially important to note that while toxic stress is extremely serious,
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it's also not the end of the road for anyone and that there's lots of things we can do
to mitigate against the effects.
When we come back, we'll chat with a few special guests to discuss the work that they do to
actually prevent toxic stress and support those who've experienced it.
Joining us today to talk about toxic stress is Professor Meagan Gunner.
(11:59):
She's the professor and director of the Institute of Child Development, University of Minnesota.
Hey, Meagan.
Hi, it's wonderful to be on this conversation.
Also on the call, we have Jeanette Vega, who's the training director at RISE Magazine.
Hi, Jeanette.
Hi, thank you so much for inviting me on this podcast today.
Also here is Dr. Kathleen Conroy, associate clinical director, Boston Children's Primary
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Care and assistant professor at the Harvard Medical School.
Hi, Kathleen, glad to have you.
Thanks so much for having me.
And also joining us is Sorella Craig, who's a community mental health worker, New Haven,
Connecticut.
Welcome to the podcast, Sorella.
Hi, happy to be here.
I'm looking forward to speaking with you all today.
Sorella, I'm wondering actually if you could provide some insight for us on if you see
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the effects of toxic stress in the work that you do directly with families.
Yes.
So one of my primary responsibilities as a research assistant and community health worker
is recruiting people who are at high risk for toxic stress into mental health services.
What for me that sometimes looks like is a mom who's very untrusting or who's very skeptical
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and almost as a result of losing trust of systems that have constantly failed her.
We're not talking about the type of neglect that may have come from a parent.
It's a different neglect.
So we're talking about a neglect from systems that have failed to serve these moms.
(13:28):
What I see is really like a lack of trust, a lack of belief that there's the ability
to help.
Jeanette, I'm wondering what you have been seeing from your perspective.
I've been working with parents for the past 15 years that were affected by the child welfare
system, the school system, hospital systems.
They were telling us that they were facing toxic stress themselves.
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I lost my son.
I ended up losing my job.
I had to quit going to school.
I ended up losing family members.
And it just felt like my anger would jump from 100 to 1,000 on a daily basis because
these things were constantly happening to me and they were repeatedly happening for
a long period of time.
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That's what families face when they face child welfare.
And when we've been studying this at RISE, how the child welfare system is giving parents
toxic stress, they're giving parents five different services to do in a week.
And they have to visit their children weekly and do therapy and parenting and anger management
classes.
Kathleen, are you seeing a similar situation?
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I know you work a lot with young parents and I'd be curious to hear if you have seen similar
distrust as Cerella described, but also what the effects of toxic stress have been on some
of the children that you've been working with.
We see a lot of families who have been failed time and time again or challenged time and
time again by trying to access systems that should be set up to help them, systems like
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public benefits, school systems, child care systems, the healthcare system, which often
put a lot of barriers in people's way.
We know there's a ton of implicit bias in these systems.
We know there's a ton of negativity in these systems.
And often people who are particularly low income people are trying to access resources
in these systems, spending a lot of their time doing that.
(15:17):
I think this can become a form of trauma in and of itself for folks.
Indeed, I think we spend a lot of time attempting to build trust and repair in some cases.
I think one of the advantages we have in pediatrics is that we get to have longitudinal relationships
with patients, which is one of the things that's really joyful about it.
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But sometimes we see things develop over time with families where we'll see an infant who
kind of appears to be thriving with a family because they're meeting their gross motor
milestones and they're going along through their first year of life.
And it's only later that we start to see some developmental outcomes that might not be as
ideal and recognize that often these kids were experiencing a lot of stress and that
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we've maybe missed the opportunity to help parents work on that with their child.
That's one of the things that we've started to pay a lot of attention to in pediatrics
is how do we talk to families about the stress their children are experiencing?
How do we acknowledge the children experience stress?
How do we distinguish tolerable from non-tolerable stress?
How do we help parents best work with their kids and promote their development?
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Since we know that parents are working so hard on that, how do we help them in the best
way that we can?
Yeah, Jeanette, I'm wondering if you have any guidance from your work that you do in
communicating directly with parents and thinking about how they talk about this toxic stress
and how they are able to kind of work through it with their children.
At RISE, we've been working and getting knowledgeable about toxic stress.
(16:49):
I ran that statement.
Science tells us that healthy brain architecture depends on genes and environment by my parent
staff this week.
And parents said it just sounds like scientists are saying that if you're a person of color,
referring to the genes, and if you live in low-income communities, referring to the environment,
that your family members are just screwed and you will get toxic stress.
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I think that, Jeanette, you're pointing out such a wonderful and really important point
that if we start talking about certain circumstances as determinative, right, like, oh, if you're
experiencing this or that, then there's this irreparable harm done and it's a simple equation.
And in fact, if we're portraying it that way, we're selling both the idea and people short,
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right, because what we know is that many, many parents are parenting really well despite
facing significant adversity.
They're modeling building relationships.
They're modeling emotional self-regulation under difficult circumstances.
And I think we need to remind parents that when they are showing those amazing skills
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to their children and when they're portraying as much love and consistency as they can under
difficult circumstances, that's actually building their children's life skills, right?
They're actually giving their child something.
I think it's a really good point that if we're talking about things being determinative,
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we are going to lose our audience for this message and we're going to be very incorrect.
Yeah, Meagan, I'm wondering what you have been seeing from your perspective as a scientist
directly working on this research, responding to both of those questions that were posed.
Oh, boy, these are very big challenges and precisely some of the ones that we were worried
about as we worked on the language.
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It is really to try to translate the science so we can change what we know children need
and what we do for kids really on the structural level of societal change.
The original reason to talk about it as we involving both genes and experience was to
get away from the idea that if you weren't doing well, it was because you were born that
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way.
Now we have this massive problem for as a society, we need to remove the barriers or
reduce the barriers for families and children who are growing up in situations or living
in situations that are not supportive of brain health.
It's not that nobody in those environments will experience brain health because families
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are amazing at what they are doing to try to compensate for everything that's coming
down on them.
