Tag Archives: infant behavior

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

Welcome and thank you for joining me for another edition of the docsmo.com 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 DocSmo.com.


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:

1. http://pediatrics.aappublications.org/content/129/1/e224.full.pdf

2.http://pediatrics.aappublications.org/content/129/1/e232.full.pdfWritten collaboratively by John Eun and Paul Smolen MD

3. http://www.cdc.gov/ncipc/pub-res/pdf/childhood_stress.pdf

Written collaboratively by John Eun and Paul Smolen MD



Happiest Baby on the Block (Book Review Pedcast)

 Help support DocSmo.com by buying this reviewed book using this affiliate link. You get Amazon’s best price and DocSmo.com earns a small affiliate marketing fee.  Thank you.


The Happiest Baby on the Block

by Dr. Harvey Karp

Bantam Books

June 2003


Welcome to another edition of DocSmo.com.  I am your host, Dr. Paul Smolen, a general pediatrician with now 31 years of practicing experience to share with you.  A few months ago I started reading and writing reviews of some of the interesting parenting books available to parents.  My hope is that I will learn a lot and I can share some of these insights with my listeners.  I might also inspire you to read and discuss books related to children.  I am excited to bring you a great book today by Dr. Harvey Karp called:  The Happiest Baby on the block.  I think you need to put this one on your must read list if you have very little babies around your house or contemplate new arrivals in the future. So lets get right into it, shall we?

Anyone who has experienced a colicky baby knows how difficult and frustrating it can be to try and console a very fretful infant less than 3 months of age. What is going on with these babies?  Why do they cry so much? You are doing everything possible and still they often cry inconsolably:  why?  Dr. Karp attempts, and to a large degree, succeeds in answering that question in his book, “The Happiest Baby on the Block”.   In a nutshell, here is what he believes is going on:  Dr. Karp believes that many human infants are born, unable to cope with the barrage of stimuli presented to them. Traditionally, we call these babies “colicy”.  He contends that human babies are born about three months before they have the coping skills they will need.  He speculates that if birth was delayed 3 more months, their brains would become so large that they would not be able to get through the birth canal.  Birth just has to happen because waiting is just not possible. He also contends that a colicy immature babies crying is their response to any irritation, both external and internal.  “Easy” babies have graded crying in proportion to what is bothering them, but “colicy” babies have a  “one size fits all cry”.  For them it’s all or none.

Dr. Karp takes all this information one step further. He believes that even the fussiest baby can be consoled and made content by simulating the conditions in the womb.  He thinks these really fussy babies are the ones that are really homesick for the womb, and that simulating conditions there is the ticket to baby happiness.  Things were pretty good in the womb:  warm, weightless, gentle motion, constant food with background music of the placenta.  Never hungry, never thirsty with no responsibilities.  Sounds pretty good.

Most of the book is spent with describing Dr. Karp’s method for simulating womb conditions, which he contends, will make even the fussy babies change into the “Happiest Babies on the Block.”  In a detailed way, he describes what he calls the 5 S’s of soothing a baby: 1. Swaddling, 2. Side position, 3. Swishy noise (loud), 4. Swinging, and finally 5. Sucking.  He calls the combination of these 5S’s the “Cuddle Cure” for infant crying.

So now for my take on this book.  I can’t hide my enthusiasm… Dr. Karp has written a classic.  This is a great book, which changes the way we look at very small infants. I think this book will be a must read for parents for decades. Dr. Karp has managed to take what is known about infant behavior and bring it to life for parents.  The book is easy to read and understand, extremely informative, and even funny.  You can tell that Dr. Karp is a practicing pediatrician because his advice is practical, practical, practical.    He understands what parents confront with a colicy baby; he sympathizes, and helps parents take charge.  He takes a look at infant crying from a cross cultural and biological viewpoints.  Amazing.

In the edition that I read, some of Dr. Karp’s advice is outdated or just wrong.  He advocates a side position for sleeping infants: a clear no from the AAP in today’s standards.   He advocates for co-sleepers, even giving “safe co-sleeper” hints.  The newest safe sleep guidelines specifically exclude co-sleeping.   He also recommends that swaddling be done with the arms inside the wrap, which some experts disagree with.

Mothers for generations have known about swaddling, soothing noise, swinging etc., but Dr. Karp has put these tools together into a “method”.    He should be applauded for his efforts and I think this book is a valuable tool for parents of young infants.  A classic.  A must read.  I give it 5 DocSmo stars on a 1-5 scale:  my highest rating possible.  Congratulations Dr. Karp.  Well done.

I welcome our comments at my website, www.docsmo.com.  If you enjoy thinking and talking about children, DocSmo.com needs to be in your weekly diet.  Most weeks, I add new content twice weekly.

This is Dr. Paul Smolen, Doc Smo, broadcasting from studio 1E in Charlotte, NC, and thanking Dr. Karp for his shedding so much light with his Happy baby insight.

Until next time.