Toxic Stress in Children: Symptoms, Effects

Article By Dr. Shilpa Ramdas

Children are more susceptible to health disorders related to stress, which can subsequently influence their physical and mental well-being in adulthood.  Today’s children face enormous challenges. The immediate and long-lasting impacts of childhood adversity carry significant implications for public health.


Studies suggest that in the first three years of life, the physical and mental hazards can lead to increased risk of adverse physical and psychological health conditions. These can impair children’s daily life activities, school performance, and social relationships.

Definition of Toxic Stress

Toxic stress in children refers to prolonged exposure to severe or chronic stressors such as physical or emotional abuse, neglect, exposure to violence etc.  It involves prolonged and intense activation of the body’s stress response systems without adequate support from caring adults.

It can negatively impact their physical, emotional, and cognitive development.

Sources of Toxic Stress

Abuse and Neglect: Physical, emotional, or sexual abuse, as well as neglect, can expose children to toxic stress.
Stressful / traumatic social experience in childhood
Emotional neglect

Family Dysfunction: Domestic violence, or parental mental health issues can contribute to toxic stress.
Poverty and financial insecurity: Living in poverty can expose children to chronic stressors that affect their well-being.
Trauma – E.g.: Loss of family member, Orphan hood
Chronic health conditions
Social isolation

Signs And Symptoms of Stress in Children

1. Headache / Stomach Ache / muscle pain without any Physical diseases.
2. Changes in eating habits / Appetite
3. Changes in sleeping pattern / Sleep disturbances
4.  Emotional outburst, Irritability, frequent mood  swings,  Separation anxiety
 5. Reluctance to participate in activities they once enjoyed.

 6. Attention deficit / difficulty to concentrate
 7. Poor Academic performance
 8. Social isolation, difficulty to interact with others
 9. Having recurrent memories or dreams about a specific event

Chronic Health conditions in children associated with adverse childhood experiences (ACE)

Dermatitis and eczema
Increased incidence of chronic disease,
Nausea/vomiting, dizziness, constipation
Poor physical growth Developmental delay
Attention deficit/hyperactivity disorder (ADHD)

Effect of toxic stress in children:

Impact on Physical Health:
Physiological Response: The body’s stress response system releases stress hormones like cortisol, which is designed to help individuals cope with threats. However, chronic activation without the buffering effect of supportive relationships can lead to dysregulation of these systems. Toxic stress in childhood is associated with an increased risk of chronic health conditions later in life, including cardiovascular disease, obesity, diabetes, and immune system dysfunction.

Immune System: Chronic stress can suppress the immune system’s functioning, making children more susceptible to infections and illnesses

Emotional and Behavioral Consequences:
Children exposed to toxic stress may exhibit behavioral challenges such as aggression, difficulty in forming healthy relationships, anxiety, or other mental health issues.

Social Consequences:
Children experiencing toxic stress may struggle to develop social skills and maintain positive relationships with others.

Impact on Brain Development: Toxic stress can negatively affect the development of the brain, particularly areas associated with emotional regulation, and memory. This can have long-term consequences for learning, behavior, and overall mental health.

Developmental Changes in Brain while exposing toxic stress

Disruption of Brain Development:
The developing brain, especially in early childhood, is highly sensitive to environmental influences. Prolonged stress can disrupt the formation of neural connections, in areas responsible for learning, memory, and emotional regulation.

Hippocampus: This region of the brain plays a crucial role in memory formation and emotional regulation. Chronic stress can result in a smaller hippocampal volume, affecting memory and increasing vulnerability to stress-related disorders

Amygdala: The amygdala is involved in processing emotions, especially fear responses. Toxic stress can lead to an overactive amygdala, contributing to heightened anxiety and emotional reactivity.

Neuroendocrine System:
Hypothalamic-Pituitary-Adrenal (HPA) Axis: Chronic stress activates the HPA axis, leading to increased production and release of stress hormones such as cortisol. This in turn leads to long-term consequences, including alterations in stress response systems, metabolic imbalances, and increased susceptibility to various health problems.

ACE s Scoring System

How to score adverse childhood experiences
Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood (ages 0-17).
ACEs Questionnaire: It includes a standardized questionnaire that lists various adverse experiences.

Scoring System:
Each type of adverse experience on the questionnaire is assigned a point or score. For example, witnessing domestic violence might be one point, while physical abuse might be another point. After completing the questionnaire, the total score is calculated by summing up the points corresponding to each adverse experience.

Interpreting Scores:
Total score provides an indication of the individual’s cumulative exposure to adverse childhood experiences.  Higher ACE scores are associated with an increased likelihood of experiencing health challenges later in life.

Developmental stages of children
Piaget’s theory put forward by  famous Psychologist Jean Piaget outlines distinct stages of cognitive development from infancy to adolescence. Here’s a simplified overview of Piaget’s stages

Sensorimotor Stage (Birth to 2 years):
Key Characteristics: During this stage, infants learn about the world primarily through their senses and motor activities. Ability to think of only one thought at a time.

Concrete Thinking Stage (2 to 7 years)
Children in this stage become more symbolic in their thinking but still lack logical reasoning. Confusion and blind belief associated with this time can lead to early developmental trauma and other neurological problems. Positive stress during this time is typically associated with challenges that lead to personal growth and development.

Abstract or Conceptual Thinking Stage (7 to 11 years):
Age of Logical thinking, and they try to solve the problems using logical reasoning. Ability to focus on several dimensions of a problem at one time, mentally.

Adolescent Thinking or Formal Operational stage(11 years and older):
This stage begins at 11 years of age and continues life-long. Individuals can think about multiple variables and outcomes, engage in systematic problem-solving, and consider future possibilities. By the end of adolescence, the individual’s intellectual ability is nearly completely developed, although learning and intellectual growth go-on throughout the lifespan of an individual. Environment surrounding them has an extreme effect on their behaviour and character development.

Prevention and Intervention:

Addressing the root causes of toxic stress and providing early intervention and support services can help mitigate its impact. This involves a holistic approach that includes the child and their family.

 Biofeedback therapies – Focusing on reducing heart rate and breathing techniques have also been helped to reduce toxic stress.

Resilience and Protective Factors: While toxic stress can have profound negative effects, the presence of supportive, nurturing relationships with adults can mitigate its impact. Resilience-building factors, such as a stable and loving environment, positive role models, and access to mental health services, can help buffer the effects of toxic stress.

Covid 19 and Toxic stress in Children

The COVID-19 pandemic has had potential impact on children’s mental health, by disruption of routine, losing the social connections, exposure to traumatic events such as hospitalization, illness, loss of family members etc. Such unusual experiences can contribute to toxic stress reactions in children.


Root cause of mental as well as many physical problems lies in childhood. Understanding and addressing toxic stress is crucial for promoting the well-being of children.  Neglecting children and their problems is like neglecting the foundation for the next generation. Early identification and intervention, along with supportive relationships, play a key role in preventing the long-term consequences of toxic stress.

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