But as a society, we should start removing some of those barriers.
So it depends on your experiences, but parents are great and even in these difficult circumstances,
most parents are doing well.
The problem is the complexity of this and trying to get the message weighted appropriately
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so that we acknowledge the fact that there are inequities in our society and those inequities
are increasing the risk of harm to our kids and to our future society while not at the
same time going deterministic.
So I think that means that when you're working with individuals, you say, look, we understand
none of this is going away until we make the structural changes that makes our society
(20:14):
more just and equitable for everyone.
But in the meantime, what can we do to help you protect, buffer and support your child?
Right.
Megan, what I've seen, a lot of that comes around teaching people skills that they can
use in real time.
I think in a perfect world, this change would happen a lot quicker than in reality it's
going to happen.
So in the meantime, what we need to do and what I've seen to be effective is to send
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parents home with skills, with tools that can teach them how to do either meditation
practices or breathing exercises or steps to learn problem solving techniques.
Some of these structures at home where they can promote their own well-being and that
of their children, I think that's really the best shot we have at ensuring some of the
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well-being of mothers and children around toxic stress, because it's not going to go
away.
So we really have to teach some concrete skills that can be used in the moment that are easy,
that are cheap, that are accessible.
I think that's one way parents can be encouraged to promote health within their home.
Oh, I agree completely.
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Yes.
And it's just combined with the message that we know this is not your fault is the piece
that sometimes I know you all are giving, but I'm not sure that we are making it really
clear when we talk about toxic stress, that we don't think it's the fault of the families.
What we believe is it's the fault of the way we've constructed society, but what do we
do to help families mitigate those negative influences?
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Yeah, Sorella, I really appreciated your specific examples of resources that parents or caregivers
can use.
I think a lot of people listening to this podcast may have experienced toxic stress
themselves.
I know children that are experiencing toxic stress, and what we want to make sure we do
is leave people with the impression that there's hope, there's opportunity to build resilience.
I'd be curious to hear from others what kinds of skills and resources you've given to parents
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or caregivers or worked with them to develop that might be beneficial for others listening.
What we found helpful at RISE and what parents have said has been helpful, even for myself,
is definitely having at least one person who's very supportive, having that peer to peer
support with someone who understands what you're going through has been amazing in
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just parents overcoming little situations.
I can definitely support what you said around social support being a tool that you've seen
parents use.
You'll hear people say the best part about this intervention was hearing that there were
other women going through the same things that I'm going through.
Outside of just that anecdotal evidence, can any of the scientists speak to some of the
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implications of social support and has that from a toxic stress perspective been shown
to be helpful?
One of the most powerful buffers of stress is supportive relationships.
We call it social buffering.
Works across the mammalian species, whether you're a rat with another rat, a parrot with
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a child or two adults.
Having another person with you who is emotionally supportive is a very powerful stress buffer.
It's the best we got, which is why the kind of history that you might have that makes
it hard to trust others is something to be of concern and where we might want to help
families or parents repair so that they can find people that they can trust.
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The work you're doing and the way that you're going about doing it, it is relationships.
So the key thing across all of human development, child into adulthood.
Can we talk a little bit about how a lack of basic needs serves as a barrier and how
those things need to be addressed first, very specifically if you have a family who's hungry?
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We can't start a conversation about resilience until I can focus enough to hear what you're
saying, if you're my pediatrician.
I've been doing surveys here from parents, what are their basic needs and what is it
that drives their families to stress or crisis mode.
I was shocked to find out that the first thing most parents say is food.
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Lack of enough food to last me the whole month.
They say public assistance doesn't provide enough food stamps to last the whole month.
Like I'm hungry, I'm not thinking straight, I'm not planning for my future.
I'm just thinking about when am I getting that meal for my children and myself for tonight.
I don't think parents can even focus on bigger issues unless we start acknowledging, like
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you said, and being aware that when parents are facing basic need issues, they're not
going to focus on the bigger issues that are causing them any stress in their life.
Another strategy that we've used is breaking down what's going on in your life.
Like I said, I work with parents affected by the child welfare system.
What I tell them is if you're feeling toxic stress, let's break down what's going on
(25:13):
in your life and prioritize what you need to do.
So let's say you don't have food and you're also about to get evicted from your apartment.
Let's concentrate on getting food in that table for today and tomorrow and then next
week let's working on the eviction.
The other thing we have to do is just being careful that we ask parents what it is they
want to focus on.
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Because I think sometimes you guys are talking about this concept of a hierarchy of needs
and I think the hierarchy of needs on some level is deeply biological, right?
None of us function well when we haven't eaten or slept, when we don't feel safe, right?
And so of course it makes sense that we need to meet our most basic needs first.
I think sometimes in places where we're prepared to meet more than one need, we also just want
(25:55):
to make sure that we're not assuming where somebody is coming in and we want to ask them
what the needs are that they want to work on.
That's something I think healthcare needs to do a lot better on is to sort of say, can
I let you guide, which is the part that's most important here and something that I think
many of us are trying to get better at in our practice.
Up next, our panelists are going to answer some of your social media questions.
(26:24):
So now that you've answered a lot of my questions, we're going to have an opportunity to answer
some questions from our social media followers.
This first one I'm going to address to you, Megan.
This comes from Fish Loves Phoenix from Instagram, who asks, what about babies who were born
with medical issues?
My baby had to sleep away from me for two months after he was born premature and I'm
(26:45):
stressing over the lifelong effects.
What can I do to minimize them or is it too late?
He's three now.
Well, it's never too late ever.
Even, you know, it's not even too late for me, you know, and I'm in my sixties.
The issue of premature birth and needing to be in a NICU for a period of time is a significant
issue.
(27:06):
This is not the environment that we evolved to develop in.
And there's been a lot of work in neonatal intensive care units on how to make that environment
more supportive of the infant's development.
And some of that has had to do with, as soon as the baby is stable, being able to support
the development of that infant with the parent.
