Stress In Children Research Articles

Paediatric chronic pain as a catalyst for toxic stress

Toxic stress, defined as intolerable, lasting, severe stress in the absence of protective relationships, has been proposed to be “the most physiological threatening kind of stressful experience” for youth, in contrast with positive (ie, mild elevations in the physiological stress response) or tolerable (ie, serious but temporary stress response elevations mitigated by protective relationships) stress.1 Abundant research has revealed that toxic stress in childhood (≤18 years of age) is a significant predictor of lifelong health-related consequences.

Physical Activity and Stress of Children and Adolescents during the COVID-19 Pandemic in Germany-A Cross-Sectional Study in Rural Areas.

Although infection with SARS-CoV-2 appears to be less dangerous for children and adolescents, research indicates that the measures to contain the COVID-19 pandemic have had and continue to have negative effects on children’s and adolescents’ mental health and physical activity (PA). Due to the different health policies, country-specific studies as well as studies in different phases of the pandemic are important to obtain a differentiated picture of the effects of the pandemic. This study set out to investigate children’s and adolescents’ PA, stress, and well-being as well as the associations between these two variables during a phase of a gradual decline in measure to contain the pandemic in Germany. For this purpose, 1293 children and adolescents in a rural area of a federal state in Germany were investigated. The results indicated that children and adolescents felt sadder and less well during this period than children and adolescents before the pandemic. Results also revealed that they were more physically active than children and adolescents before the pandemic as well as in the second lockdown but less active than in the first lockdown. Both well-being and sadness were positively associated with the PA. The study contributes to a more comprehensive understanding of the situation of children and adolescents during the COVID-19 pandemic.

Evaluation of Salivary Thiol/Disulfide Homeostasis and Oxidative Stress in Children with Severe Early Childhood Caries Using a Novel Method

Abstract Objective This study aimed to assess the role of thiol/disulfide homeostasis and oxidative stress in the saliva of children with severe early childhood caries (S-ECC). Methods Eighty children aged 3 to 6 years were involved in this case-control study. The study consisted of two groups: the study group (S-ECC) and the control group with no caries. Thiol/disulfide homeostasis and antioxidant levels were calculated after obtaining unstimulated saliva samples from all participating children. Results The native/total thiol and total oxidant status (TOS) levels of the study group were higher than those of the control group, though not statistically significant (p > 0.05). The oxidative stress index (OSI) value was significantly higher in the study group compared to the control group (p = 0.024). Conclusion Our results confirmed that the thiol/disulfide homeostasis was reduced, and disulfide formation, which is rereducible to thiol, was insufficient in children with S-ECC to compensate oxidative stress compared with the control group. Also, thiol levels were inadequate to compensate for oxidative stress, and thiol/disulfide homeostasis was not an independent parameter for S-ECC. Besides, the increases in the TOS level and OSI value show that oxidative stress had significant effects on S-ECC's etiopathogenesis.

Are Phthalate Exposure Related to Oxidative Stress in Children and Adolescents with Asthma? A Cumulative Risk Assessment Approach

Childhood asthma has become one of the most common chronic diseases in children and adolescents. However, few case–control studies investigating the relationship between phthalate exposure and asthma in children and adolescents have been conducted, especially in Asia. Therefore, we assessed the potential associations between phthalate exposure and asthma among children and adolescents in Taiwan. Because various demographic and environmental variables may influence the incidence and prognosis of asthma, we performed a case–control study with propensity score matching. Out of 615 Childhood Environment and Allergic Diseases Study participants, we conditionally matched 41 children with clinically diagnosed asthma with 111 controls. We then analyzed 11 phthalate metabolites by using liquid chromatography with tandem mass spectrometry. Compared with the control group, the median urinary phthalate levels for most phthalate metabolites in the case group were slightly increased, including monomethyl phthalate, mono-n-butyl phthalate, monobenzyl phthalate, monoethylhexyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, and mono-(2-carboxymethylhexyl) phthalate. Hence, our results suggest that phthalate exposure may be associated with the development of asthma. In addition, prenatal environmental factors, such as active or passive smoking during pregnancy, may increase the risk of asthma.

Maternal posttraumatic stress predicts Mother-Child Symptom Flare-Ups over Time.

