When stress turns toxic: strategies to support children experiencing damaging levels of stress – Amy Armitage-Reay


Seven-year-old Christopher’s father left the family home abruptly six months ago, leaving him with his twin brother and mother. His father was the stabilising presence in the family and since his departure and disappearance from every day life, Christopher’s mother has struggled to cope with every day tasks, including cleaning, washing and feeding the children. She often tells Christopher that they may lose their home and don’t have enough money to buy food. She has also started drinking heavily, which often results in prolonged episodes of verbal abuse aimed at Christopher.

During these episodes, Christopher feels his heart pounding in his chest and his hands shake. When his mother blocks his path during a confrontation, he feels uncontrollable rage and has punched the wall or his brother on many occasions. He has also started to wet the bed, something he has never done before.

At school, Christopher’s behaviour has deteriorated. He is disruptive in class, is prone to loud outbursts and frequently challenges his teachers.

Christopher is suffering from toxic stress.


Good stress and bad stress

Stress is an unavoidable part of every day life. In evolutionary terms, the physiological symptoms we experience in periods of stress, including increased heart rate and blood pressure and the release of adrenaline, are part of the fight or flight response that helps us to cope with whatever stressful event we find ourselves facing.

However, stress, and our physiological reaction to it, should only ever be short-term. In children, research has shown that exposure to prolonged or constant periods of stress, known as toxic stress, can permanently damage organ system development and brain architecture. It can cause permanent psychological damage and places children at higher risk of physiological problems, such as diabetes and heart disease.


Types of stress

Researchers at Harvard University’s Center on the Developing Child have divided childhood stress into three categories:

 - Positive – in which the child experiences brief increases in heart rate and mild increases in stress hormone levels, for example when taking a test. This type of stress helps children learn coping mechanisms to deal with it.
- Tolerable – in which the child experiences serious, temporary stress responses, which are buffered by supportive relationships, for example, falling off a bike and breaking their arm.
 - Toxic – in which the child experiences prolonged activation of stress response systems in the absence of protective relationships. For example when a child is subject to physical violence in their home and has no adult caregiver to turn to for comfort or support.


What is toxic stress?

According to the Center on the Developing Child, toxic stress occurs when a child experiences ‘strong, frequent, and/or prolonged adversity – such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship – without adequate adult support.’

It is important that children are taught how to deal positively with incidences of stress. Unlike everyday stress, however, toxic stress is characterised by ‘the prolonged activation of the stress response system’, which eventually disrupts the development of a child’s brain and other physiological systems, leading to permanent damage.

Toxic stress is becoming more common in children and, in the last six years, it is estimated that thousands of children in Syria have experienced, and continue to experience, toxic stress.

According to a report by charity Save the Children entitled Invisible Wounds, many children in the war torn country are exposed to violence on a frequent basis and live in a constant state of fear resulting from incessant shelling and airstrikes. Two-thirds of children in Syria have lost a loved one, and one in four children ‘rarely or never have anywhere to go or someone to talk to when they are scared, sad or upset.’

Signs of toxic stress in these children include behavioural changes, such as increased aggression, bed-wetting or involuntary urination and loss of the ability to speak. Additionally, they may experience head and chest pain, loss of limb movement, and breathing difficulties. Some children attempt suicide, and 51% of adolescents have turned to drugs to help cope with stress.


Strategies to support children

Research has shown that children who receive nurturing and responsive care thrive developmentally. They are also able to develop healthy stress response systems that enable them to manage the physiological effects of stress and return to a normal physical state once the stressful event is finished. This is a skill that they will use throughout their lifetimes.

Hallmarks of toxic stress include that the level of stress never dissipates and many children lack supportive, responsive relationships with caregivers that would help them to manage the stress.

Researchers believe that there are strategies that can be used by teachers and caregivers to support children experiencing toxic stress that will improve their long-term outcomes and even reverse its effects.

Here we explore 9 different strategies to help children deal with toxic stress.

  1. Model how to deal with stress. If a caregiver deals with stressful situations calmly, in a measured way and using a soothing tone of voice, children will remember that behaviour and eventually try to emulate it.
  2. Plan ahead. Children suffering from toxic stress may react badly to sudden or frequent changes. To reduce a child’s anxiety and a toxic stress response, talk to them about what will be happening next. You could plan events out on a chart that is placed in a prominent place in the classroom so there is a simple visual point of reference.
  3. Create a ‘buffer’. The researchers at Center on the Developing Child believe that if children have access to ‘safe, stable, nurturing relationships and communities’, this can help them to avoid having a toxic stress response during periods of instability or uncertainty. If the classroom or care environment is consistent, routines are predictable and repetitive, children are taught to be kind and empathetic and supportive and caring behaviour is rewarded, then children will be able to build up resilience to stressful events.
  4. Create a ‘safe space’. This could be an area such as a pop-up tent that is away from the hustle and bustle of the classroom/care environment. It could contain sensory activities that will help the child to calm down and relax when they feel anxious or upset.
  5. Learn what makes the child anxious. By identifying triggers, you will be able to minimise them or plan for them.
  6. Teach different ways to communicate. Some children may not be able to put into words how they are feeling, but they may be able to express their feelings through painting or drawing. Reading books about other children’s problems and seeing how they solve them will also help. Teachers can also use role-play, puppets and songs to help children express themselves.
  7. Provide a physical distraction. Children who experience toxic stress deal with high levels of cortisol – the stress chemical, which means that they are always in a heightened state of alert. The presence of cortisol in children can make them fidgety and impulsive, and a good way of helping to release this energy in a less disruptive way can be with a simple stress ball. Using the stress ball will actually help highly-stressed children to concentrate on the task at hand.
  8. Create activities that develop children’s self-confidence and create a positive belief in themselves. These skills will be valuable during times of toxic stress and will help them to regulate their physiological reactions.
  9. Reduce sources of toxic stress by creating strong relationships with caregivers. By developing strong bonds with caregivers, educators can help them access support and services that will enable them to recognise what toxic stress is and their role in it. They will also learn strategies to reduce or eliminate toxic stress from their family life.

In the case of Christopher, a teacher could deploy many of the strategies explored in this article. Providing him with a stress ball could divert his fits of rage, allowing him to focus on his class work. Teaching him different tools to communicate how he is feeling would also help instances of disruptive behaviour, as would giving him permission to go to the ‘safe space’ whenever he feels that he is on the verge of losing control. Speaking to his mother and suggesting different forms of support could also be beneficial for the whole family as it may help the mother to feel less alone and isolated and encourage her to seek assistance.

As the pressures and pace of modern life increase, it is likely that more and more children will experience toxic stress at some point in their lives. A teacher’s ability to recognise a child experiencing this level of stress and utilise appropriate strategies could make a huge difference to the child’s long-term outcome.


To learn more about toxic stress and its impact on the developing child’s brain and organs, go to https://developingchild.harvard.edu/resourcetag/toxic-stress/.

The Save the Children report can be read in full here: https://i.stci.uk/sites/default/files/Invisible%20Wounds%20March%202017.pdf.


Amy Armitage-Reay runs ethosediting.com and is a writer who specialises in creating content for the education sector. Coming from a family of teachers, Amy grew up with a love of learning and she lives to help people get their message across through well-written, informative content. Follow her on Twitter @ethosediting.