Wednesday, October 4, 2017

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

The Lifelong Effects of Early Childhood Adversity and Toxic Stress
Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Wayne Dobbins                                                               Date: 10.04.17

Article Title: The Lifelong Effects of Early Childhood Adversity and Toxic Stress
Author(s): Boyce WT
Journal: Pediatr Dent 2014;36:102-8
Date: March/April 2014
Major Topic: Development
Type of Article: Conference Paper
Main Purpose:
An early childhood spent in an environment characterized by poverty, disadvantage, adversity, and stress, in combination with individual susceptibilities towards such environmental stressors, creates risk for chronic disease that persists through life.
Key Points: 

Twenty percent (20%) of children will suffer half of the medical morbidities of a given population. A low socioeconomic status (SES) is a strong epidemiological predictor of this morbidity. This alone, cannot be attributed to exposures to toxins, malnutrition, substandard access to medical care, and other adversity  because the linear relationships observed between socioeconomic status and health are present above the poverty line, where it would be predicted that many of these challenges would no longer be seen. Furthermore, low childhood socioeconomic status is associated not only with childhood disease, but also with lifelong morbidity as well, even when other factors, including adult socioeconomic status, are controlled.

Research indicates that a subset of the population (~20%) is more highly susceptible to environmental stressors, and these individuals will potentially demonstrate either the least or most healthy outcomes, dependent upon the stressors they face in the environment. This susceptibility may in turn be upregulated by adversity.

Children with a lower self-perceived social rank had more depressive symptoms than their more dominant peers, and social subordination is associated with worse health and delayed development.

The link between low SES and caries has traditionally been explained by poor diets and poor oral hygiene. A 2010 paper has postulated that this relationship can instead be explained by neuro-endocrine changes in the population, caused by chronic stressors in the environment. A study using DNA analysis to compare methylation noted different epigenetic patterns between adolescents who had suffered high versus low levels of stress during childhood, and it is speculated that these patterns may remain in place for life.

The stresses of growing up in a low socioeconomic status, including insufficient resources, greater physical and emotional danger, and social subordination, is thus speculated to ultimately affect the child's neuroendocrine balance (ie cortisol). Chronic imbalance will affect a child’s overall development, resulting in impaired wellbeing and increased susceptibility to chronic disease, feeding into a multigenerational circle of poverty.

Remarks:
Interesting points, particularly the fact that such a small percentage of the population so greatly bears the burden of disease. To what extent can our early intervention, with education, fluoride, and treatment, ease this burden of disease, and to what extent does this affect lifetime morbidity?
Assessment of Article:  Level of Evidence/Comments: II


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