Good, Bad, and Ugly Stress in Children (Pedcast)

Welcome and thank you for joining me for another edition of the pediatric blog… a blog dedicated to children and their families.  I’m your host, Dr. Paul Smolen, a general pediatrician practicing in Charlotte, NC, the Queen City as we like to call it. From the crib to the country club as we like to muse in studio 1E… if it involves children, we discuss it here. I read a lot about children and learn new things constantly.  Recently I was doing what I have done for 30 years, reading one of my pediatric journals and I came across some articles that I found extremely interesting and I thought my listeners might as well. The article gives the reader a glimpse into some of the new research about something they call “Toxic Stress”. I think after to listening to the new research child development experts are doing, you might think about infants and toddlers a little differently, I know I now do. So sit back and listen carefully to this and I hope informative  important edition of


Children know stress.   Before your child graduates from high school, you are likely to hear them complain about stress in their day-to-day lives.  Psychologists believe that your child experiences various kinds of stress well before he or she can even say the word. For older children, stress may be from academics demands, conflict with friends, or failure in sports.  Sources of stress are similarly diverse for younger children, whether it is having a toy taken away, being left by a parent or adapting to a new daycare.  Are these stresses all bad or are some of them good for your child?  We are going to analyze that question today and help you recognize different kinds of stress as well as understand how stress can affect your child’s well being.


Although we sometimes wish for “stress-free” life, we know that a healthy dose of stress is necessary to push us to wake up in the morning for work or pay our bills.  Likewise, children need stress to develop the skills to adjust and overcome new and potentially threatening situations throughout their lives.  Doc Smo pearl: Stress is the engine behind your child’s growth, propelling him or her up the next summit of life.  But when stress is severe enough to overwhelm a child’s ability to cope, even support from parents or other caregivers will not help the child adapt.  If severe stress is prolonged, especially when they are under 2 years of age, this kind of stress can lead to various short- and long-term negative health effects.  Current research indicates that a child’s brain can be so altered by severe stress that they seem never to be able to recover.  A permanent scar has been left even before they can even talk or remember the events. Doc Smo pearl:  Stressing a very small child can leave scars as bad as third degree burns.   Remember,  Scars you can’t see are sometimes the worst kind.

Young children’s brains are rapidly changing and appear to be extremely vulnerable to life events that researchers now call “toxic stress.”  In fact, they can measure this with something called an ACE score or Adverse Childhood Experience score.  On average, the higher the score, the worse the outcome for the child. Things that are considered toxic include witnessing violence toward women, divorce or separation of parents, emotional, physical, or sexual abuse, neglect of any sort, household substance abuse, having a household member with mental illness or becoming incarcerated.  Children raised in these types of environments can have very high stress hormones, impaired immune responses, and impaired memories and intelligence.  We are talking serious, real permanent, physical stuff all from “toxic stress.”


But Doc Smo, you started by telling us that stress is essential to growth in a child.  Is stress good or bad?  Which is it?

That’s a great question and the answer is “it depends”!


Researchers have identified three types of stress and “it depends” on the type.  Remember them by the title of this pedcast…the Good, the Bad, and the Ugly.


Positive stress (the good): These are adverse experiences that are short-lived and cause minor physiological changes (e.g., increased heart rate). Getting a flu shot, meeting new people, or preparing for an important test are all important part of your child’s development process. With your care and support, your child will easily climb these hilltops.

Tolerable stress (the bad): more intense adverse experiences but relatively short-lived. Examples include the death of a loved one, witnessing a frightening accident, or a house fire. With sufficient support of a caring adult, tolerable stress becomes positive stress in many cases.

Toxic stress (the ugly): intense adverse experiences that may be sustained over weeks, months, or even years. Child maltreatment, witnessing violence against your mother, or living with severely affected mentally ill adults are all examples of “ toxic stress”.


So here is what I want to shout from the rooftops and get people to remember… Toxic stress is extremely damaging to young brains, causing real physical scars that can be permanent and intervention, that is teaching families how to protect their children from this stress can really help…there is something that we can do to help thank goodness!  I find this very empowering and I hope you do too. Now that we know about toxic stress, I think we all need to do everything possible to help children who find themselves in this situation. Our help may make all the difference.


Thanks for joining me today.  I hope I got you thinking while you are getting your advanced pediatric degree.  Make sure you pass this important DocSmo pedcast to anyone who will listen because of it’s importance.  Let’s spread the word. If you want to learn more, explore the Smo Notes at the end of this talk.  This is Dr. Paul Smolen, hoping you won’t find it too strange to advocate for some change.  Until next time.

Smo Notes:


2. collaboratively by John Eun and Paul Smolen MD


Written collaboratively by John Eun and Paul Smolen MD