Although concurrent associations between parent and child posttraumatic stress symptoms (PTSS) have been well-documented, few longitudinal studies have examined bidirectional influences by modeling the effects of both parent and child PTSS simultaneously over time. The current study examines patterns of PTSS in children and their mothers beginning in preschool and continuing through elementary school age (ages 4-9 years) in a large, heterogeneous sample (N = 331 mother-child dyads). Mothers reported on their own and their child's posttraumatic stress symptoms. A random intercept cross-lagged panel model (RI-CLPM) was used to examine associations between symptoms across six time points. Results indicated that maternal and child symptoms were associated with each other at concurrent time points and tended to fluctuate in a synchronized manner relative to their overall mean symptom levels. Longitudinal cross-lagged paths were significant from mother to child, but non-significant from child to mother, suggesting that mothers' symptom fluctuation at one time point predicted significant fluctuation in children's symptoms at the subsequent time point. The concurrent co-variation of maternal and child symptoms and the predictive nature of maternal symptom flare-ups have important implications for both maternal and child mental health interventions and underscore the importance of attending to mothers' symptomatology early in treatment.

Adaptive Care for Perioperative Patients With Developmental Disabilities: An Exploration of Interventions and Family Experience

Patients with developmental disabilities commonly experience psychological distress during health care visits. There is limited research describing which individualized interventions are being implemented to promote optimal care in the perioperative area. In this prospective observational study of 60 patients with developmental diagnoses, aged 3-21 years, we recorded adaptive care plan (ACP) interventions and assessed family experience. Patients receiving ACPs had diverse diagnoses, including autism spectrum and 10 other unique syndromes. Most patients received previsit planning (90%), adaptations to standard protocols (60%), child life specialist preparation (67%), procedural support (90%), and were given fast-acting anxiolytics before anesthesia induction (68%). Families reported that ACPs were important for managing a child's stress (94%) and promoting safety (92%). ACPs promote safe, productive health care encounters for patients with various diagnoses, ages, and coping abilities. Families find ACPs important for stress management and promoting safety.

Predictors of children's emotion regulation outcomes during COVID-19: Role of conflict within the family.

ObjectiveThis work aimed to analyze the role of family conflict on children's emotion regulation and stress outcomes during the COVID‐19 pandemic.BackgroundThe COVID‐19 pandemic brought novel stress to families. The stress experienced could impact family relationships—specifically, perceptions of closeness and patterns of conflict. Positive family environment and high‐quality family relationships are associated with adaptive coping and lower levels of stress among children.MethodData were collected online from 110 participants at baseline and again 30 days later. Associations between parent–child relationship, sibling relationships, and child stress and emotion regulation outcomes 30 days later were tested through multiple stepwise regression.ResultsBoth significant regression models suggest that parent–child conflict is the strongest predictor of child stress and negativity over the 30‐day assessment period. Sibling conflict predicted child stress but not negativity.ConclusionFamily conflict during the COVID‐19 pandemic influenced children's emotion regulation outcomes as seen through significant associations between child–parent conflict, sibling conflict, perceived child stress, and children's negativity.ImplicationsFamily scientists and practitioners should consider interventions that help parents teach their children how to cope with their own stresses and emotions after conflict.

Correlation between childhood episodes of stress and long bone-ratios in samples of medieval skeletons - using linear enamel hypoplasia as proxy

Background: Linear enamel hypoplasia (LEH) in the canines is used as an indicator of ill health in early childhood. LEH is assumed to be an indicator of catch-up growth in archeological material. Previous research indicated that certain body proportions were altered due to catch-up growth during childhood.
 Objectives: The aim of this study was to assess whether catch-up growth during childhood affects the long bone ratios of the arms and legs of adults.
 Sample and Methods: Positive or negative scores for LEH in the four canines and anthropometric measurements of humerus, radius, femur, and tibia were obtained for 67 skeletons from two Danish medieval cemeteries in Nordby (Jutland) and Refshale (Lolland). Age and sex was estimated to see if any uneven distribution was present. The data was processed using the St. Nicolas house analysis, t-tests, univariate ANOVA and Kaplan-Meier survival analyses.
 Results: The St. Nicolas house analysis showed no correlation between hypoplasia score and anthropometric measurements. No statistically significant difference was found between the long bone ratios of the arms and legs in adults with and without LEH.
 Conclusion: Contrary to earlier research on body proportions in Medieval Denmark this study showed no significant difference in the long bone ratios of arms and legs associated with LEH. It did, however, find an alteration of femur and tibia length associated with hypoplasia. The findings indicate that males and females react differently to physiological stress in childhood.

