Can Hospitalization Precipitate Toxic Stress?

Abstract

* Abbreviation: ACE — : adverse childhood experience During morning rounds, I introduced myself to the parent of a patient with bronchiolitis. As trainees, we are taught the medical management of bronchiolitis and how to set families’ expectations for the course of illness. However, we are not taught how to help families cope with the stress of a hospitalization. As we entered the room to discuss her child’s illness, the mother was on edge. Although her son was due to feed, she firmly requested that we let him sleep. Then she glanced at the textbook in her lap, remarking that her child was finally comfortable. Although she had not slept herself, she needed to catch up with her schoolwork. This interaction prompted our team to consider whether this mother’s stress, the challenge she felt juggling her son’s illness with her own responsibilities, was affecting her son’s clinical course. Could the stress of this hospitalization be toxic to her? To this family? The 2012 American Academy of Pediatrics Policy Statement called on pediatricians to screen for and act on factors that could precipitate toxic stress responses.1 The report introduced positive, tolerable, and toxic physiologic responses to stress.1 Events that trigger positive and tolerable stress may elevate the body’s physiologic response system, but buffers such as social supports make the biological response mild and brief, preventing harm. Events that trigger positive stress provide the opportunity “to observe, learn, and practice healthy, adaptive responses.”2 Alternatively, … Address correspondence to Anita N. Shah, DO, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 9016, Cincinnati, OH 45229. E-mail: anita.shah{at}cchmc.org