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Children
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Treating Toxic Stress in Pediatric Clinical Practice
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Treating Toxic Stress in Pediatric Clinical Practice

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Global Pediatric Health".

Deadline for manuscript submissions: 25 September 2026 | Viewed by 1457

Special Issue Editors

Dr. Rachel Gilgoff

E-Mail Website
Guest Editor
1. Department of Pediatrics, Division of Allergy and Immunology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
2. UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN), Los Angeles, CA 90024, USA
3. The Center for Youth Wellness, a Program of Safe & Sound, San Francisco, CA 94124, USA
Interests: stress; adverse childhood Experiences; trauma-informed care; integrative medicine; lifestyle medicine; precision medicine; translational research; addressing health issues resulting from child abuse and toxic stress; promoting multidisciplinary; patient-centered clinical care
Dr. Devika Bhushan

E-Mail Website
Co-Guest Editor
Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA
Interests: adversity; childhood trauma; toxic stress physiology and amelioration; trauma-informed care approaches; emotional regulation and parent–child co-regulation; stress; resilience; trauma-informed systems; life course health; well-being; reducing stigma and bias; health equity; reducing health disparities; gender norms and health; media and mental health
Dr. Jorina M. Elbers

E-Mail Website
Co-Guest Editor
HeartMath Inst, Trauma Recovery Program, 14700 West Park Avenue, Boulder Creek, CA 95006, USA
Interests: stress; adversity; childhood trauma; impact of toxic stress on nervous system development; nervous system dysregulation in children and adolescents; autonomic nervous system function and heart rate variability (HRV); somatic symptoms and functional neurological disorders; trauma-sensitive approaches in patient care and medical education; integrative and mind–body therapies; resilience; emotional regulation and parent–child co-regulation

Special Issue Information

Dear Colleagues,

We are witnessing dramatic increases in mental health concerns and chronic health conditions—including obesity, diabetes, and liver disease—appearing at ever younger ages. A growing body of research highlights stress biology as a central, underlying contributor. At the same time, stress biology offers tremendous opportunities, including new insights into how we can better understand and treat toxic stress, with the potential to profoundly improve both mental and physical health outcomes.

The National Academies of Science, Engineering, and Medicine define toxic stress as the “prolonged activation of the stress response systems that can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment well into the adult years.”

This Special Issue is dedicated to exploring innovative interventions and treatments for toxic stress. We are particularly interested in multidisciplinary approaches that translate recent scientific breakthroughs into clinical practice. Our goal is to showcase integrative approaches—including psychosocial programs, medications and supplements, and lifestyle medicine strategies—that demonstrate measurable improvements at the physiological or neurobiological level.

We welcome original research, systematic and narrative reviews, and clinical studies on emerging biomarkers, novel interventions, and longitudinal outcomes. Studies highlighting therapeutic interventions and improvements in stress-related biomarkers, wearable technology data, or neurophysiological mechanisms are especially encouraged.

Together, we can expand the current evidence base and accelerate the translation of science into practice, helping to reduce the burden of toxic stress and foster resilience across the lifespan.

We look forward to your contributions.

Kind regards,

Dr. Rachel Gilgoff
Guest Editor

Dr. Devika Bhushan
Dr. Jorina M. Elbers
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • toxic stress
  • adverse childhood experiences
  • neurobiology
  • physiology
  • biomarkers
  • wearable technology
  • interventions
  • psychosocial programs
  • medications and supplements
  • lifestyle medicine
  • chronic stress
  • stress
  • stress biology
  • resilience
  • adversity
  • trauma
  • immunology
  • metabolism
  • endocrinology
  • post-traumatic growth
  • recovery