(27:27):
Now, the part that's important for the baby, it probably doesn't have to be the actual
parent.
It's the touch and the stroking and the holding and so on once the baby's stable.
But for the parent, it's that it's critically important, it is important, to help the parent
feel that they're able to take care of that child and do well by that child and that when
(27:48):
the child comes home, they are going to be able to provide what the child needs.
There is a great deal of plasticity left in development.
And many, many, many babies who were born prematurely go on to do just incredibly well.
Yeah, that's great.
Kathleen, do you want to address the same question from your perspective as a pediatrician?
(28:08):
Well, I just really agree with everything that Megan said.
This notion that she introduced of plasticity just means like things are changing and have
the capacity to change and improve over time.
I think that parents do a tremendous amount of good when their children are in the NICU,
when they are able with a stable baby to hold and do the skin to skin with that baby.
(28:32):
I know parents often really enjoy that and the kids enjoy it too.
Then I also think about for these folks who, you know, you have so many nights after you
take that baby home and you are instilling all the good, caring and attachment during
that time period for folks who've had to have that experience or at an older age with a
medically complex child, providing that wonderful consistency when a child is able to have it
(28:57):
goes a long way.
Great.
We have another question from Fiery Boots 2 who asks, what can I do right now to help
protect my child against the harmful effects of stress?
And I'm wondering, Sorella, if you could give us some ideas that you've seen with your work.
I think the best that we can do to really model some of those healthy practices coming
(29:20):
to mind when we're talking about parents and children, I think breathing exercises.
And I keep going back to that because it's simple, it's easy.
And I think some of the, you know, scientists will attest to the fact that it's almost like
a physiological reset within your body.
We are feeling these really intense feelings.
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It's a quick method that you can use to bring yourself down.
And there are a ton of ways that you can do this with your child as well and get them
into the practice of bringing themselves off that ledge when they're really hyped up in
terms of big feelings.
I think the more that we can just try to model some of those healthy coping mechanisms for
(30:03):
our children that could really go a long way.
As a parent myself, I think nothing is more powerful than just love and compassion for
the children and just understanding what the child is feeling and actually talking to them
about it, depending on their age level, has been very helpful for some families also.
I agree with everything that was just said.
(30:24):
One of our challenges though, I believe, is making sure that we're protecting them from
the potential impact of toxic stress versus protecting them from stress.
Stress is actually an important part of growing up and experiencing and learning to handle
it and not having people take care of it for you completely is critical to being able to
(30:45):
develop resilience.
And we talk about that as positive stress.
But positive stress doesn't look like you're happy.
It often looks like you're very unhappy, frustrated, angry.
As parents and teachers and so on, we sometimes are great desire to take that pain away.
Whereas it's normative pain.
So we've been talking about toxic stress to really identify the serious stress issues
(31:10):
that many children face.
I'll just say, I think whenever we're thinking about whether we need to shield our kids from
stress, I think we should be asking, is there a life skill my child is trying to build here
that I want to give them the opportunity to build, whether that's learning to go to sleep
on their own or learning to walk into school by themselves, things that we really want
(31:33):
the child to be able to do and thrive in versus protecting the child from something that's
in fact traumatic.
And I think when we contested a bit with that question, we may be able to sort out the difference
between tolerable stress and life skills promotion versus toxic stress.
That was a really great conversation.
I just really want to thank all of you for your time being here and for giving us your
(31:54):
expertise on these topics.
And up next, Dr. Shonkoff is back to discuss a common misconception people have about toxic
stress.
And we're back with Dr. Jack Shonkoff.
We're talking about toxic stress.
And Jack, this is a particularly favorite part of the podcast for me.
(32:16):
We're thinking about myths and I think there are many of them when it comes to toxic stress.
So for you, what is the most important myth that you would like to dispel related to this
issue?
I would say the biggest misconception of toxic stress is when people talk about it to describe
the cause of the stress rather than understand it's the biology of the stress response.
(32:38):
It refers to what's going on inside your body when your stress system is activated.
Toxic stress is not referring to what's toxic about the cause of the stress activation.
It's how does the body deal with serious threats.
Toxic stress is how your body is responding and nobody is helping you feel safe.
(32:59):
Think about some of these school shootings.
Everyone has experienced the same trauma, but there's tremendous variability in how
people respond to it.
That's the way we need to kind of think about toxic stress.
It's not the trauma, it's the response.
And the response is wide.
And most people do not experience toxic stress because most people have somebody to turn
(33:22):
to.
It's not in any way minimizing the horror of the event, but that's not what toxic stress
is about.
And toxic stress is when you're all by yourself for more than a day or two or more than a
couple of days.
It's when you're all by yourself for weeks and months.
When you're talking, thinking about the situation at the border, which is so heartbreaking,
(33:44):
thinking about that sometimes children are being separated from their caregiver for such
a long stretch of time.
You just imagine that system being activated.
But here's where misunderstanding can work on either side.
So let's stick with the border separation, or we could take survivors of a school shooting
because it's the same.
From a toxic stress point of view, it's the same.
(34:04):
So if someone wants to pull out from that some child who has done remarkably well and
survived and puts up as an example of, see that kid over there?
Look at what that child went through.
And that child is really okay.
So the rest of you should also be that strong.
That's just so wrong, not to mention unfair.
(34:26):
But scientifically it's wrong because yeah, there are people who get through.
In the same way that if a child is completely incapacitated and devastated with lifelong
serious mental health and physical problems, it would be equally wrong to say, see that
child?
That's what we have done to every child who's been separated from parents.
That's what we've done to every child who's been a survivor of a school shooting.
(34:48):
It's just not true.
So if there's one thing that the science is just kind of screaming at us, it's about human
variation.
It's about you can't overgeneralize.
But the concept of toxic stress is real.
It's real.
It's physical.
It's biological.
The threat of toxic stress and what it could lead to is real.
(35:11):
No scientists disagree with that.
Really appreciate you being here, Jack, and for sharing that important information.
