Pediatrics. 2012 Jan;129(1):e232-46. doi: 10.1542/peds.2011-2663. Epub 2011 Dec 26.
Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
神经科学、分子生物学、基因组学、发展心理学、流行病学、社会学和经济学等领域的研究进展正在推动我们对整个生命周期中健康和疾病的理解发生重要的范式转变。这种多学科的人类发展综合科学对我们增强儿童的生活前景和加强社会的社会和经济结构具有深远的影响。本报告借鉴了这些多方面的研究，提出了一个生态生物发育框架，说明了早期经验和环境影响如何在影响新兴大脑结构和长期健康的遗传倾向中留下持久的印记。该报告还考察了大量有毒压力的破坏性影响的证据，为将早期逆境与后来的学习、行为以及身体和精神健康障碍联系起来的因果机制提供了有趣的见解。该框架对医学实践的意义，一般来说，对儿科学特别有潜在的变革性。它们表明，许多成年疾病应该被视为从生命早期开始的发育障碍，并且与贫困、歧视或虐待相关的持续健康差距可以通过减轻儿童时期的有毒压力来减少。生态生物发育框架还强调了需要对儿科学实践的重点和界限进行新的思考。它呼吁儿科医生既要作为健康儿童发育的第一线守护者，又要作为战略定位的社区领导者，为基于新科学的策略提供信息，为教育成就、经济生产力、负责任的公民身份和终身健康奠定坚实的基础。