Assessing Visual Avoidance of Faces During Real-Life Social Stress in Children with Social Anxiety Disorder: A Mobile Eye-Tracking Study

This study measured visual attention (fixation count, dwell time) during two real-life social stress tasks using mobile eye-tracking glasses in children (9–13 years) diagnosed with social anxiety disorder (SAD; n = 25) and a healthy control group (HC; n = 30). The influence of state anxiety on attention allocation and negative self-evaluation biases regarding gaze behavior were also examined. Compared to the HC group, children with SAD showed visual avoidance (i.e., fewer fixations) of the faces of interaction partners during the second social stress task. While visual avoidance in HC children decreased with declining state anxiety from the first to the second social stress task, no such effect was found in children with SAD. A negative self-evaluation bias regarding gaze behavior in children with SAD was not found. In sum, measuring visual attention during real-life social situations may help enhance our understanding of social attention in childhood SAD.

ALSPAC parents' descriptions of childhood stresses in their parents and grandparents.

Background: There is evidence that childhood stresses or traumas influence individuals' descendants' health and wellbeing through epigenetic mechanisms. However, few longitudinal studies have details of such ancestral data. Methods: Nearly 7,000 parents of the original Avon Longitudinal Study of Parents and Children (ALSPAC) cohort completed questionnaires concerning their parents' and grandparents' childhoods. As part of a questionnaire validation exercise we conducted recorded interviews with 100 of these parents. Here we describe some of the vivid accounts from these interviews of stresses encountered by the parents' ancestors. Results: The interviews provided insights into the childhoods of two previous generations of this cohort, most of whom had lived through one, if not two, World Wars. Many children were brought up, not by their parents but by relatives or acquaintances and/or left home very young to 'go into service' or start work. A few interviewees had wealthy relatives with nannies and governesses and attended expensive boarding schools but by far the most frequent accounts were of poverty, often severe, with related lack of education and illiteracy, alcoholism and violence, alongside devastating effects of the World Wars. Conclusions: Although the interviews focussed on stresses in childhood and therefore the accounts seemed somewhat negative, many interviewees described their relatives as having secure, stable childhoods. Of the many struggling families though, the predominant impression was their remarkable resilience; all went on to have children or grandchildren who are stable enough to participate for three decades, entirely altruistically, in ALSPAC.

Well-Being and Stress of Children in Teaching by Digital Means during the COVID-19 Pandemic: A Case in Santarém, Brazilian Amazonia.

The COVID-19 pandemic has caused and is still causing many infections. An important change brought about by prevention actions was the closing of schools, and the adoption of teaching by digital means in private institutions. In this article, we aim to analyze the subjective well-being and stress of children aged 8 to 12 years in digital education during the COVID-19 pandemic in a city in the Brazilian Amazon. For data collection, we used the Children’s Global Life Satisfaction Scale, the Multidimensional Scale of Life Satisfaction for Children (MSLSC), and the Infantile Stress Scale, all via Google Forms. To analyze the data, we used descriptive statistics, correlation between variables and logistic regression. The Family domain obtained higher scores (4.54 ± 0.45). The Infantile Stress Scale showed that the children were in a normal phase, with some of them in an alert and even resistance phase. There was a strong positive correlation between the Family domain (r = 0.70; p-value < 0.05) and the Self domain (r = 0.70; p-value < 0.001). The higher the value of the predictor variable (Family domain), the lower the chances of a child belonging to the Resistance category. Therefore, the Family domain is an important component of children’s well-being, acting as a protective factor against child stress.