Up next, we're going to talk a little bit more about how to apply this information and
have conversations about toxic stress with people in your lives.
So if this conversation left you wanting to discuss toxic stress further, we thought that
it might be helpful to leave you with some meaningful ways to talk about it.
(35:33):
If you bring up the subject, make sure to always talk about toxic stress alongside the
idea of resilience.
The two always go hand in hand because recovery from the effects of toxic stress is possible,
though it is hard work.
You can say something like, toxic stress can be harmful to healthy development, but there
are always ways to heal from it as well.
No one who's experienced toxic stress is damaged beyond repair.
(35:57):
The Brain Architects is a product of the Center on the Developing Child at Harvard University,
and you can find us at developingchild.harvard.edu, where we'll post any resources that were discussed
in this episode.
We're also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram
at Developing Child Harvard.
Brandi Thomas, Charlie Gibney, and Kristin Holmstrand are our producers.
(36:19):
Bridget Sear is our audio editor, and our music is Brain Power by Mila from freemusicarchive.org.
The podcast is recorded at PRX Podcast Garage in Alston, Massachusetts.
Welcome to The Brain Architects, a new podcast from the Center on the Developing Child at
(00:05):
Harvard University.
I'm your host, Sally Fitzer.
Our center believes that advances in science can provide a powerful source of new ideas
that can improve outcomes for children and families.
We want to help you apply the science of early childhood development to your everyday interactions
with children and take what you're hearing from our experts and panels and apply it to
your everyday work.
(00:27):
So in today's episode, we're going to explore this concept called toxic stress, which is
actually a buzzword you may have heard and potentially used incorrectly.
So we're going to discuss what toxic stress is and what it can do to a child's body and
development and we'll learn a little bit more about what we can do to counteract its effects.
Here to discuss this topic of toxic stress with us is Professor of Child Health and Development
(00:49):
and the Director of the Center on the Developing Child, Dr. Jack Shonkoff.
Hey, Jack.
Hey, Sally.
So glad to have you back with us today.
Great to be here.
Today, we're digging into a topic that has quite a bit of research around it and a lot
of different ideas out there in terms of what it actually is and how it affects children's
brains.
And this is the topic of toxic stress.
(01:09):
So from your perspective, could you just give us a little bit of background on what is toxic
stress and how did the term come to be?
This is a really important one to talk about.
The story starts with a group of scientists working together to figure out how to make
biological aspects of stress understandable for the public.
When we talk about stress, we're talking about not the thing that causes stress, but the
(01:33):
body's response to stress.
What's going on inside of our bodies biologically?
And in the culture in the United States, there's no sympathy for stress.
To think about the impacts of stress on children as something we should worry about.
It's a roadblock of people saying, you know, let them just suck it up and get over it.
But, you know, you can't ask babies to pull themselves up by their bootstraps, right?
(01:55):
So the stress response can save our lives.
But it's only meant to be up long enough to deal with the threat and then go back.
So the first thing we did was come up with a very simple three category way of thinking
about stress.
The first level we called positive stress.
What's positive stress for a very young child?
It's the stress of the first day in a child care center where people are all strangers.
(02:17):
It triggers the stress response, but it doesn't last very long.
When they're adults who kind of help you deal with the stress and you deal with the strangeness
of the child care center and the stress system comes back down and you're back to baseline.
The next level we call tolerable stress.
Tolerable stress is there's a serious illness in a family or you've just survived a natural
disaster.
(02:38):
Again, it's the same stress system getting activated.
The question is how do you get it back down?
And when it's a really serious threat, that's where serve and return interactions and supportive
relationships are critical.
It first creates a sense of safety for the child.
You'll be okay.
I'm here.
I'm taking care of you.
And so is modeling and helping children build their own coping skills to deal with stress,
(03:00):
which is critical for a healthy life.
The third level is what we call toxic stress.
And by that, it's the same elevation of all of these biological responses.
The system doesn't go back to baseline quickly and it stays elevated for days or weeks or
months.
What causes toxic stress?
It's not so much what causes the stress.
(03:22):
It's whether there are people there who will help you deal with it and feel more comfortable.
So toxic stress is when there is no reliable adult to help you through.
It's the stress from severe chronic neglect.
It's the stress from being in deep poverty or in a violent environment where you don't
feel like anybody is helping you feel safe.
Toxic stress is about the absence of adult support to get through.
(03:45):
And we've learned to talk about that always connected to the idea of resilience because
kids can do well in horrible circumstances if there's an adult to help them through.
It's usually a parent, but it doesn't have to be a parent.
It could be another family member.
It could be a neighbor.
It could be a preschool teacher.
It could be a child care provider.
We don't talk about toxic stress anymore without talking about how you build resilience to
(04:08):
make sure that any potential toxic stress gets converted into tolerable stress.
Could you talk a little bit more about what you mean by resilience?
And is there a way that we know how to actively build that in brains?
Resilience is learning coping skills.
It's learning adaptive skills.
It's being able to feel a sense of control over what's going on.
But when children are very young and they feel less control, the resilience is built
(04:29):
by adults creating a sense of safety and protection and then modeling for children.
There isn't a day that goes by for any child at any age where there aren't challenges.
And what parents are doing in terms of building resilience without calling it resilience is
they're helping the child develop a sense of what scientists call agency.
A sense that you have some control over your own life.
(04:52):
It's things like what you eat and whether you will only eat candy or will eat some reasonably
healthy foods, whether you learn to share your toys.
The critical issue for children is are the adults who care for them able to provide a
sense of safety?
Sometimes the adults are so traumatized themselves that they can't without help.
(05:15):
This is why when you're on an airplane and they say if the oxygen mask come down, put
your own mask on first before you assist your child.
That's based on good scientific understanding.
Adults have to be capable of providing that.
If you have at least one secure relationship that gives you a sense of safety and security,
you are on your way to building resilience because it's those relationships that provide
(05:39):
safety and help model coping behavior that are the active ingredient in building resilience.
