Murray John S
Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
J Spec Pediatr Nurs. 2018 Jan;23(1). doi: 10.1111/jspn.12200. Epub 2017 Nov 20.
The purpose of this article was to describe the phenomenon of toxic stress and its impact on the physical and mental health of child refugees. Almost two decades ago, researchers found that recurring adverse childhood events (ACEs; e.g., physical, psychological, and sexual abuse, neglect, and household dysfunction such as substance abuse, mental illness, and criminal behavior) were associated with a significant increase in serious illnesses during adulthood. Illnesses include heart, lung, and liver disease, cancer, and bone fractures. The scientists reported that experiencing four or more ACEs during childhood significantly increases the risk for toxic stress. Toxic stress is defined as the exposure to extreme, frequent, and persistent adverse events without the presence of a supportive caretaker. There is a paucity of literature related to toxic stress and child refugees. However, it has been clearly established that the prolonged brutal and traumatizing war in Syria is having a profound impact on the physical and mental health of child refugees at a distressing rate. Prevention of toxic stress should be a primary goal of all pediatric healthcare professionals working with child refugees. While this seems daunting given the population, and the seemingly insurmountable stressors they experience, some basic interventions should be considered. Providing basic anticipatory guidance to parents and caregivers of child refugees, to encourage positive parenting and strengthening support networks, will be highly effective in developing the requisite buffers that mitigate the effects of stress and avoid toxic stress. Efforts should also be focused on addressing caregiver stress and improving their ability to provide safe, reliable, and nurturing care that will help to mitigate any stress response experienced by a child.
It is critical that greater awareness be placed on the effects of toxic stress on child refugees who are exposed to significant adverse events early in life.
本文旨在描述毒性应激现象及其对儿童难民身心健康的影响。大约二十年前，研究人员发现童年期反复出现的不良事件（如身体、心理和性虐待、忽视以及家庭功能失调，如药物滥用、精神疾病和犯罪行为）与成年后患严重疾病的显著增加有关。这些疾病包括心脏病、肺病、肝病、癌症和骨折。科学家报告称，童年期经历四次或更多不良事件会显著增加毒性应激的风险。毒性应激被定义为暴露于极端、频繁和持续的不良事件且没有支持性照料者在场的情况。关于毒性应激和儿童难民的文献很少。然而，已经明确的是，叙利亚长期残酷且造成创伤的战争正在以令人痛心的速度对儿童难民的身心健康产生深远影响。预防毒性应激应成为所有为儿童难民提供医疗服务的儿科医护人员的首要目标。鉴于这一群体以及他们所经历的看似无法克服的压力源，虽然这似乎令人生畏，但仍应考虑一些基本干预措施。向儿童难民的父母和照料者提供基本的预期指导，鼓励积极育儿并加强支持网络，将非常有效地建立起必要的缓冲机制，减轻压力影响并避免毒性应激。还应努力解决照料者的压力问题，提高他们提供安全、可靠和关爱的照料的能力，这将有助于减轻儿童所经历的任何应激反应。
必须更加关注毒性应激对早年就遭受重大不良事件的儿童难民的影响。
