Faces of Public Health: James Perrin, MD, American Academy of Pediatrics
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
We’ve done a lot of work with pediatricians in practice so that they’re increasingly aware of the research. And it’s increasingly the case across all medical schools to be addressing social determinants of health in general, and that has become much more of the curriculum in medical schools and all health professional schools. Students may not necessarily learn the term “toxic stress,” per se, but they’re certainly learning about the fact that social and environmental experiences are very important in the development, maintenance and treatment of disease.
NPH: How can pediatricians best address the issue in their practices?
Perrin: I think it’s important to realize that we’re moving in pediatric practice—and I think, frankly, in primary care practice in general—increasingly toward team-based care in communities and away from physicians doing it all by themselves. We’re teaching pediatricians how to ask a couple of leading questions about issues of hunger, housing, things like that, and a couple leading questions about things like health and mental health and how the family is doing in general. But, once we find the answers to some of these questions, it’s often better to have someone else in the practice follow up and really make sure the families are getting access to the kinds of resources they need.
We’re working with pediatricians on the questions to ask. It’s not only “Has he had any fevers recently and how well is he walking.” It’s also asking questions about how his mood has been recently. “How are you doing, mom? What’s going on with you? What’s going on in the family?” It’s asking questions about whether you have enough food on the table or whether your child sometimes goes hungry. It’s asking a series of new questions, but we’re teaching pediatricians how to do that.
NPH: What are we learning about best practices for assessing and dealing with toxic stress?
Perrin: I think we know some answers at this point, but we don’t know all the answers and I want to stress that. But we don’t know all the answers about how best to treat 45-year-olds with arthritis, either. We do know that a number of programs are really important in lowering family stress, so nutrition programs are critically important such as WIC and supplemental school food programs.
We also know that helping parents deal with the stress in their own lives and then to be able to help them deal with the stress in the lives of their children is an effective strategy. It’s not an easy strategy. There’s no pill. Toward that end, there are some imaginative practices and children’s hospitals where they actually have food banks or other fresh food, but more often it’s really about identifying families in need, and knowing enough about community resources that the practices are able to help families get access to those resources and assure that they really maintain that access. I don’t think we actually have a title for that job, and I don’t think it’s a specific job. It varies from practice to practice. In many practices, for example, it’s working with a medical-legal partnership program which can bring in law students and lawyers to help families get access to resources. There’s another program called Health Leads, which matches college students and puts them in practices to help create compendiums of resources and match families.