Spotlight Series: Dr. Eric Ball

Beyond Medicine: Treating ACEs and Toxic Stress in Children to Prevent Adult Chronic Diseases

Orange County pediatrician Dr. Eric Ball talks about the importance of ACE screening to identify patients who may be at risk for chronic disease in adulthood.

As a pediatrician seeing young patients during the COVID-19 emergency, I know that the virus, and the drastic measures being taken to curb its spread, amount to the most traumatic experience they have or will ever have. This is true for my own young children. Disruptions to the daily rhythms of life – of going to school, practicing sports or engaging in other favorite activities, or connecting with friends – can have a profound impact.

Even changes in sleep habits can take a toll. I saw two teens recently who were really anxious because they missed so much school. They were staying up until 2 a.m., sleeping in until Noon, and generally feeling awful.

The virus and mandated physical distancing policies also have exacerbated social and economic inequalities. Kids who don’t live in safe neighborhoods are having a harder time getting outdoor exercise. Those without access to computers are losing precious learning time and the ability to stay connected with peers or trusted adults.

For kids who have had Adverse Childhood Experiences (ACEs) or other trauma – abuse, neglect, or dysfunction – at home, the additional COVID-19-related stressors can have an even more long-lasting effect on their physical and mental health.

What research teaches us is there are biological consequences when a child is exposed to adversity. In the absence of the buffering protections that come with trusted, nurturing caregivers and safe, stable environments, repeated or prolonged activation of a child’s stress response can lead to long-term changes in their developing brain and metabolic, immune, and neuroendocrine responses. We call this the toxic stress response. These changes can contribute to many poor health outcomes, such as asthma, learning or behavior problems, can lead to an increased risk of chronic disease later in life.

I went into pediatric medicine because I wanted to prevent disease by encouraging children to adopt healthy lifestyles and habits early on. When I came to understand the role of ACEs and toxic stress in the development of disease, a lightbulb went off. I thought, ‘Here’s a whole other avenue for helping kids grow up to be healthy adults.’

As pediatricians, we can do more than treat disease with medicine.

We can identify children and adolescents with exposure to ACEs and other trauma and respond with trauma-informed care and evidence-based interventions to toxic stress. These include things patients try to do at home, like regular physical activity, mindfulness and medication, balanced nutrition, supportive relationships, high-quality, and sufficient sleep. In some cases, we can refer patients to mental health providers. These interventions have proved invaluable to me and my patients in recent months.

Recovering from the impacts of COVID-19 will not be easy, and I worry deeply about the physical and mental health risks our children are facing now and over the long-term. Now, more than ever, the ACEs Aware initiative, and the resources it offers for providers, are essential as we navigate our journey toward recovery and resilience for ourselves, our patients, and their families.

Watch the video below to hear more from Dr. Eric Ball.

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