As challenging as it can be to talk about and as uncomfortable as it can be to really
think through, could you tell us a little bit about what does actually happen to a brain
of a child who's experiencing toxic stress?
I think it's really important for listeners to understand the biological implications
(06:02):
of what this trauma can really be doing for children.
Yeah, I'm really glad you asked that question because different parts of the body that are
dimensions of the stress response system have different effects in different ways.
So for example, very high levels of stress hormones, particularly one that's called cortisol,
which in the acute situation is very protective.
It helps make you more alert and it helps you deal with stress.
(06:24):
If that stress hormone stays up for a long period of time, it actually starts to have
a negative wear and tear effect on parts of the brain.
So the parts that are most vulnerable to chronically elevated stress hormones are parts of the brain
that affect your memory, affect your ability to regulate your emotions and behaviors.
There are other parts of the stress system, for example, elevated inflammation.
(06:47):
If that stays very high, that can affect parts of the brain that make you more at risk for
serious cognitive thinking problems and actually later in your life, increase your risk for
dementia.
At the same time, it's affecting other parts of the body.
Inflammation creates heart disease.
It increases the risk for a lot of chronic illnesses like arthritis.
(07:07):
It's the wear and tear effect on the body of this stress activation, which actually
accelerates aging.
But remember, every time we talk about this, this is not a doomsday scenario because stress
is normal.
Stress is part of our everyday life.
It's not about whether you're experiencing stress.
It's about whether there are adults to help you learn how to deal with it and help you
feel safe.
(07:28):
Yeah, if a child experiences toxic stress or if a listener is thinking about the toxic
stress they experienced in their childhood, what would you sort of say to them about these
outcomes that you've described?
Anytime I give a lecture anywhere or a presentation, there are always people in the audience who
are sitting there saying, oh my goodness, this is me.
I know that because they come up to you after you've given a presentation and people will
(07:52):
say I'm really understanding what's been going on in my life in a different way.
For some people, it's very frightening.
For some people, it's a relief to say this isn't my fault.
I'm not a weak character.
Now I understand.
But what's most important is that none of us is perfect.
None of us has a life without challenges.
(08:13):
But the brain and the rest of the body is always trying to get back on track.
That's the other thing about biology.
If you're weighted down with risk factors and problems in your life and you find supports
and you find ways to build better skills to cope, the brain can't wait to get back on
track.
It is always trying to do that.
We know this is something that we don't have to passively sit by and accept.
(08:34):
We can always do something.
We can always make things better.
Always.
Better to get it right early the first time.
Better to prevent problems than try to figure out how to treat them later.
But it's never too late to make things better.
It's never too late to improve outcomes.
Jack, as we wrap up here, I wanted to think a little bit more with you about how parents
(08:54):
or caregivers or anyone who's really interacting with these children who might be experiencing
stress can make sure that these stress responses are more tolerable as opposed to more toxic.
That's a really important question because there are so many times when we oversimplify
this story.
I think the key difference between tolerable and toxic stress at any age is not the cause
(09:18):
of the stress but how your body is dealing with the stress.
The younger you are, the more you depend upon adults to kind of provide that protection
although there's no age at which we do it by ourselves.
We're always looking for support.
I think what's really important, particularly for parents to understand and providers of
(09:42):
early care and education who spend lots of time with kids, is that very often the challenges
facing the children may be more than a parent or a child care provider alone can deal with.
There's no shame in saying, I need help.
I need help to protect my child.
(10:02):
I need help to make sure that my child is protected in the face of these circumstances
we're dealing with.
Or I need help to be able to help my child develop better skills to cope and to be more
resilient.
I think one of the most dangerous things and one of the most harmful things that we do
(10:25):
is to basically send a message to parents and child care providers and others who are
facing serious challenges and tough circumstances to kind of say to them, you know, this is
all on you and if you don't do a good job, you know, X things are going to happen.
I think one of the healthiest and most promising ways for any of us to deal with threat and
(10:48):
challenge is to be able to say when we need help.
And so it's not just the help that children need from adults can only best be given when
adults who need help themselves to do that are comfortable enough and we make it easy
enough to provide that help for the adults.
The relationship between the young child and the adult is critical.
(11:13):
Adults thrive in their own environment of relationships.
None of us can do everything by ourselves.
And if we understand that importance, then we will minimize if not eliminate toxic stress
in the lives of everybody.
Thank you, Doc, for being here and for talking with us about this really important concept.
I think it's especially important to note that while toxic stress is extremely serious,
(11:35):
it's also not the end of the road for anyone and that there's lots of things we can do
to mitigate against the effects.
When we come back, we'll chat with a few special guests to discuss the work that they do to
actually prevent toxic stress and support those who've experienced it.
Joining us today to talk about toxic stress is Professor Meagan Gunner.
(11:59):
She's the professor and director of the Institute of Child Development, University of Minnesota.
Hey, Meagan.
Hi, it's wonderful to be on this conversation.
Also on the call, we have Jeanette Vega, who's the training director at RISE Magazine.
Hi, Jeanette.
Hi, thank you so much for inviting me on this podcast today.
Also here is Dr. Kathleen Conroy, associate clinical director, Boston Children's Primary
(12:21):
Care and assistant professor at the Harvard Medical School.
Hi, Kathleen, glad to have you.
Thanks so much for having me.
And also joining us is Sorella Craig, who's a community mental health worker, New Haven,
Connecticut.
Welcome to the podcast, Sorella.
Hi, happy to be here.
I'm looking forward to speaking with you all today.
Sorella, I'm wondering actually if you could provide some insight for us on if you see
(12:42):
the effects of toxic stress in the work that you do directly with families.
Yes.
So one of my primary responsibilities as a research assistant and community health worker
is recruiting people who are at high risk for toxic stress into mental health services.
What for me that sometimes looks like is a mom who's very untrusting or who's very skeptical
(13:07):
and almost as a result of losing trust of systems that have constantly failed her.
We're not talking about the type of neglect that may have come from a parent.
