Mitigating toxic stress in children affected by conflict and displacement

Abstract

Armed conflict and displacement pose a threat to the health and wellbeing of children. As the global community begins to recognize the cumulative effects of conflict and displacement related stressors, our attention has shifted to toxic stress and its short and long term health effects. 1 Toxic stress, regarded as the result of prolonged activation of the stress response, can occur before birth and during childhood is known to contribute to epigenetic changes, with health and neurodevelopmental consequences. 2 However, various social factors and early and appropriate intervention can help mitigate the negative effects. 3 How conflict and displacement affect children Over 415 million children were living in conflict affected countries in 2018, 4 including 33 million displaced children (16 million refugees and asylum seekers, and 17 million internally displaced children). 5 Although all children are vulnerable to toxic stress, certain subgroups are particularly vulnerable because of their marginalization-for example, orphaned or unaccompanied children, girls, children with HIV infection, and children with developmental disorders or a disability. These groups may face additional stressors and have reduced access to services. The emergence of covid-19 has also raised concerns about spread in conflict affected populations adding to the risk of toxic stress (box 1). Box 1: Covid-19 in humanitarian settings Conflict affected populations are particularly vulnerable to covid-19. Overcrowding and inadequate water and sanitation systems in refugee camps and informal settlements, coupled with previously existing illnesses, may increase the spread and severity of covid-19. 6 7 Moreover, resource and health system constraints may restrict access to adequate and appropriate care. 6 7 Control measures such as physical distancing may be difficult and may also increase economic precarity, intimate partner violence, and food insecurity in populations already vulnerable because of conflict or displacement. There are concerns that the health needs of conflict affected populations may be deprioritized by host 1

Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic

“…First, there is an urgent need for investments in adolescent-responsive mental health services to support young people most at risk of depression and anxiety, given that more than 15% of the sample—and especially older girls—are experiencing moderate to severe symptoms of depression and anxiety. Community-based and online counselling services should be prioritized to support these young people, especially in host communities, where the risk of social isolation appears greater [ 106 , 107 ]. Given that more than a third of adolescents also reported that they lacked access to trusted peers and family members, and could therefore also be vulnerable to mental ill-health in the medium to longer term, investments in low-cost, peer-to-peer support groups that can be maintained through online and (physically distanced) in-person platforms during crisis episodes could be trialled.…”

Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association

“…These environments have proven negative effects on ECD. [43][44][45] Pediatricians who work in conflict areas or where there are substantial numbers of refugee families should pursue training that equips them to care for the specific developmental needs of these children.…”

Informal early childhood education: the influences of parents and home on young children's learning

“…However, others experience home as a hostile, violent space characterised by familial dysfunction (Judge, Ilies, and Scott 2006;Murray et al 2019). Equally, many young children are displaced from their homes, for example through conflict or migration (Ataullahjan et al 2020;Maldonado, Swadener, and Khaleesi 2019), often leading to experiences of exclusion and alienation (Mack 1993;Wahle et al 2019).…”

“…During the pandemic, while many parents will have provided astimulating home environment that has afforded young children high quality informal learning (Sylva et al 2010), this will not have been the case universally. Reasons may include lack of time, physical resources or space (Andrew et al 2020b; UNICEF 2020b), parents' lack of interaction with their young children (Hart and Risley,1995;Umek et al 2008), or increased toxic stress levied by confinement (Ataullahjan et al 2020). Moreover, the combination of setting and playground closures and mandates to stay at home have meant that young children have had fewer opportunities for outdoor play and free play (Gill and Munro 2020).…”