ALSPAC parents’ descriptions of childhood stresses in their parents and grandparents

Background: There is evidence that childhood stresses or traumas influence individuals’ descendants’ health and wellbeing through epigenetic mechanisms. However, few longitudinal studies have details of such ancestral data. Methods: Nearly 7,000 parents of the original Avon Longitudinal Study of Parents and Children (ALSPAC) cohort completed questionnaires concerning their parents’ and grandparents’ childhoods. As part of a questionnaire validation exercise we conducted recorded interviews with 100 of these parents. Here we describe some of the vivid accounts from these interviews of stresses encountered by the parents’ ancestors. Results: The interviews provided insights into the childhoods of two previous generations of this cohort, most of whom had lived through one, if not two, World Wars. Many children were brought up, not by their parents but by relatives or acquaintances and/or left home very young to ‘go into service’ or start work. A few interviewees had wealthy relatives with nannies and governesses and attended expensive boarding schools but by far the most frequent accounts were of poverty, often severe, with related lack of education and illiteracy, alcoholism and violence, alongside devastating effects of the World Wars. Conclusions: Although the interviews focussed on stresses in childhood and therefore the accounts seemed somewhat negative, many interviewees described their relatives as having secure, stable childhoods. Of the many struggling families though, the predominant impression was their remarkable resilience; all went on to have children or grandchildren who are stable enough to participate for three decades, entirely altruistically, in ALSPAC.

Bidirectional relationships between parenting stress and child behavior problems in multi-stressed, single-mother families: A cross-lagged panel model.

Investigations on the bidirectional relationships between parenting stress and child behavior problems are important to inform intervention strategies; however, prior research has provided inconsistent findings. Using a national sample of multi-stressed single-mother families from the Fragile Families and Child Wellbeing study, the present study examined the bidirectional relationships between maternal parenting stress and children's behavioral problems spanning from early childhood through adolescence at the child's ages 3, 5, 9, and 15. Reciprocal transactions were found between parenting stress and behavior problems in early childhood between the ages 3 and 5. From age 5 to age 15, our findings also suggest that children's behavior problems at an earlier time point predict mothers' parenting stress at a later time point. Unexpectedly, the lagged effects of parenting stress on child behavior problems in school ages were not significant in our sampled data. Early childhood interventions should address mitigating both parenting stress and their toddlers' behavior problems. During middle childhood and adolescence, interventions to directly address children's behavior problems are critical both to the well-being of mothers and to assist in the reduction in levels of behavior problems.

Epigenetic mechanisms and stress coping in mood disorders

IntroductionExperimental data from both clinical and preclinical studies have unequivocally shown positive correlations between stress and depression, stress, depression and epigenetic changes.ObjectivesThe aim of this research is to analyze clinical trials on coping mechanisms and their interaction with epigenetic mechanisms in patients with mood disorders. Generally, we studied the interaction between these two mechanisms and its effects on the onset, recurrence and progression of these disorders.Methods109 articles were analyzed, of which 37 were considered relevant. 72 studies were excluded based on titles and abstracts. Regarding the coping mechanisms, 10 longitudinal and cross-sectional studies were selected. Longitudinal studies are defined here by a follow-up period longer than 6 months.ResultsThere is a consistent association in the literature between the degree of methylation of the NR3C1 gene, stress and affectivity disorders. The analyzed studies showed that methylation of the NR3C1 gene is associated with both stress and mood disorders. FKBP5 influences glucocorticoid receptor sensitivity and stress response. SLC6A4 gene methylation has been systematically associated with stress and affectivity disorders. Higher BDNF methylation has also been found in people who report high levels of stress at work. The data collected suggest that SKA2 methylation may serve as a biomarker for certain features of depression, such as suicidal ideation, and is not directly involved in the etiology of mood disorders.ConclusionsThe results suggest that environmental stress and adversity in early childhood may change biological systems through epigenetic mechanisms and have long-term consequences, increasing the risk for unfavorable prognosis of mood disorders.DisclosureNo significant relationships.

Racial Differences in Cumulative Disadvantage Among Women and Its Relation to Health: Development and Preliminary Validation of the Cumulative Stress Inventory of Women's Experiences.

