The other day, a mother of a 15-month-old walked into Andrew Garner’s office, oozing frustration.
“Is it normal for them to never sit still?” she asked.
Garner, a pediatrician in Westlake, Ohio, leapt on the remark as a teachable moment.
“He doesn’t sit still?!” he said, “That’s a compliment to you! You want him to do that.”
At 15 months, he explained, children are itching to explore, and then toddle back, and then wander off again. It’s a sign the baby is developing apace.
The goal is to make the woman feel confident in her mothering abilities. If he builds up her self-esteem, Garner hopes, she’ll be more invested and engaged as a mom, and the child will grow up smarter and healthier as a result. Garner bases this chain of events on a spate of recent studies that have shown that supportive parents breed better-off children.
So, now, on top of taking measurements, asking about sleep and food habits, and giving vaccinations, Garner devotes part of the visit to checking up on mom. Particularly if the family comes from a harsh environment or if the mother shows signs of depression, he tells her to make sure “you're smiling at your baby, you're being aware of your emotions, and using positive discipline techniques.”
“I tell them things like that tantrums are emotional overload and not how they feel about you,” said Garner, who is also an associate professor of pediatrics at Case Western Reserve University. “Or at 12 months, I spend a lot of time talking about the fact that they’re soon going to want to prove they can do stuff.”
Garner knows that if the mom gets angry about the child's normal behavior, she might develop a negative attitude toward parenting. And that could be poisonous in a very real way. Pediatricians are growing increasingly alarmed about the dangers of so-called “toxic stress”—certain kinds of childhood experiences, like turmoil, violence, and neglect, that, when chronic, can alter brain structure and chemistry and hurt a child’s chances of long-term success. Harsh parenting by itself won't necessarily doom a child, but when combined with other stressors, it might.
“When bad things happen early in life, whether you remember them or not, the brain doesn't forget,” Jack Shonkoff, a professor of pediatrics at Harvard Medical School, said at a recent conference in Washington, D.C.
When we experience everyday stress, our bodies kick into high gear by releasing adrenaline and cortisol. When the stress goes away—or if, as children, we’re comforted by trusted adults—our bodies return to normal. But if there is no adult around, or the stressors are ongoing, the response system stays activated. This chronic, “toxic stress” throws the brain into a permanent state of high alert, weakening the neural connections that are essential for learning and cognition.
“It's not black and white. It’s not like the baby gets hosed for life if you're not smiling at it,” Garner said. “But our brains and our genome are very plastic early in life. They're taking in cues to prepare us for what's coming.”
Experience influences which genes get switched on and the way our brains anticipate the future. A child tumbling through the toxic stress cycle might have a brain that’s ready for “a dog-eat-dog world. That child will be more hypervigilant, anxious, on edge and less likely to learn as easily as another child will,” he added.
Studies show that children who are exposed to toxic stress fare worse over the course of their lives. Family poverty is strongly correlated with lower cognitive test scores, even when controlling for the mother’s education and other family factors. Children who are neglected have worse executive functioning, attention, processing speed, language, memory, and social skills. People who are mistreated as children are more likely to suffer from heart disease as adults. Our brains and genomes are particularly sensitive during so-called “critical periods”—the times during early childhood when the brain is rapidly changing.
Poverty is the most common reason why Garner’s patients' moms have a harder time mothering. Maslow’s Hierarchy dictates that if food, shelter, safety, and other essentials aren’t in place, there will be a dearth of brain space for bedtime stories and positive affirmations.
Still, other moms might flag in supportiveness because their jobs are too demanding or because they have postpartum depression. Garner says he’s even seen the reverse of poverty turn harmful: Two uber-successful parents spending their free time twiddling on their phones rather than attending to their newborn.
About 10 years ago, Joan Luby, a psychiatry professor at the Washington University School of Medicine, invited 92 children between the ages of four and seven to a lab in St. Louis. The kids took a test that measured whether they were depressed—some were, and some weren’t. One by one, the children and their primary caregivers (in most cases, the mom) were invited into a room that contained a brightly wrapped gift with a bow on top. A research assistant told the children they could have the gift if they waited patiently for eight minutes. In the meantime, the mother was told to fill out a daunting stack of complicated forms. Annnd ... go!
As expected, the kids went bonkers. They begged. They whined. They stretched their tiny hands toward the box. They, being kids, yearned for nothing more than to rip it open.