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

16 pages, 1423 KB  
Article
Developing a Mindfulness Program for Families in a Pediatric Weight Management Clinic
by Megan Lane, Bobby Verdugo, Natacha D. Emerson, Miranda Kim, Qiang Zhang, Christine K. Thang, Cambria L. Garell, Allison Gabriella Depas, Wendelin M. Slusser, Shanika Boyce and Alma D. Guerrero
Children 2026, 13(5), 601; https://doi.org/10.3390/children13050601 - 27 Apr 2026
Viewed by 267
Abstract
Background/Objectives: Pediatric obesity is a public health epidemic in the United States and in many countries worldwide. Due to the interrelatedness of obesity and toxic stress, mindfulness is a promising practice to support healthful eating behaviors and combat stress in the management of [...] Read more.
Background/Objectives: Pediatric obesity is a public health epidemic in the United States and in many countries worldwide. Due to the interrelatedness of obesity and toxic stress, mindfulness is a promising practice to support healthful eating behaviors and combat stress in the management of this condition. In this pilot study we evaluated the acceptability and feasibility of implementing a brief mindfulness-based program for pediatric patients seeking treatment for overweight and obesity, with an assessment of exploratory outcomes. Methods: Nineteen children (ages 8–17 with body mass indices (BMIs) ≥ the 85th percentile) and caregiver dyads (n = 19) were recruited from a multidisciplinary pediatric weight management clinic. Four thirty-minute psychoeducational mindfulness-based sessions were provided via telehealth. Qualitative feedback was sought during and after program completion. Child and caregiver mindful eating and general mindfulness measures were collected from participant dyads at baseline, and one month and three months after program completion. Results: Qualitative program feedback from participants was generally positive. Session attendance rates were high (89%), with most participants highly engaged during sessions and the follow-up clinic visits. An analysis of exploratory measures data revealed no significant changes in child or caregiver dyad mindful eating or general mindfulness scores at one month (n = 9) or three months (n = 7) post-program completion compared to baseline (n = 10). Conclusions: This pilot, mindfulness-based program was feasible and acceptable to implement as a scalable behavioral intervention in long-term pediatric obesity treatment. Study of a larger, controlled sample is needed to determine the impact of program participation on mindful eating and general mindfulness, along with clinical obesity-related outcomes, in the management of pediatric obesity. Full article
(This article belongs to the Special Issue Treating Toxic Stress in Pediatric Clinical Practice)
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18 pages, 1248 KB  
Article
Families Implementing Resilient Systems Together (FIRST)
by Ariane Marie-Mitchell, Catherine A. Tan, Elizabeth Park, Gabriela A. Plascencia and Cameron L. Neece
Children 2026, 13(4), 572; https://doi.org/10.3390/children13040572 - 20 Apr 2026
Viewed by 520
Abstract
Background/Objectives: Prior research suggests that it is possible to improve health outcomes in children with adverse childhood experiences (ACEs) through multi-component interventions that promote protective factors. We designed the Families Implementing Resilient Systems Together (FIRST) study to address the gaps in research [...] Read more.
Background/Objectives: Prior research suggests that it is possible to improve health outcomes in children with adverse childhood experiences (ACEs) through multi-component interventions that promote protective factors. We designed the Families Implementing Resilient Systems Together (FIRST) study to address the gaps in research on the potential effectiveness of screening for specific ACEs through pediatric practice. Methods: As part of our clinical quality improvement efforts to improve patient care for children impacted by ACEs, we trained a random sample of pediatricians on strategies to promote protective factors and encouraged them to make referrals to community health workers (CHWs) and parenting education resources. This manuscript describes our clinic data on practice changes associated with the FIRST physician training, and our data collection plan for our research study. Results: Physician training resulted in attitudinal shifts and measurable behavioral changes. Trained providers made referrals to CHWs for approximately 5–10% of well-child care visits. The majority (84%) of referrals were for multiple risk factors, most commonly ACEs and socioeconomic concerns. The most common ACEs were parental divorce/separation, parent–child verbal abuse, and caregiver mental health problems. Conclusions: FIRST training improves counseling, education and referrals for children exposed to ACEs. Our research study will evaluate the impact of the FIRST intervention and address important questions about associations between specific ACEs, protective factors, and biomarkers of toxic stress. Full article
(This article belongs to the Special Issue Treating Toxic Stress in Pediatric Clinical Practice)
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