Background:Cumulative disadvantage (CD) is a measure of accumulated social, economic, and person-related stressors due to unequal access to resources and opportunities, which increases a person's biological risk for disease. The purpose of this research was to develop an instrument tailored to women's experiences that had intervention and translational potential. In addition, we explored whether CD contributed to racial health disparities among black and white women.Methods:In-depth life course interviews were used to assess stressful experiences of 15 black and 15 white women. Using information from the interviews, we developed the Cumulative Stress Inventory of Women's Experiences (CSI-WE) as a quantitative instrument to measure stressful life experiences from childhood to adulthood. The CSI-WE was then administered to the original 30 women for validation and feedback.Results:Qualitative and quantitative assessments were highly correlated, which suggested that the CSI-WE reliably captured the experiences of the interviewed women. Black participants reported significantly higher numbers of childhood and adult stressors, more acute adulthood and lifetime stressors, and worse adult physical self-rated health.Conclusions:This study supports the preliminary validity of an instrument that once fully validated may be used in future studies to elucidate the experiences of CD among black and white women and examines how these experiences relate to perceived and objective health status.

A multicentre Canadian survey of caregiver perspectives on COVID vaccine-related pain and stress for their family.

Caregiver hesitancy for their children to receive the COVID-19 vaccine remains due to concerns regarding safety and efficacy, but also due to fear of vaccine administration-related pain and distress. Study objectives were to determine caregivers' perceptions regarding both their personal and child's COVID-19 vaccine administration-related stress and fear and relate this to their likelihood to allow their child to receive COVID-19 vaccinations. This study was a secondary data analysis of a multicentre, cross-sectional survey of caregivers presenting to four Canadian pediatric emergency departments. Caregivers were surveyed between December 2020 and March 2021 and completed a digital survey on their own smartphones. 331 caregivers responded to the survey (mean age 39.9 years [SD 7.71]); 74.2% (245/331) were mothers. Children's mean age was 8.8 years [SD 5.4]; 49.8% (165/331) were female. 64.1% (209/326) of caregivers were willing to vaccinate their child against COVID-19, while 35.9% (117/326) were not. Greater perceived COVID-19 vaccine administration-related pain (0.88 [0.80; 0.95], p = .003) and stress (0.82 [0.76; 0.89], p = <.001) for their child as well as greater perceived personal stress with their own COVID-19 vaccine administration (0.81 [0.75; 0.88], p = <.001) were associated with caregivers being less likely to vaccinate their child. During the time period between COVID-19 pandemic waves 2 and 3, and after the vaccine had been federally approved for adults, one-third of Canadian caregivers surveyed reported being unwilling to vaccinate their child against COVID-19 in the future. Managing children's and caregivers' vaccine administration-related fear and stress may improve vaccine uptake for children.

Parameterizing Toxic Stress in Early Childhood: Maternal Depression, Maltreatment, and HPA-Axis Variation in a Pilot Intervention Study.

Adverse experiences superseding a child's capacity to sustain regulation of emotion and adaptive function are theorized to constitute "toxic stressors"when they induce a deleterious biological response within an individual. We ascertained presumptive parameters of toxic stressamong 164 low-income infants and toddlers (ages 4-48months) from 132 families enrolled in Early Head Start (EHS). We randomized a subset of these families into a pilot intervention arm of parenting education (the Incredible Years, TIY), which supplemented the EHS curriculum. Official report child abuse and neglect (CAN) and child behavior were serially ascertained over the course of the study. We observed relatively low associations among maternal depression, CAN, caregiver-child relationship quality, hair cortisol, and adverse child behavioral outcomes. Moreover, despite poverty and thehigh prevalence (51%) of CAN in this sample, the frequency of clinical-level internalizing and externalizing behavior among the children did not exceed that of the general population, by their parents' report. The pilot supplementation of EHS with TIY improved attendance in group meetings but did not significantly reduce adverse behavioral outcomes or CAN. This study revealed marked independence of standard indices of toxic stress (child maltreatment, maternal depression, caregiver emotional unavailability) which have been presumed to be risk factors for the development of psychopathology. That they were weakly inter-correlated, and only modestly predictive of child behavioral outcomes in this EHS sample, caution against presumptions about the toxicity of individual stressors, highlight the importance of ascertaining risk (and compensatory influences) comprehensively, suggest buffering effects of programs like EHS, and demonstrate the need for greater understanding of what parameterizes resilience in early childhood.

Variations in Biochemical Values under Stress in Children with SARS-CoV-2 Infection.

