Helping children exposed to toxic stress

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Adam Toledo, Trayvon Martin, Tamir Rice, Laquan McDonald. These are names that have become synonymous with the violence and trauma Black Americans face every day. They are the names of children. That their lives were cut so short is the irreversible result of systemic racism and oppression.

But they aren’t the only children whose lives are changed by the trauma inflicted by racism. Dae’Anna Reynolds wasn’t shot and killed by an officer, but she was in the car as her mother’s boyfriend, Philando Castile, died before her eyes.

Jordan Rogers was just trying to raise money for a trip to Disneyland for her family when police were called on her for selling water. And then there is Davianna Simmons. Police raided her home in Chicago based on a false tip and proceeded to slam her handcuffed mother against the wall and point a loaded gun at her grandmother’s head.

Like any three-year-old would do who doesn’t understand what is going on, she started screaming. So, an officer pointed a loaded gun at her just inches from her chest.

These children have all experienced a form of trauma called toxic stress, in this case due to systemic racism. Over time, toxic stress can damage the body and lead to long-term impacts on health, so it is important we all recognize signs and symptoms and help get our children the support they need.

Stress: positive, tolerable and toxic

Stress is often seen as coming from situations like having too much work to do in too little a time, not having enough money, or dealing with struggles in family or personal relationships. For children, their stress generally comes from pressure to do well in school or sports and social situations at school or in the neighborhood.

Some stress is good as it helps children develop the capacity to manage situations, navigate conflict, and build confidence. This “positive” stress, though, is by definition brief and mild, allowing for the body’s stress response to not overwhelm other functions.

Tolerable stress results from situations that are more severe (like the death of a loved one), but children are able to navigate as long as they have a safe, stable, nurturing relationship with an adult. Toxic stress, on the other hand, is an extreme or prolonged situation that activates the body’s stress response system and leads to harmful changes in the body, particularly in children who are still developing.

Chronic situations like not having enough to eat, not knowing where you will be sleeping that night, or feeling unsafe due to police or community violence, create toxic stress. The stress is even more harmful if there are no safe, stable and nurturing adult relationships in a child’s life.

After a year of COVID-19, a month of the Chauvin trial, and weeks of the aftermath of Daunte Wright’s murder, we’ve all been exposed to toxic stress. As adults it has been impossible to escape the reality of how racism continues to impact our lives each and every day, and our children pick up on this, even from a very young age.

As a parent or caregiver we should be talking with our children about themes of injustice, structural racism, White Supremacy, and how these have played out in why police killings happen and what drives protests to take place. Framing the violence is important.

Most of the violence is actually being carried out by the police. Most of the protests are peaceful. Instead of saying it’s horrible that a Black man has been murdered but the property damage needs to stop, we should be saying it’s horrible that there is property damage but the murder of Black men and women needs to stop.

Age is a consideration

The conversation does need to be different based on age. We know children start to internalize differences in people based on their skin color and how they’re treated as early as age three. But how you talk to a three-year-old will be very different than a 13-year-old.

For toddlers and preschool-age children, I recommend keeping it concrete. For our youngest children, talk about the emotions. Why what happened makes Mom or Dad sad or angry. Why other people may be feeling and acting the way they are.

School-age children benefit from talking about the history of institutions like slavery and Jim Crow laws and how that impacts the unfairness we see today. For teenagers, in-depth conversations about our country’s history of racism and White Supremacy are important, but it also is a conversation where you can highlight what allyship looks like and highlight the actions of allies. I refer families to the American Academy of Pediatric’s resources (see below).

Finally, if you have concerns about your children’s emotional health or behavior, have them see their pediatrician. We are seeing more children have difficulty with anxiety and depression. Your physician can help you and your child create a plan to get back to health.

And if situations arise before you can get in to your doctor, there are a number of crisis hotlines you can call. I recommend starting with either the Minnesota crisis text line (text MN to 741741) or calling your local county crisis team (call **274747), both available 24 hours a day, seven days a week.

I especially highlight the county crisis teams; the last thing we want to do is call the police to respond to a mental health crisis, particularly one they may have caused in the first place. We don’t need to add any more of our children’s names to that list.

For more on the American Academy of Pediatric’s resources, visit, EmbraceRace (

Dr. Nathan T. Chomilo is medical director for the State of Minnesota’s Medicaid/Medical Assistance & MinnesotaCare programs and practices as a general pediatrician in Brooklyn Center with Park Nicollet. He is a board member of the Minnesota Chapter of the American Academy of Pediatrics and an adjunct assistant professor of pediatrics at the University of Minnesota Medical School. He lives in Minneapolis with his wife and son.