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President’s Perspective – March 2014

Baby Brains and Baby Buffers

By Kathy Ellerbeck, MD, MPH, FAAP

In January of 2012, the AAP published a new Policy Guideline called “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health.”   I know this, because in April 2012 I was asked as a KAAP representative to go to the Kauffman Center and talk about the Policy Statement.  Which I didn’t know a darn thing about.  So many Policy Statements, so little time.  But – being a good student – I “crammed” the night before and (I think) responsibly represented the KAAP.  Since then – I’ve learned a lot about early brain and child development and the effect of stress on the brain.  Some of it is quite frightening, actually.  Much of it makes me proud that I’m a pediatrician, because we may have the power and the knowledge to make children’s brains better.

What is the scary part?  In the 1990s, pediatrician Nadine Burke-Harris was trying to figure out why so many of the children coming to see her were coming in for ADHD.  She was working in a low-income area in San Francisco, and she had planned on improving immunization rates, and asthma care and all the other important stuff we pediatricians work on.  But parents were saying that kids couldn’t pay attention in school.  One day one of her colleagues dropped an article on her desk called “Turning Gold into Lead” by Vincent Felitti.  And she described it as an epiphany.  The article described the Adverse Childhood Experiences (ACE) Study.  And she suddenly understood why the children she cared for were having so many problems.

The ACE study is now sometimes referred to as the “most important public health study you never heard of”.  The original ACE study was published in 1998 – and I’m not sure where it was for the last 15 years.  The study began with Dr. Vincent Felitti in his adult obesity clinic.  Dr. Felitti was Chair of Preventive Medicine at Kaiser Permanente in San Diego, California.  He couldn’t figure out why about half of the people he was following kept dropping out of the program.  They were succeeding in losing weight – so that wasn’t it.  He started asking questions, and rather unexpectedly discovered that many of the individuals who were dropping out had been sexually abused as children.  He presented this at an obesity conference in Atlanta, and while it didn’t really catch the attention of obesity researchers, it did catch the attention of the CDC.

Subsequently, Dr. Fellitti and Dr. Robert Anda from the CDC sent questionnaires to 17,421 adults who were receiving preventative and regular medical care at Kaiser Permanente.  They were mostly white; mostly middle-class, mostly middle-aged, and 74% had some college education.  The questionnaire asked about 10 adverse childhood experiences or ACEs.  The list of ACEs included 3 questions on types of abuse, 2 questions on types of neglect, and 5 questions on types of family dysfunction.  (To see the Adverse Childhood Experience Questionnaire, go to:  http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf.) The first major finding was that almost 2/3 of the study participants reported at least one ACE, and more than one in five reported three or more ACEs.  When Felliti and Anda looked at the relationship between ACE and health outcomes – they were stunned.  As the number of ACE increase, the risk for all kinds of medical and mental health conditions increased in a strong and graded fashion.

This obviously matters to pediatricians.  And the AAP Policy Guideline and accompanying Technical Report talks about adverse childhood events as toxic stress.  There is better understanding on how stress affects the developing brain.  Everybody experiences stress – but toxic stress is that stress that is not buffered by supportive caring adult relationships.  To pediatricians – it is not exactly “new news” that parenting matters.  As pediatricians – we think about, worry about, and counsel parents about parenting all the time.  But I don’t think that I ever really thought about the effect of stress on the developing brain exactly the same way as I think about it now.  For more on Toxic Stress and brain development go to: http://developingchild.harvard.edu/

As you know by now (I hope) – the Kansas Chapter has a Healthy People 2020 grant called the Baby Buffer Social Media Program.  The goal of the grant is to promote “literacy” about the brain science of parenting (www.babybuffer.org).  We would like for pediatricians to sign on to the Baby Buffer program and “prescribe it” to the parents and grandparents of the young children you see in your practice.  The sign-up is easy and over 200 young parents and grandparents are currently receiving age appropriate emails ranging from information on bonding with your infant to how to teach about telling the truth to how parents can help with their child’s Brain Health.

Many parents need more help with parenting.   Pediatrician Harvey Karp (author of the Happiest Baby) came and talked at KU a few months ago.  And he said something that stuck with me – he said that in no other country do parents have to “go it alone” as much as they do in ours.   We hope that the Baby Buffer Social Media Program supports parents and give you some tools to reinforce positive parenting.

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