In the case of SARS-CoV-2 infection, children seem to be less affected than adults, but data regarding epidemiologic characteristics and biochemical values are poor and essentially based on limited case series. The aim of our study is to highlight the predictive value of some biochemical markers at hospitalization, for the correct classification of the patient in the form of disease. Methods: We performed an analytical retrospective study on 82 pediatric patients diagnosed with COVID-19 in the emergency department, with moderate or severe form of disease, and treated in our tertiary hospital. We analyzed the epidemiologic characteristics, symptomatology and biochemical values and compare the data according to the form of disease. Results: The mean age at admission was 4.5 years (median 1 year) and the masculine/feminine ratio was 1.5. Comparing the data between the two groups of patients (42 severe/40 moderate), we observed that the severe form presented with a lower pH at admission (p = 0.02), hyperglycemia (p = 0.01), increased values of transaminases (p = 0.01 and 0.02) and hypoproteinemia (p = 0.01). Also, the severe form was statistically significantly associated with comorbidities, acute respiratory distress, rising of the inflammatory markers during hospitalization. Hyperlactatemia (Lactate > 1.5 mmol/L) was significantly associated with the age under one year (p < 0.001). Mortality rate was 9.75% and the median age at death was 3 months. Univariate logistic regression model shows that the presence of anemia increased the probability of death 88 times, comorbidities 23.3 times and ketoacidosis 16.4 times. Conclusions: Metabolic acidosis, hyperlactatemia, hyperglycemia, modified hepatic values and hypoproteinemia are biochemical markers associated with the severe form of disease in SARS-CoV-2 infection in children. Presence of anemia, comorbidities and ketoacidosis are important risk factors for death of pediatric patients with SARS-CoV-2 infection.

Abstract 169: Assessment Of Adverse Childhood Experiences In The South Bronx On Risk Of Developing Chronic Diseases As Adults

Background: Adverse Childhood Experiences (ACE) are understood to have a negative impact on health outcomes. Events such as abuse, neglect, family dysfunction early in life have shown a strong association with cardiovascular disease (CVD), as well as, premature death in adulthood. Our objective was to identify the prevalence of ACE events within the South Bronx, NY population and the relationship these stressors have with chronic disease affecting CVD health and high-risk behaviors in adults. Methods: Patients were recruited from a hospital-based ambulatory primary care. The survey was conducted between September 2017 and January 2018 with questions on demographics, ACE events, high-risk behavior (smoking, alcohol dependence, substance abuse), mental health, and chronic disease (hypertension, diabetes, hyperlipidemia) with patients of the S. Bronx. The chronic disease was stratified to assess for association with ACE score (1 to 11) and ACE event subcategories. Results: A total of 454 patients participated in the study. The overall age was 53.1±14.2 years and females were 49%. Hispanic were 54% followed by Black at 20%. Subjects had a high prevalence of both chronic disease (82%) and ACE events (69%) within the community. Our findings demonstrated a significant relationship between ACE events with chronic disease and high-risk behavior with higher odds among subjects with exposure to childhood stressors (OR 1.26, 95% CI- 1.1-1.5, p&lt;0.01). Each ACE category - Physical &amp; Sexual abuse, Household substance abuse, Separation from parents, Incarcerated household member, Parental separation/divorce, and Bullying - was associated with one and more chronic CVD diseases (OR-2.03, 21.53, 2.82, 2.94, 2.61, 3.83, &amp; 4.84, respectively) significantly, p&lt;0.01. High-risk behaviors were significant and correlated with an ACE score of more than 4. Conclusion: Among residents of the S. Bronx, having one or more ACE events had a significant association with chronic disease. Socio-economically deprived regions, such as S. Bronx, should entail ACE surveillance to detect exposure to risk factors that stimulate a need for evidence-based interventions that can be assigned to social determinants of health and aid with mental health and early screening for CVD risk factors.

P134. Anterior Pituitary Volumes and Stress in Children and Adolescents With Chromosome 22q11.2 Deletion Syndrome

Children with 22q11.2DS have high rates of anxiety and 30% will develop a psychotic disorder by adulthood. The physiological effects of long-term stress and dysregulation of the hypothalamic-pituitary-adrenal cortical (HPA) and/or sympathetic adrenal medullary (SAM) systems may contribute to the etiopathology of mental illness in this population.