Tackle toxic stress: Ensure safe, stable and nurturing relationships

The American Academy of Pediatrics (AAP) has released a statement amplifying the importance of safe, stable and nurturing relationships as a protective buffer against the biological harms of toxic stress on children.

AAP has described their recently revised policy statement, Preventing Childhood Toxic Stress: Partnering with Families and Communities to Promote Relational Health, as a ‘paradigm shift,’ asserting the necessity to promote relational health and positive childhood experiences to prevent the negative impacts of toxic stress.

Relational health refers to the ability to form and maintain safe, stable and nurturing relationships (SSNRs), as these are described by AAP as “potent antidotes for childhood adversity and toxic stress responses.”

Driving AAP’s approach are advances in developmental sciences that inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span.

Toxic stress derails a child’s healthy development, weakening the architecture of their developing brain, with long-term consequences for learning, behaviour, and physical and mental health.

Author of the AAP statement, Andrew Garner, MD, PhD FAAP, explained that concept of drawing on positive relationships as a shield against the toxic stress caused by adverse experiences has never been more relevant.

“Over the past few years, we’ve experienced a socially-isolating pandemic and reckoned with centuries of structural racism. We must take steps to help kids form close, healthy, and nurturing bonds, whether it is within the family, schools or community,” he said.

The prominence of early childhood educators in the lives of many young children, some with different levels of trauma and stress, means educators have a role to play in helping to reduce toxic stress. By adopting a trauma-responsive approach, support strategies would be child-centred and individualised, with an emphasis on enhancing the child’s social and cognitive development in a stable, caring and enriched learning environment.

Parent-focused assistance also needs to be on offer, this could include; enhancing parent’s personal development; promoting positive parent-child interactions; providing information on nutrition, health, and safety; and providing referrals to appropriate services.

To provide a trauma-responsive environment, however, educators need relevant training and support.

Understanding toxic stress

According to Centre on the Developing Child at Harvard University, learning how to cope with adversity is an important part of healthy child development. When threatened, the body activates a variety of physiological responses, including increases in heart rate, blood pressure, and stress hormones such as cortisol.

When a young child is protected by supportive relationships with adults, they learn to cope with everyday challenges and their stress response system returns to baseline. Scientists call this positive stress.

Tolerable stress occurs when more serious difficulties – such as the loss of a loved one, a natural disaster, or an injury – are buffered by caring adults who help the child adapt, mitigating the potentially damaging effects of abnormal levels of stress hormones.

Toxic stress is the body’s response to lasting and serious stress. It’s triggered when a child experiences strong, frequent, and/or prolonged adversity – such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship – without adequate adult support.

During toxic stress the body and brain are bathed in cortisol for a long period of time, triggering a fight-or-flight response. Normally, this hormone is helpful, allowing individuals to respond quickly in an emergency, but when cortisol levels are chronically elevated it can cause harmful changes in a child’s rapidly developing brain and result in long-term problems in learning, behaviour, and physical and mental health.

An overview of toxic stress includes:

• Body and brain go on high alert
• When the stress is relieved, the response declines and the body returns to normal
• Abuse and neglect allow the stress response to stay activated therefore causing significant damage to neural connections.
• No response from a caring adult prolongs the stress response
• Repeated stress response weakens, overloads developing systems
• It thwarts normal development, areas of the brain for reasoning and coping become weakened.
• Environments need to be nurturing and stable to avoid toxic stress.

Creating a trauma-sensitive approach in ECE

Early childhood centres are designed to provide learning environments that are predictable, provide consistent care, and promote responsive relationships and feelings of physical and emotional safety – all the requisites for trauma-sensitive learning environments.

Strategies that address trauma and its effects need to be embedded within the organisational culture, practices, and policies. Alongside this commitment, strong partnerships need to be built that facilitate access to specialist support for children and their families.

Collaboration between educators and family members or carers is also essential, as it can increase consistency and routines across home and educational settings that can improve a child's sense of safety and security.

It is important for educators to receive relevant training on trauma-informed care, this includes:

• Understanding the impact of trauma
• Recognising its signs in children and families
• Responding by using evidence-based strategies for addressing children’s traumatic stress reactions
• Self-care strategies.

Challenging behaviour is common among young children who have experienced trauma and this can cause negative impacts on educators’ psychological wellbeing and stress levels.

Teaching is emotional labour, and while leadership support is paramount, educators should also build their awareness of vicarious trauma and adopt self-care strategies when working with traumatised children.

To support children using a trauma-sensitive approach here are ten proactive steps educators can take:

1. Commit to learning about trauma and its impact through professional training. Any outbursts/meltdowns are understood as reflexive attempts made by the child to feel safe in what they perceive as a dangerous world.
2. Listen to the child without interrupting and without judgement.
3. A trauma-informed approach asks: ‘What happened to you?’ not ‘What is wrong with you?’
4. Help children identify, express and label their emotions.
5. Transitions are huge stressors for children with trauma history. Transitions signal uncertainty/change, potentially unsafe situations, and potentially the loss of reliable relationships. Create predictable transitions. Build routine around transitions. Scaffold these transitions by engaging in regulating activities (such as reading, singing, freeze dance, breathing buddies or blowing imaginary candles out on our fingertips) can all help to soothe a child’s response.

The following transitions may be particularly difficult for children who have trauma history:

• Beginning or end of the day
• Horizontal transitions e.g. moving from one activity to another
• End of year vertical transitions e.g. moving on from toddler group to preschool, moving from preschool to junior infants etc.

6. Recognise publicly and redirect behaviour privately, and always in a calm voice/tone. ‘Catch’ children doing good: “I really like the way …”
7. Always greet the children with a smile. Yours might be the only smile they see that day. Be kind, joy is given and received through spreading unexpected kindness.
8. Understand that days, dates, and celebratory holidays that signal fun for many children can be difficult for children who have experienced trauma. For example, for some, weekends may mean higher alcohol consumption in the home and more domestic violence.
9. Relationship-based approaches are central to healing. Connections with caring adults who are positive role models are essential and can improve future outcomes. Be the buffer!
10. We want the child to internalise many positive beliefs about themselves. We need to reinforce that they are loved, valued, and respected and especially when they are feeling very strong emotions.

References and further resources:

Australian Childhood Foundation: Relational Exchange

Literature Review: A Trauma Sensitive Approach for 0-8-year-olds

American Journal of Psychology: The Role of Early Care and Education in Addressing Early Childhood Trauma