It's a different neglect.
So we're talking about a neglect from systems that have failed to serve these moms.
(13:28):
What I see is really like a lack of trust, a lack of belief that there's the ability
to help.
Jeanette, I'm wondering what you have been seeing from your perspective.
I've been working with parents for the past 15 years that were affected by the child welfare
system, the school system, hospital systems.
They were telling us that they were facing toxic stress themselves.
(13:49):
I lost my son.
I ended up losing my job.
I had to quit going to school.
I ended up losing family members.
And it just felt like my anger would jump from 100 to 1,000 on a daily basis because
these things were constantly happening to me and they were repeatedly happening for
a long period of time.
(14:09):
That's what families face when they face child welfare.
And when we've been studying this at RISE, how the child welfare system is giving parents
toxic stress, they're giving parents five different services to do in a week.
And they have to visit their children weekly and do therapy and parenting and anger management
classes.
Kathleen, are you seeing a similar situation?
(14:31):
I know you work a lot with young parents and I'd be curious to hear if you have seen similar
distrust as Cerella described, but also what the effects of toxic stress have been on some
of the children that you've been working with.
We see a lot of families who have been failed time and time again or challenged time and
time again by trying to access systems that should be set up to help them, systems like
(14:55):
public benefits, school systems, child care systems, the healthcare system, which often
put a lot of barriers in people's way.
We know there's a ton of implicit bias in these systems.
We know there's a ton of negativity in these systems.
And often people who are particularly low income people are trying to access resources
in these systems, spending a lot of their time doing that.
(15:17):
I think this can become a form of trauma in and of itself for folks.
Indeed, I think we spend a lot of time attempting to build trust and repair in some cases.
I think one of the advantages we have in pediatrics is that we get to have longitudinal relationships
with patients, which is one of the things that's really joyful about it.
(15:40):
But sometimes we see things develop over time with families where we'll see an infant who
kind of appears to be thriving with a family because they're meeting their gross motor
milestones and they're going along through their first year of life.
And it's only later that we start to see some developmental outcomes that might not be as
ideal and recognize that often these kids were experiencing a lot of stress and that
(16:05):
we've maybe missed the opportunity to help parents work on that with their child.
That's one of the things that we've started to pay a lot of attention to in pediatrics
is how do we talk to families about the stress their children are experiencing?
How do we acknowledge the children experience stress?
How do we distinguish tolerable from non-tolerable stress?
How do we help parents best work with their kids and promote their development?
(16:27):
Since we know that parents are working so hard on that, how do we help them in the best
way that we can?
Yeah, Jeanette, I'm wondering if you have any guidance from your work that you do in
communicating directly with parents and thinking about how they talk about this toxic stress
and how they are able to kind of work through it with their children.
At RISE, we've been working and getting knowledgeable about toxic stress.
(16:49):
I ran that statement.
Science tells us that healthy brain architecture depends on genes and environment by my parent
staff this week.
And parents said it just sounds like scientists are saying that if you're a person of color,
referring to the genes, and if you live in low-income communities, referring to the environment,
that your family members are just screwed and you will get toxic stress.
(17:10):
I think that, Jeanette, you're pointing out such a wonderful and really important point
that if we start talking about certain circumstances as determinative, right, like, oh, if you're
experiencing this or that, then there's this irreparable harm done and it's a simple equation.
And in fact, if we're portraying it that way, we're selling both the idea and people short,
(17:36):
right, because what we know is that many, many parents are parenting really well despite
facing significant adversity.
They're modeling building relationships.
They're modeling emotional self-regulation under difficult circumstances.
And I think we need to remind parents that when they are showing those amazing skills
(17:59):
to their children and when they're portraying as much love and consistency as they can under
difficult circumstances, that's actually building their children's life skills, right?
They're actually giving their child something.
I think it's a really good point that if we're talking about things being determinative,
(18:19):
we are going to lose our audience for this message and we're going to be very incorrect.
Yeah, Meagan, I'm wondering what you have been seeing from your perspective as a scientist
directly working on this research, responding to both of those questions that were posed.
Oh, boy, these are very big challenges and precisely some of the ones that we were worried
about as we worked on the language.
(18:40):
It is really to try to translate the science so we can change what we know children need
and what we do for kids really on the structural level of societal change.
The original reason to talk about it as we involving both genes and experience was to
get away from the idea that if you weren't doing well, it was because you were born that
(19:04):
way.
Now we have this massive problem for as a society, we need to remove the barriers or
reduce the barriers for families and children who are growing up in situations or living
in situations that are not supportive of brain health.
It's not that nobody in those environments will experience brain health because families
(19:28):
are amazing at what they are doing to try to compensate for everything that's coming
down on them.
But as a society, we should start removing some of those barriers.
So it depends on your experiences, but parents are great and even in these difficult circumstances,
most parents are doing well.
The problem is the complexity of this and trying to get the message weighted appropriately
(19:51):
so that we acknowledge the fact that there are inequities in our society and those inequities
are increasing the risk of harm to our kids and to our future society while not at the
same time going deterministic.
So I think that means that when you're working with individuals, you say, look, we understand
none of this is going away until we make the structural changes that makes our society
(20:14):
more just and equitable for everyone.
But in the meantime, what can we do to help you protect, buffer and support your child?
Right.
Megan, what I've seen, a lot of that comes around teaching people skills that they can
use in real time.
I think in a perfect world, this change would happen a lot quicker than in reality it's
going to happen.
So in the meantime, what we need to do and what I've seen to be effective is to send
(20:38):
parents home with skills, with tools that can teach them how to do either meditation
practices or breathing exercises or steps to learn problem solving techniques.
Some of these structures at home where they can promote their own well-being and that
of their children, I think that's really the best shot we have at ensuring some of the
(21:01):
well-being of mothers and children around toxic stress, because it's not going to go
away.
So we really have to teach some concrete skills that can be used in the moment that are easy,
that are cheap, that are accessible.
I think that's one way parents can be encouraged to promote health within their home.
