Intended for healthcare professionals

Toxic stress and PTSD in children

Many children experience levels of adversity that give rise to toxic stress. Contributors may include war, natural disasters, and displacement, as well as poverty, violence at home, family breakdown–and the effects of the covid-19 pandemic.

Adversity in childhood can lead to behavioural, physical, and psychological problems throughout life. Children who experience toxic stress are at greater risk of many health problems in adulthood, from depression to cardiovascular disease and obesity.

All children deserve the chance to thrive in safe and supportive environments. Governments, non-governmental organizations, and healthcare providers must minimise the risk of toxic stress in childhood and intervene early when it occurs.

This collection, commissioned for the 2020 Virtual WISH summit, suggests ways forward.


Adversity in childhood is linked to mental and physical health throughout life
The prevalence of toxic stress and huge downstream consequences in disease, suffering, and financial costs make prevention and early intervention crucial, say Charles A Nelson and colleagues.

Mitigating toxic stress in children affected by conflict and displacement
Anushka Ataullahjan and colleagues describe the myriad stressors related to conflict and displacement experienced by children and how best to reduce their negative effect.

Psychopathology in children exposed to trauma: detection and intervention needed to reduce downstream burden
The clinical implementation of assessment and evidence based interventions is lagging behind research, with huge cost to individuals and society, write Andrea Danese and colleagues. To provide the best possible care to some of the most vulnerable children, specialist training, clinical capacity, and access to care must be increased.

Children’s prolonged exposure to the toxic stress of war trauma in the Middle East
Conflict leads to toxic stress and health problems in childhood and beyond. Long term investment in evidence informed mitigation strategies is needed to end the devastating cycles of violence, write Muthanna Samara and colleagues.


The Muppets bringing child resilience into Middle Eastern humanitarian work
The makers of Sesame Street are working with a global humanitarian agency to try to help children affected by conflict and displacement. Ingrid Torjesen reports.


Our children face “pretraumatic stress” from worries about climate change
Children are particularly vulnerable to the psychological trauma from current extreme weather events. They can also be harmed by the fear of future harms, writes Lise Van Susteren. Adults have the power to do something about it.

Covid-19 could prompt an end to our continued betrayal of childhood
Many children in wealthy countries such as the UK face huge yet avoidable adversities, risk factors for toxic stress and lifelong physical and mental health problems. Al Aynsley-Green notes how the covid-19 pandemic has compounded this scandal, but presents a chance to reset the baseline and end the betrayal

This collection was launched at the World Innovation Summit for Health, 15-19 November 2020. Funding for the articles, including open access fees, was provided by the World Innovation Summit for Health (WISH), which is an initiative of the Qatar Foundation. The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles.

Nadine Burke Harris and Zulfiqar A. Bhutta guest edited this collection, with the support of advisory panel members Marcia Brophy, Andrea Danese, Charles A. Nelson and Muthanna Samara. Richard Hurley and Kamran Abbasi were the lead editors for The BMJ.

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