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Leaving a Lasting Impression

"He's just a baby. He won't remember this." How many times have we heard some version of those words, spoken during a traumatic time in hopes that the toddler will emerge unscathed? Not so long ago, even doctors subscribed to thinking along these lines, and, as a result, failed to appropriately manage pain medication for infants. Even today, many people believe that young children are somehow impervious to stress.

We now know that, contrary to previous scientific thinking, the young child's brain is actually disproportionately receptive to stimuli – both positive and negative. On the positive end, this helps to explain why a preschool-aged child can learn a second language after just a few months, when it might take her mother years and years. On the negative side, however, it explains why young children exposed to toxic stress (repeated exposure to very difficult situations in their surroundings), trauma, abuse and neglect are at particular risk for problems later in life. The early childhood brain is like a sponge, and it soaks it all up, the good and the bad.

At Montefiore, we pay particular attention to early childhood development and well-being, in acknowledgment of the critical importance of these early years, via our Healthy Steps program, established in 2006.

Over the last seven years, we have screened nearly 10,000 young children regarding their social emotional development, and provided follow-up whenever indicated. Some families enroll in Healthy Steps even before the baby is born, and enjoy three to five years of co-managed well child care – every visit to the pediatrician also includes a Healthy Steps Specialist, who may be a social worker or a child psychologist with special expertise in early childhood development and parent-child relationships. 

The well-being of parents also is of particular importance when we think about ensuring young children live lives free of toxic stress, trauma, neglect and abuse. As such, we also screen parents of young children for current depression and for their own adverse childhood experiences, or ACES. If parents request their own help to manage any of these issues, we offer onsite psychotherapy and psychiatry, as needed.

We also spend a lot of time teaching medical students, pediatric residents, nursing staff and attending physicians about early childhood brain development, attachment theory, and ways to prevent and recognize toxic stress in the life of a young child.

All of this is with the express goal of ensuring that Montefiore's infants, toddlers and preschool aged children grow up in environments where everyone acknowledges how "spongey" their brains are, soaking it all up at all hours. We are working to create communities of awareness within our pediatric practices to ensure we are doing everything we can to prevent early childhood exposure to toxic stress and trauma.  And in those unfortunate events when these things do happen, that we offer a family all the supports we have, within their medical home, at the earliest possible moment. The future looks bright for our Healthy Steps kids. 

Rahil D. Briggs, PsyD. is director of Pediatric Behavioral Health Services at Montefiore and assistant professor of Pediatrics at Albert Einstein College of Medicine.



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