THE STRESS RESPONSE & THE PAEDIATRIC PATIENT

As part of survival, the child's nervous system needs to be attuned to changes in the mother's non-verbal cues. These non-verbal cues may include; muscle tension, respiration rate, facial expression, eye contact, gesture, space and touch. As the child's nervous system is not developed enough to readily judge the safety of each stimulus in its environment, the short cut used is to respond to changes in the mother's physiology. Establishing these patterns of reactivity contributes to formation of conditioned responses which may influence the way the i n d i v i d u a l re s p o n d s to st re ss throughout life. Additionally, if the mother has experienced episodes of extreme or ongoing stress previously her amygdala response may be primed to g e n e r a t e a f e a r r e s p o n s e inappropriate to the actual current stimulus. Clinical examples of events include; difficulty conceiving, recurrent miscarriage, threatened preterm labour, premature birth or other threats to the health of the child or mother.(2) As the thalamo-amygdala pathways operate at twice the speed of the cortical interactions with the amygdala it should be noted that many of these physical responses occur without conscious awareness. (3) CLINICAL APPLICATIONS *Aim first to connect and generate rapport with the mother on the first office visit. This calms the parent and the child will respond to these changes in non-verbal cues. Be aware that your office environment may trigger a conditioned response in the p a r e n t r e l a t e d t o p r e v i o u s experiences. *A complete history should carefully evaluate any current stresses the family face as well as a history of previous stressful events. Examples include: • Did you have difficulty conceiving? • Is there any history of miscarriage or other pregnancies? • What is the age gap between siblings? (Babies born close together or multiple births can increase the likelihood of parents being in a constant state of fight or flight. If the age gap is four years or more I ask if there is a reason for this.) • Were there additional stresses when you were pregnant with this child or their siblings? • Has the parent had any significant health issues themselves? • Are the symptoms worse when you or the child are stressed? • Wa s a n y o n e i n t h e f a m i l y experiencing stress when the symptoms began? * Be aware of symptoms that are heightened in the presence of the mother and relieved in her absence. This may indicate physiological covariation. For example, a colicky baby that the mother can't settle, but the grandmother can. * Chiropractic techniques such as sutural and cranial balancing along with Neuroemotional Technique (NET) which may be useful in using in extinguishing an inappropriate stress response. (See case study). * Home care: Explain to the parents how their stress load affects their own physiology and how this affects the physiology of their child. Encourage parents to reduce their own stress load where possible and to utilise stress management techniques such as meditation for stresses that currently can't be changed. From an NET perspective we work to have the parents be congruent with saying no when they need to and asking for and accepting help wherever possible.