Addressing childhood adversity is crucial for post-COVID-19 recovery

CHILDREN have been spared the worst of the COVID-19pandemic. They are at lower risk of becoming infected, symptomatic and transmitting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet the indirect impact of the public health response has led to rapid and major upheavals with substantial and pervasive consequences for children’s lives.

Children are experiencing a range of adversities as a result, including parents struggling with mental health problems and substance misuse, relationship breakdowns, financial stress, and an alarming increase in family violence. Calls to Kids Helpline have seen a 28% spike in demand in Victoria between March and July 2020. An additional 4500 Victorian children will potentially enter out-of-home care as a result of the COVID-19 pandemic, burgeoning to a total of 27 500 children in out-of-home care by 2026.

Even before the current pandemic, childhood adversity was a priority because of its high prevalence and harmful effects on mental and physical health throughout life. This was first appreciated in the 1990s. Early studies reported that the number of adversities retrospectively reported by adults had a dose–response relationship to risk for adult non-communicable diseases, such as cardiovascular disease, type 2 diabetes, cancer and mental illness.

Addressing childhood adversity – defined by the World Health Organization as “as sources of stress that children may suffer early in life like abuse, neglect, violence between parents or caregivers, and other kinds of serious household dysfunction such as alcohol and substance abuse” – has since been recognised as a key opportunity to improve public health across the lifespan. The American Heart Association has identified action on childhood adversity as vital to reducing the adult burden of cardiovascular disease. Such efforts have the potential to generate significant cost savings — the long term health consequences of childhood adversity are estimated to cost the US and Canada a staggering $748 billion each year.

To effectively drive the impetus for early intervention and prevention, we need to understand how adversity gets “under the skin” to affect long term health. Inflammation is likely a central mechanism. While heightened stress can be helpful in responding to short term threats and adversity, chronically activated stress responses may result in immune dysregulation, leading to chronic inflammation. In turn, chronic inflammation is considered a common cause of a range of non-communicable diseases, including those that have been linked to childhood adversity.

Our recent article supports this conceptualisation and suggests that these impacts can already be seen in early life. Children’s exposure to adverse experiences was related to a marker of chronic inflammation at both 4 and 11–12 years of age. Intriguingly, we found small differences in one inflammatory biomarker (GlycA) but not the other we examined (hsCRP), suggesting GlycA better captures chronic, as opposed to acute, inflammatory responses. There are currently no standard biomarkers for indicating the presence of health-damaging chronic inflammation, and we still have much to learn about the clinical implications of these modest differences in inflammatory biomarkers over the life course.

As we experience the long tail of COVID-19 and associated restrictions, good data are needed more than ever to understand the ongoing impacts for children. To assist we can use the power of the Murdoch Children’s Research Institute’s LifeCourse platform, which brings together over 40 longitudinal cohort studies. Our study used data from two LifeCourse cohorts (the Barwon Infant Study and Longitudinal Study of Australian Children Child Health CheckPoint) and found similar results in each, meaning that we can be more confident in the study findings. As children continue to be followed up over the course of the pandemic and beyond, the LifeCourse platform provides an ongoing opportunity to understand how small differences in chronic inflammation sustained over long periods might translate to disease risk. Biosocial research that brings together biological and social sciences is critical to making best use of these data and to maximise positive contributions of research for policy and society.

What is already clear from the evidence, however, is that as children’s exposure to adversity increases in the wake of the necessary public health responses to COVID-19, the long term health impacts are likely to be felt well into the future. Leveraging the existing scientific evidence on childhood adversity will be critical in planning and implementing the road to recovery and mitigating these effects.

This includes translating current evidence to better tackle the occurrence of childhood adversity. For example, sustained nurse home visiting can make a difference for families living in adversity, improving parenting and home environment determinants of children’s health and development. Acting early is key; estimates suggest that AU$15.2 billion is wasted on late, high intensity services, for problems that could have been prevented through early intervention. The Centre of Research Excellence in Childhood Adversity is working to develop a sustainable service approach, co-designed with end users, that can better detect and respond to adversity in the early years.

We also need to address the unequal exposure to adversity across our community. Before COVID-19, the percentage of Australian families experiencing high levels of adversity was almost double in those with the lowest, as compared to highest, socio-economic circumstances. Children from Aboriginal and Torres Strait Islander backgrounds and from ethnic minority backgrounds were also disproportionately exposed. Critically, these disparities are not the fault of the families experiencing them. They reflect social policies and structural conditions, including racism and poverty, that profoundly shape the conditions in which children live, learn and grow, creating health disparities in good times and inflating them in a crisis.

What are the remedies? We need to develop a new kind of “herd immunity,” whereby resistance to the spread of poor health comes from prevention and protection against the drivers of adversity for all children.

Dr Meredith O’Connor is a developmental psychologist, Senior Research Fellow and Program Manager of the LifeCourse platform at the Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, and an Honorary Fellow in the Department of Paediatrics, University of Melbourne.

Professor Sharon Goldfeld is a paediatrician, public health physician, Theme Director of Population Health and Co-Group Leader of Policy and Equity at the Murdoch Children’s Research Institute (MCRI) and Director of the Centre for Community Child Health at MCRI and the Royal Children’s Hospital, Melbourne.

Professor David Burgner is a paediatric infectious diseases physician and researcher. He leads the Inflammatory Origins research group and co-leads the LifeCourse platform at the Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne.

Associate Professor Naomi Priest is a social epidemiologist, Group Leader of Social-Biological research and National Health and Medical Research Council Career Development Fellow in the Centre for Social Research and Methods at the Australian National University and an Honorary Fellow in Population Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.