by Cason Benton, MD, FAAP

Toward the end of the last century, groundbreaking work by Vincent Felitti and Robert Anda established that adults with Adverse Childhood Experiences (ACEs) are much more likely to experience lifelong poor physical and mental health outcomes at the population level. Subsequent research found that unmitigated toxic stress damages and changes the genome resulting in poor health.

Children in Alabama are at risk because of a higher level of stress: one in four live in poverty with 16 percent facing food insecurity

Yet, adversity is not destiny. We all know children and adults who show remarkable resilience in facing adversity. Research shows that the most powerful mitigating factors for ACEs is experiencing safe, stable, nurturing relationships (SSNRs) and having positive childhood experiences (PCEs.) In addition to buffering toxic stress responses, SSNRs foster adaptive skills to cope with adversity. Rather than focusing on toxic stress for pediatric well-being, the American Academy of Pediatrics (AAP) now strongly recommends pediatricians focus on relational health.

Instead of "summing up the suffering," we should "build the buffering"

Specifically, AAP policy urges pediatricians to promote resiliency by integrating three levels of relational health into clinical care. 

• For primary prevention, we should universally utilize a strengths-based relational health approach at health supervision visits.
• At the secondary level, we should identify and address barriers to developing SSNRs
• At the tertiary level, we should connect families and children experiencing toxic stress with appropriate treatments to repair strained relationships 

To assist Alabama practices in honing their trauma-informed/early relational health skills, ACHIA and the AL-AAP hosted Michael Arenson, MD, Research Fellow at the UMass Chan Medical School’s Center for Child Equity, as he presented at the AL-AAP Annual Meeting on the pediatrician’s role in preventing and responding to toxic stress.

These discussions served as a soft launch for ACHIA’s Healthy Beginnings 2024: An ACHIA Trauma-Informed Care and Resiliency QI Collaborative. During the collaborative, clinical supervisors will measurably improve strengths-based messaging and add, or enhance, screening and follow-up for perinatal depression, food insecurity, and social-emotional wellness at selected early childhood health supervision visits between December 2023 and August 2024. Pediatricians who participate will engage in in-person meetings with local community organizations, which will foster SSNRs, and referrals resulting from these personal connections are more likely to be successful in leading to “warm handoffs.” Elizabeth Dawson, MD, FAAP, will be the lead content expert and Part 4 MOC points will be awarded to practices for 25 points.

To enroll or learn more about the collaborative, contact Rachel Latham at rlatham@alaap.org. Limited enrollment is available on a first come, first served basis.

This article first appeared in the Third Quarter 2023 Edition of the Alabama Pediatrician Newsletter.