By: Rachel Gilgoff, MD, FAAP & Devika Bhushan, MD, FAAP
We all experience stress, even babies! Some stress can be good for us. But too much stress, like with what scientists call
adverse childhood experiences, can cause problems with our physical and mental health and overall well-being.
Every potentially stressful experience (stressor) is different, and every person may react in different ways (stress response). However, there are some common ways we all respond – babies, children and adults. Learn more below and see other articles in this series:
Stress and the brain
When we feel threatened, attacked or scared, our brain releases powerful hormones such as adrenaline, cortisol and oxytocin. These may activate different stress responses: freeze, fight, flight or affiliate. Here's what those are like:
Freeze response. If we cannot escape from a threat, we may feel powerless, withdrawn, spaced out,
dissociated, numb or faint. Think of animals "playing dead" with the hope that the predator loses interest and moves on. For example, this could feel like you are floating or separate from the stressful event or fainting at the sight of blood.
Fight or flight response. Our heart rate and blood pressure go up, we breathe faster, our palms get sweaty, and we send more energy to our brains and muscles (and away from our gut) to be able to fight or flee. This can be helpful and energizing, such as before a big race or performance. However, if the stress response is super strong, we may "flip our lid" – when our thinking brain is no longer in charge. Instead, we react by instinct, learned habits and emotion. This can save our lives when we see a bear in the woods. However, in our modern world, "flipping our lid" can also show up as the temper
tantrum in the grocery store or "losing it" with our kids.
Affiliate response. This response involves connecting with others in times of great danger. This can be seen in a parent putting themselves at risk to help their child (tend), or in making new alliances against a common threat (befriend). The impulse to reach out to others for support can be healthy and lead to fewer freezing, fighting or flighting responses. When we can't find that support in others because they cannot or will not help, it can mean that we have to resort to freeze and fight-or-flight.
Some stress is good!
Positive stress response
Some stress is good for our health. It can help build motivation in the moment and resilience for future challenges. When stress hormones are released, our heart rate and blood pressure may go up. But if we have built some social supports and learned some coping skills, the stress response is quickly dialed back down. This builds our resilience "muscles." We can practice our coping skills, and learn how to respond adaptively in the face of a future challenge.
Tolerable stress response
We all may experience something really scary, sad or threatening in our lives. For example, witnessing a burglary quickly activates our stress response. However, if we have enough of a support system and coping tools, we can learn to eventually feel safe again. This turns off the stress response system and keeps the stress hormones from staying activated for too long.
Toxic stress response
The repeated, excessive or prolonged activation of the stress response can, over time, lead to health problems. This is especially the case if we are without sufficient helpful and protective factors, like the love and support of a caring person to help us lower our stress hormones and feel safe again.
If a child's fight or flight or freeze response becomes activated over and over again, the child is essentially practicing "survival mode." Their brain and body may even get "stuck" in survival mode.
At some point, our brains and bodies adapt and become really good at detecting and reacting to potential threats, even when the threat is no longer here.
When this happens, the stress response system goes from being helpful to damaging. It can go on to change the developing brain, hormones, the immune system, metabolic processes and even our genes, speeding up aging on a cellular level. This can then lead to health risks that range from
asthma and infections, to dental problems, to mental health conditions.
Toxic stress: possible signs and symptoms
For a child that is experiencing a toxic stress response and is 'stuck' in survival mode, their stress biology may keep them on high alert and make them over-responsive to possible threats in their environment. Seemingly random or small things like a raised voice, a specific smell or loud noise could more easily trigger freeze, fight or flight, or affiliate responses. The changes in the brain and body could appear as:
Frequent flares of physical health problems like asthma, allergies, eczema or hives
Frequent headaches, stomachaches, nausea/vomiting, constipation
Chronic or frequent infections
Menstrual disturbances (such as later first period)
Overweight and obesity
Poor dental health
nightmares, memories or acting out what happened in play
Avoidance or withdrawal
Dissociation (present in body, not in mind)
Perfectionism; overly people-pleasing
Anger, guilt, shame, self-blame
Loss of trust; often or constantly feeling unsafe
Absenteeism from school
Dropping grades; repeating a grade; not graduating from high school
Substance use disorders
Looking for love – and developing unhealthy friendships and romantic partnerships
Early sexual activity
Eating disorders like anorexia and bulimia
Trouble concentrating; learning and behavioral concerns
Suicidal ideation and attempts
Can we prevent or "treat" overactive stress responses?
The good news is that toxic stress responses are preventable. And once they occur, they are still very treatable. While unbuffered stress can move any person toward symptoms and illness, the opposite is just as true. Providing safety, support, coping skills and healing strategies can move you or your child, no matter what's happened to them, toward wellness.
If your child's behavior, mood or health is changing:
Talk to them about how they're responding to specific stressors and what you might do differently to help them feel better.
Know that there are things you and your child can do right now, including healing strategies to help turn off the biological stress response. These include focusing on healthy relationships, sleep, diet, exercise, time in nature, mindfulness practices, mental health supports and cultivating
resilience and more.
About Dr. Gilgoff
Rachel Gilgoff, MD, FAAP is an integrative medicine specialist, child abuse pediatrician, researcher, science writer, and mother of two amazing kiddos. She is dedicated to improving care for stress-related health issues and promoting lifelong health and wellness.
About Dr. Bhushan
Devika Bhushan, MD, FAAP is an equity- and resilience-focused pediatrician, public health leader, parent, and Indian-American immigrant who served as California’s Acting Surgeon General in 2022. She leads a community focused on resilience and well-being at