Left un­treated, stress can af­fect kids’ health for a life­time. Here’s how to help them cope.

The Myanmar Times - Weekend - - Weekend|Health -

Iwoke up in an am­bu­lance.

The last thing I could re­mem­ber was stand­ing on a ledge in an au­di­to­rium and prac­tic­ing for my school’s choir per­for­mance. I was in ninth grade, it was my first field trip in my new home here in the United States, and I was ner­vous. Then ev­ery­thing went black.

I had fainted. Al­though my front teeth bore the brunt of my fall and saved me from se­ri­ous in­jury, I had bro­ken them all. As the para­medic gen­tly ex­plained to me why there was blood gush­ing from my mouth, he asked, “Did you eat to­day?”

“Yes,” I re­sponded. But I was ly­ing. Shortly af­ter mov­ing to the United States, I de­vel­oped al­most de­bil­i­tat­ing anx­i­ety. I wor­ried about ev­ery­thing, es­pe­cially my fam­ily’s safety. On that field trip, I trav­eled in a bus with the choir and the whole time, I wor­ried about mak­ing it home safely. Con­sumed with my stress, I had for­got­ten to eat.

At the hos­pi­tal, doc­tor af­ter doc­tor asked me about my sur­gi­cal his­tory, any med­i­ca­tions I was tak­ing and if I had ever fainted be­fore. I had an en­tire work-up for faint­ing spells, and my pe­di­a­tri­cian pre­scribed anti-anx­i­ety med­i­ca­tions. While ev­ery­one was try­ing to fig­ure out what was wrong with me, though, no one asked what had hap­pened to me.

My anx­i­ety con­tin­ued to hound me, re­main­ing in the back­ground as I went to col­lege and med­i­cal school. Though it wasn’t as se­vere as the time that I fell, it be­came a part of me, like an extra ap­pendage I just had to deal with. Then I had a child, and shortly af­ter my daugh­ter was born, I felt the anx­i­ety rise to the sur­face again. I woke up sev­eral times a night to make sure she was breath­ing, and fol­lowed her around as she started to walk, con­stantly wor­ry­ing about her safety. Al­though I don’t like to ad­mit it, my anx­i­ety made her anx­ious.

Then an en­counter with a pa­tient in my pe­di­atric clinic changed the way I prac­tice medicine, and my life.

Par­ents of­ten bring chil­dren in for med­i­ca­tion to treat at­ten­tion­d­eficit/hy­per­ac­tiv­ity dis­or­der. The chil­dren of­ten have dif­fi­culty fo­cus­ing at school and at home, and the symp­toms can be dis­tress­ing for par­ents and teach­ers. One young boy I saw looked quite with­drawn, so I put down the eval­u­a­tion forms from his school and in­stead asked him about cur­rent or past stress. He told me that his dad had left their fam­ily six months ago, and shortly af­ter that he started hav­ing trou­ble fo­cus­ing in school. I didn’t know it at the time, but I had used one of the ba­sic prac­tices of trauma-in­formed care, where in­stead of ask­ing “what’s wrong with this child,” we ask “what hap­pened to this child.”

As I watched this young boy heal with ther­apy (and with­out med­i­ca­tion), I took a look at the root of my own anx­i­ety. I came to the United States af­ter leav­ing a coun­try un­der the threat of war. I was sep­a­rated from my par­ents for a pe­riod of time, and I watched them worry about our safety. As we trav­eled un­der a cloud of un­cer­tainty, the young child in me be­gan to see the world as chaotic and some­times un­safe. And shortly af­ter that, my anx­i­ety be­gan. But none of my doc­tors had asked about this.

In 1998, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion and Kaiser Per­ma­nente pub­lished a study in the Amer­i­can Jour­nal of Preven­tive Medicine that sur­veyed more than 17,000 adults about their his­tory of ex­po­sure to child­hood trau­mas, in­clud­ing sex­ual and phys­i­cal abuse, emo­tional and phys­i­cal ne­glect and fam­ily dys­func­tion. They la­beled these as Ad­verse Child­hood Experiences, or ACES, and de­vel­oped a scor­ing sys­tem.

The re­sults showed a clear con­nec­tion be­tween high ACE scores and poor adult health out­comes, mean­ing emo­tional trau­mas in child­hood can trans­late into phys­i­cal health ail­ments in adults. Com­pared to a per­son with an ACE score of 0 (with no ex­po­sure to trauma), some­one who scored four or higher had more than twice the risk of de­vel­op­ing liver and chronic lung dis­ease. A score top­ping seven tripled your life­time risk of hav­ing lung can­cer and heart dis­ease.

Sev­eral sub­se­quent stud­ies showed how dif­fer­ent types of child­hood trau­mas (or toxic stress) can re­wire a child’s brain. Chil­dren who have ex­pe­ri­enced toxic stress live a ma­jor­ity of their lives in the body’s ac­ti­vated ‘fight or flight’ mode. Be­cause of this, their brains are over­loaded with stress hor­mones and they can­not fo­cus on learn­ing, caus­ing them to fall be­hind in school.

As par­ents, it’s im­por­tant to ask your pe­di­a­tri­cian to screen your child for ex­po­sure to traumatic experiences. And it’s per­haps even more im­por­tant to un­der­stand that a high score on this screen­ing does not have to dic­tate their des­tiny. Just as chronic toxic stress can re­wire a child’s brain, the ex­po­sure to in­ter­ven­tions that pro­mote re­silience (in­clud­ing trauma-fo­cused ther­apy, proper nu­tri­tion, yoga and mind­ful­ness) can help the brain to form new con­nec­tions, a phenomenon called neu­ro­plas­tic­ity. With the right tools, chil­dren can thrive de­spite hav­ing ex­pe­ri­enced trauma.

Now in my work as a pe­di­a­tri­cian, a child’s ACE score is as im­por­tant to me as their pulse or res­pi­ra­tory rate. I un­der­stand that in my workup for a child’s ab­dom­i­nal pain, I must also look at social and emo­tional deter­mi­nants of health. I ed­u­cate par­ents about tools to help build re­silience, and the im­por­tance of hav­ing a com­pas­sion­ate and avail­able adult in a child’s life. I coun­sel par­ents about how their own child­hood experiences and trau­mas can af­fect their par­ent­ing, just as I of­fer ad­vice about how to teach their kids den­tal hy­giene skills.

When a child breaks their an­kle or has a phys­i­cal in­jury, we are quick to get them in for treatment. But emo­tional wounds, if left un­treated, can scar quickly as well. And those scars can live with our chil­dren for a life­time.

– The Wash­ing­ton Post

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