Oh, I agree completely.
(21:22):
Yes.
And it's just combined with the message that we know this is not your fault is the piece
that sometimes I know you all are giving, but I'm not sure that we are making it really
clear when we talk about toxic stress, that we don't think it's the fault of the families.
What we believe is it's the fault of the way we've constructed society, but what do we
do to help families mitigate those negative influences?
(21:46):
Yeah, Sorella, I really appreciated your specific examples of resources that parents or caregivers
can use.
I think a lot of people listening to this podcast may have experienced toxic stress
themselves.
I know children that are experiencing toxic stress, and what we want to make sure we do
is leave people with the impression that there's hope, there's opportunity to build resilience.
I'd be curious to hear from others what kinds of skills and resources you've given to parents
(22:10):
or caregivers or worked with them to develop that might be beneficial for others listening.
What we found helpful at RISE and what parents have said has been helpful, even for myself,
is definitely having at least one person who's very supportive, having that peer to peer
support with someone who understands what you're going through has been amazing in
(22:32):
just parents overcoming little situations.
I can definitely support what you said around social support being a tool that you've seen
parents use.
You'll hear people say the best part about this intervention was hearing that there were
other women going through the same things that I'm going through.
Outside of just that anecdotal evidence, can any of the scientists speak to some of the
(22:55):
implications of social support and has that from a toxic stress perspective been shown
to be helpful?
One of the most powerful buffers of stress is supportive relationships.
We call it social buffering.
Works across the mammalian species, whether you're a rat with another rat, a parrot with
(23:17):
a child or two adults.
Having another person with you who is emotionally supportive is a very powerful stress buffer.
It's the best we got, which is why the kind of history that you might have that makes
it hard to trust others is something to be of concern and where we might want to help
families or parents repair so that they can find people that they can trust.
(23:42):
The work you're doing and the way that you're going about doing it, it is relationships.
So the key thing across all of human development, child into adulthood.
Can we talk a little bit about how a lack of basic needs serves as a barrier and how
those things need to be addressed first, very specifically if you have a family who's hungry?
(24:05):
We can't start a conversation about resilience until I can focus enough to hear what you're
saying, if you're my pediatrician.
I've been doing surveys here from parents, what are their basic needs and what is it
that drives their families to stress or crisis mode.
I was shocked to find out that the first thing most parents say is food.
(24:28):
Lack of enough food to last me the whole month.
They say public assistance doesn't provide enough food stamps to last the whole month.
Like I'm hungry, I'm not thinking straight, I'm not planning for my future.
I'm just thinking about when am I getting that meal for my children and myself for tonight.
I don't think parents can even focus on bigger issues unless we start acknowledging, like
(24:50):
you said, and being aware that when parents are facing basic need issues, they're not
going to focus on the bigger issues that are causing them any stress in their life.
Another strategy that we've used is breaking down what's going on in your life.
Like I said, I work with parents affected by the child welfare system.
What I tell them is if you're feeling toxic stress, let's break down what's going on
(25:13):
in your life and prioritize what you need to do.
So let's say you don't have food and you're also about to get evicted from your apartment.
Let's concentrate on getting food in that table for today and tomorrow and then next
week let's working on the eviction.
The other thing we have to do is just being careful that we ask parents what it is they
want to focus on.
(25:34):
Because I think sometimes you guys are talking about this concept of a hierarchy of needs
and I think the hierarchy of needs on some level is deeply biological, right?
None of us function well when we haven't eaten or slept, when we don't feel safe, right?
And so of course it makes sense that we need to meet our most basic needs first.
I think sometimes in places where we're prepared to meet more than one need, we also just want
(25:55):
to make sure that we're not assuming where somebody is coming in and we want to ask them
what the needs are that they want to work on.
That's something I think healthcare needs to do a lot better on is to sort of say, can
I let you guide, which is the part that's most important here and something that I think
many of us are trying to get better at in our practice.
Up next, our panelists are going to answer some of your social media questions.
(26:24):
So now that you've answered a lot of my questions, we're going to have an opportunity to answer
some questions from our social media followers.
This first one I'm going to address to you, Megan.
This comes from Fish Loves Phoenix from Instagram, who asks, what about babies who were born
with medical issues?
My baby had to sleep away from me for two months after he was born premature and I'm
(26:45):
stressing over the lifelong effects.
What can I do to minimize them or is it too late?
He's three now.
Well, it's never too late ever.
Even, you know, it's not even too late for me, you know, and I'm in my sixties.
The issue of premature birth and needing to be in a NICU for a period of time is a significant
issue.
(27:06):
This is not the environment that we evolved to develop in.
And there's been a lot of work in neonatal intensive care units on how to make that environment
more supportive of the infant's development.
And some of that has had to do with, as soon as the baby is stable, being able to support
the development of that infant with the parent.
(27:27):
Now, the part that's important for the baby, it probably doesn't have to be the actual
parent.
It's the touch and the stroking and the holding and so on once the baby's stable.
But for the parent, it's that it's critically important, it is important, to help the parent
feel that they're able to take care of that child and do well by that child and that when
(27:48):
the child comes home, they are going to be able to provide what the child needs.
There is a great deal of plasticity left in development.
And many, many, many babies who were born prematurely go on to do just incredibly well.
Yeah, that's great.
Kathleen, do you want to address the same question from your perspective as a pediatrician?
(28:08):
Well, I just really agree with everything that Megan said.
This notion that she introduced of plasticity just means like things are changing and have
the capacity to change and improve over time.
I think that parents do a tremendous amount of good when their children are in the NICU,
when they are able with a stable baby to hold and do the skin to skin with that baby.
(28:32):
I know parents often really enjoy that and the kids enjoy it too.
Then I also think about for these folks who, you know, you have so many nights after you
take that baby home and you are instilling all the good, caring and attachment during
that time period for folks who've had to have that experience or at an older age with a
medically complex child, providing that wonderful consistency when a child is able to have it
(28:57):
goes a long way.
