First Person with Dr. Mariana Glusman: What Happens in Early Childhood Does Not Stay in Early Childhood
In November 2022, Lurie Children’s celebrated a $25 million gift from Chicago philanthropists Kathleen and John Schreiber to establish the Schreiber Family Center for Early Childhood Health and Wellness. As part of the Patrick. M. Magoon Institute for Healthy Communities, the hospital’s hub for all community-focused initiatives, the Schreiber Family Center will focus on the most important years of development—birth to age five—bringing together the hospital’s experts with community partners to ensure children thrive where they live, learn and play.
In this Q&A with Dr. Mariana Glusman, the new Associate Medical Director of the Schreiber Family Center, she discusses the framework for programs that can change the trajectory of children’s lives.
“In order to develop normally, a child requires progressively more complex joint activity with one or more adults who have an irrational emotional relationship with the child. Someone’s got to be crazy about that kid. That’s number one. First, last and always.” -- Urie Bronfenbenner
Q: How do interpersonal relationships affect child development?
A: We start out with 100 billion neurons, or brain cells. Instead of dividing, brain cells grow by making connections, called synapses. The more connections we make, the better. As scientists, we want to know: How do these synapses form, and how do we maintain them?
The answer is interpersonal interaction. Experience forms the basis for brain development by stimulating and maintaining synaptic connections. Babies are not sponges; they do not passively absorb information from their environment. Instead, they’re active participants in their learning.
Q: How does trauma or stress threaten healthy, meaningful connections?
A: Our bodies respond to stress by releasing adrenalin and cortisol. That is why they are called stress hormones. When the stress is limited and mild or moderate, the stress hormone levels rise and then come back to baseline. But when the stress is constant and severe, it can become toxic, with our stress hormone levels remaining permanently elevated. It has been known for decades that Adverse Childhood Experiences (ACEs), including domestic violence, parental incarceration and mental health concerns, and severe unmet social needs are associated with toxic stress. Toxic stress prevents synapses from forming and damages the architecture of the developing brain. In addition, we know that ACEs can manifest as learning and behavioral concerns during childhood, and ultimately can lead to worse adult health outcomes including increased cardiovascular disease, immune problems, cancer and stroke.
Q: Can toxic stress be inherited from parent to child?
A: While toxic stress does not change our actual DNA, it causes changes in the way the DNA folds and unfolds, which in turn affects which genes are expressed or not expressed. This is another way toxic stress can make us more susceptible to health problems, such as cancer or decreased life expectancy. This also means the effects of toxic stress can be passed down from one generation to the next. So, as pediatricians, we are not just treating the immediate needs of the children we care for; we are also addressing their family’s history.
Q: What is the role of the pediatrician in addressing ACEs?
A: Not all children who experience ACEs have bad outcomes. Some people who experience adversity succumb to it while others are resilient, and even flourish. It’s our job to help our patients find ways to avoid succumbing and guide them toward flourishing.
That’s where caring adults come in. Caring adults protect children from the effects of toxic stress by providing Positive Childhood Experiences (PCEs) which promote safe stable and nurturing relationships (SSNRs) and mitigate the health effects of ACEs. The term for the ability to form SSNRs is “Early Relational Health” and it is now considered the “other side of the coin” to toxic stress.
This is brand new, cutting-edge knowledge, found in studies just within the last few years, and can help guide our work with families. In order to help prevent toxic stress in our patients, we need to reduce ACEs and external stressors such as poverty, racism, and social isolation. We also need to help caregivers strengthen the core life skills required to create healthy environments for their children, and finally, we need to support nurturing relationships in families and promote early relational health.
Q: Why is reading crucial to child development?
A: It is well known that reading aloud with children, starting in infancy, leads to improved language skills and basic knowledge. But the benefits go even further. Cuddling with a book and reading aloud is a fantastic way to promote SSNR’s.
As part of the Reach Out & Read Program, pediatricians give out books to patients at every visit from birth to five years and use the book as a tool to evaluate child development, to model for parents how to read interactively with kids of different ages, and talk about the importance of reading for their children’s development. What started out as a literacy program is something we’ve come to understand as a universal relational health tactic that helps form relationships and promote bonding between child and caregiver.
Healthy, secure relationships and interaction with caring adults helps lay children’s language, cognitive and socioemotional foundation for school readiness. Improved school readiness can lead to improved reading skills and school success, which can open a world of economic opportunity. We can begin to break the cycle of poverty right here.
James Heckman, a Nobel Prize-winning economist, writes, “investment in early childhood is the best investment.” He developed the Heckman equation which determined that for every dollar spent in early childhood there is a seven-dollar return.
With the generous support from the Schreiber family, we have an incredible opportunity to make an even bigger, more meaningful investment in the futures of the children of Chicago.