A conversation about toxic stress and its effects on family dynamics with Dr. Marlene Melzer-Lange, MD [webinar]

In preparation for FAST’s first Coffee Break with Toni webinar, we spoke with Dr. Marlene Melzer-Lange, Professor of Pediatrics at the Medical College of Wisconsin, about adverse childhood experiences and toxic stress. Here are a few key takeaways:

Uncontrollable circumstances of the coronavirus pandemic are having significant impacts on families, putting children at risk for adverse childhood experiences. While the last few months have brought some families closer together, for other families, it has only made the stress they are under worse, Dr. Melzer-Lange said. Specifically, social isolation and high rates of unemployment can lead to an increased risk of violence in the home. Dr. Melzer-Lange noted that the homicide rate in Milwaukee has increased significantly during this time – up 96% compared to May of last year, according to CBS 58 Newsroom. Domestic violence and inter-partner relationship issues are of particular concern.

“Whenever unemployment goes up, child abuse and intimate partner violence go up because it’s another stress; it adds stress to the parents,” Dr. Melzer-Lange said. Both of these factors are considered to be Adverse Childhood Experiences (ACEs), which Dr. Melzer-Lange defined as events that have happened in someone’s past, during childhood, that have lifelong effects. According to the Center on the Developing Child, these adverse events include, but are not limited to, “physical and emotional abuse, neglect, caregiver mental illness, and household illness.”

Dr. Melzer-Lange explained that witnessing or enduring ACEs, even as a fetus or an infant, can impact a child’s cognitive development. “Their neurons actually wire differently, and their stress response is different if they’ve sustained adverse childhood events,” she said. The resulting stress response is known as “toxic stress.”

Toxic stress, or the excessive activation of the stress response resulting from ACEs, wears on both the mind and body, leading to long-term negative impacts. Dr. Melzer-Lange said that every child reacts differently to ACEs, with some being more resilient than others. In her own practice as a medical professional, she has seen how children who have witnessed domestic violence or parental separation are impacted in a negative way – ranging from withdrawal behaviors to aggression.

The negative impacts of ACEs and toxic stress can also manifest later in life. Dr. Melzer-Lange referenced a pioneer research study on ACEs (Felitti et. al., 1998), which concluded that adults exposed to more ACEs as children suffered from increased health risks later in life, including alcohol and drug abuse, smoking, depression, and obesity. Overall, the study found a strong relationship between ACEs and multiple risk factors for leading causes of death among adults.

The coronavirus will likely affect almost everyone in some long-term capacity, especially those who are already vulnerable, Dr. Melzer-Lange said. She also clarified that long-term impacts of toxic stress, as they relate to COVID-19, are not the same as post-traumatic stress, which typically results from a one-time, short-lived event. “I don’t know if you can call it post-traumatic stress – we might call it post-virus stress,” Dr. Melzer-Lange said. “But I think if you’ve already been affected by something [like post-traumatic stress], as many children have, as many families have, this just makes it all worse.”

A significant relationship in a child or family’s life is one of the most important protective factors to mitigate these risks and negative impacts, and FAST helps to foster such relationships. According to Dr. Melzer-Lange, many children and families rely on the relationships they have with teachers and the meals that are served by schools. Now that both of these supports have been disrupted by the coronavirus pandemic, finding a way to maintain contact with teachers, grandparents, next door neighbors, or other adults during this time may be the best protection children have against ACEs. “A significant adult is probably the most important resiliency factor for kids when they’re in situations like that, or someone that they can call or someone that they know is there if they really need them,” Dr. Melzer-Lange said.

FAST is in a strong position to provide the missing support to parents to build and maintain healthy family relationships during and after COVID-19, especially as access to in-person school remains limited. In the FAST Program, children and families eat together, work on learning projects, discuss educational and family challenges, and implement solutions. FAST reinforces positive parenting, supports the educational needs of children, and builds strong bonds and connections between families, schools, and communities while working with parents on solutions that meet their unique challenges. Parents who can lessen their toxic stress and increase their social interaction (virtually) during this time are better able to support themselves and their children.

Dr. Melzer-Lange concluded the conversation by offering advice for parents as we continue navigating the coronavirus and ‘post-virus stress’ together: “The most important thing is to give their kids lots of hugs and play with them and read to them as much as possible because I think that stabilizes things.” And FAST’s structured agenda of evidence-based activities, which can be adapted at home, aims to help parents do exactly that.

ABOUT MARLENE MELZER-LANGE, MD Marlene Melzer-Lange is Professor of Pediatrics at the Medical College of Wisconsin and has been an attending physician in the Emergency Department at Children’s Hospital of Wisconsin for the past 39 years and served as the emergency services medical director for nine years. She serves as chair of the American Academy of Pediatrics Subcommittee on Violence Prevention. Dr. Melzer-Lange serves as medical director of Project Ujima, a violence intervention/ prevention program at Children’s Hospital of Wisconsin that provides community aftercare services to youth and their families following violent injuries. Her research interests include youth violence intervention, firearm prevention, and care of adolescents in the emergency setting. She is married, has two children, and four grandchildren.