Toxic stress caused by adverse childhood experiences: the hidden epidemic.

Adverse childhood experiences (ACEs) are associated with negative consequences for physical and mental health. ACEs are defined as harmful experiences from conception to age 18. They generate chronic toxic stress when exposed to emotional or sexual abuse or a dysfunctional home. ACEs produce "programming" on brain plasticity with immunoneuroendocrinological, cerebral, and epigenetic changes. The result is suboptimal development of physical, mental, and emotional abilities. This "programming" can be mitigated by resilience, family and social support. When faced with new stressors, psychological and physiological dysregulation will occur, exposing the individual to disease. Between the ages of 0 and 17, 55.9% have had 1 ACE, and 30.6% have had ≥2 ACEs. The consequences are aggression, drug addiction, obesity, asthma, depression/anxiety, decreased resilience, juvenile recidivism, and suicide. Pediatricians are the ones who can detect, prevent, and mitigate ACEs.