Great.
We have another question from Fiery Boots 2 who asks, what can I do right now to help
protect my child against the harmful effects of stress?
And I'm wondering, Sorella, if you could give us some ideas that you've seen with your work.
I think the best that we can do to really model some of those healthy practices coming
(29:20):
to mind when we're talking about parents and children, I think breathing exercises.
And I keep going back to that because it's simple, it's easy.
And I think some of the, you know, scientists will attest to the fact that it's almost like
a physiological reset within your body.
We are feeling these really intense feelings.
(29:41):
It's a quick method that you can use to bring yourself down.
And there are a ton of ways that you can do this with your child as well and get them
into the practice of bringing themselves off that ledge when they're really hyped up in
terms of big feelings.
I think the more that we can just try to model some of those healthy coping mechanisms for
(30:03):
our children that could really go a long way.
As a parent myself, I think nothing is more powerful than just love and compassion for
the children and just understanding what the child is feeling and actually talking to them
about it, depending on their age level, has been very helpful for some families also.
I agree with everything that was just said.
(30:24):
One of our challenges though, I believe, is making sure that we're protecting them from
the potential impact of toxic stress versus protecting them from stress.
Stress is actually an important part of growing up and experiencing and learning to handle
it and not having people take care of it for you completely is critical to being able to
(30:45):
develop resilience.
And we talk about that as positive stress.
But positive stress doesn't look like you're happy.
It often looks like you're very unhappy, frustrated, angry.
As parents and teachers and so on, we sometimes are great desire to take that pain away.
Whereas it's normative pain.
So we've been talking about toxic stress to really identify the serious stress issues
(31:10):
that many children face.
I'll just say, I think whenever we're thinking about whether we need to shield our kids from
stress, I think we should be asking, is there a life skill my child is trying to build here
that I want to give them the opportunity to build, whether that's learning to go to sleep
on their own or learning to walk into school by themselves, things that we really want
(31:33):
the child to be able to do and thrive in versus protecting the child from something that's
in fact traumatic.
And I think when we contested a bit with that question, we may be able to sort out the difference
between tolerable stress and life skills promotion versus toxic stress.
That was a really great conversation.
I just really want to thank all of you for your time being here and for giving us your
(31:54):
expertise on these topics.
And up next, Dr. Shonkoff is back to discuss a common misconception people have about toxic
stress.
And we're back with Dr. Jack Shonkoff.
We're talking about toxic stress.
And Jack, this is a particularly favorite part of the podcast for me.
(32:16):
We're thinking about myths and I think there are many of them when it comes to toxic stress.
So for you, what is the most important myth that you would like to dispel related to this
issue?
I would say the biggest misconception of toxic stress is when people talk about it to describe
the cause of the stress rather than understand it's the biology of the stress response.
(32:38):
It refers to what's going on inside your body when your stress system is activated.
Toxic stress is not referring to what's toxic about the cause of the stress activation.
It's how does the body deal with serious threats.
Toxic stress is how your body is responding and nobody is helping you feel safe.
(32:59):
Think about some of these school shootings.
Everyone has experienced the same trauma, but there's tremendous variability in how
people respond to it.
That's the way we need to kind of think about toxic stress.
It's not the trauma, it's the response.
And the response is wide.
And most people do not experience toxic stress because most people have somebody to turn
(33:22):
to.
It's not in any way minimizing the horror of the event, but that's not what toxic stress
is about.
And toxic stress is when you're all by yourself for more than a day or two or more than a
couple of days.
It's when you're all by yourself for weeks and months.
When you're talking, thinking about the situation at the border, which is so heartbreaking,
(33:44):
thinking about that sometimes children are being separated from their caregiver for such
a long stretch of time.
You just imagine that system being activated.
But here's where misunderstanding can work on either side.
So let's stick with the border separation, or we could take survivors of a school shooting
because it's the same.
From a toxic stress point of view, it's the same.
(34:04):
So if someone wants to pull out from that some child who has done remarkably well and
survived and puts up as an example of, see that kid over there?
Look at what that child went through.
And that child is really okay.
So the rest of you should also be that strong.
That's just so wrong, not to mention unfair.
(34:26):
But scientifically it's wrong because yeah, there are people who get through.
In the same way that if a child is completely incapacitated and devastated with lifelong
serious mental health and physical problems, it would be equally wrong to say, see that
child?
That's what we have done to every child who's been separated from parents.
That's what we've done to every child who's been a survivor of a school shooting.
(34:48):
It's just not true.
So if there's one thing that the science is just kind of screaming at us, it's about human
variation.
It's about you can't overgeneralize.
But the concept of toxic stress is real.
It's real.
It's physical.
It's biological.
The threat of toxic stress and what it could lead to is real.
(35:11):
No scientists disagree with that.
Really appreciate you being here, Jack, and for sharing that important information.
Up next, we're going to talk a little bit more about how to apply this information and
have conversations about toxic stress with people in your lives.
So if this conversation left you wanting to discuss toxic stress further, we thought that
it might be helpful to leave you with some meaningful ways to talk about it.
(35:33):
If you bring up the subject, make sure to always talk about toxic stress alongside the
idea of resilience.
The two always go hand in hand because recovery from the effects of toxic stress is possible,
though it is hard work.
You can say something like, toxic stress can be harmful to healthy development, but there
are always ways to heal from it as well.
No one who's experienced toxic stress is damaged beyond repair.
(35:57):
The Brain Architects is a product of the Center on the Developing Child at Harvard University,
and you can find us at developingchild.harvard.edu, where we'll post any resources that were discussed
in this episode.
We're also on Twitter at Harvard Center, Facebook at Center Developing Child, and Instagram
at Developing Child Harvard.
Brandi Thomas, Charlie Gibney, and Kristin Holmstrand are our producers.
(36:19):
Bridget Sear is our audio editor, and our music is Brain Power by Mila from freemusicarchive.org.
The podcast is recorded at PRX Podcast Garage in Alston, Massachusetts.
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