When children face continuous traumatic stress disorder

It was like any other day. An early-morning panel of pediatric patients. A mother asking me why her 6-month-old is always crying no matter what she does to calm him. A 3-year-old asthmatic child jumping back slightly as I approach to listen to his lungs. A 12-year-old in for a suture removal after getting hurt in a fight at school, his third this year.

As a pediatrician working at St. Christopher's Hospital for Children in North Philadelphia, I see these scenarios play out daily. Our hospital is smack in Philly's epicenter of childhood poverty, hunger, violence, and unemployment - factors that contribute to individual, family, and community stress. Factors that can make babies more twitchy, toddlers more hyper-vigilant, school-aged children more prone to headaches, and children more overweight and likelier to be asthmatic. These factors can also cause tweens to be more apt to fight and teens to self-medicate and engage in more violent acts. As I read The Inquirer's seven-part series on school violence, "Assault on Learning," that exposed the brutal attacks on both children and teachers and the complexities of balancing school safety and learning, I saw a common thread in this tragedy: stress.

When a soldier comes home after witnessing the horrors of war, or a woman is raped, they may be diagnosed with post-traumatic stress disorder. Many studies in adults have shown the devastating costs of trauma and the difficulty of treating PTSD. What about the consequences of trauma in the developing brains of our children? What if there is no post in their trauma? What if it's continuous traumatic stress disorder.

This term was introduced in 1986 by South African writer Frank Chikane as he chronicled the effects of continuous trauma on children living through apartheid.

Research has confirmed the detrimental effects of pesticides, childhood lead poisoning, and secondhand smoke. More recent work has pointed to substances made internally to ward off actual or perceived danger: hormones involved in the fight-or-flight mechanism for human survival. Substances that, if chronically bathing a child's developing brain, will alter its architecture along with the child's response to environmental stimulus.