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Toxic Stress: When Stress Moves from Manageable to Dangerous

Stress. It’s a concept with which we are all intimately acquainted. But when does stress go from a normal hormonal response that many of us experience on a daily basis to a toxic state that needs special attention? When hormonal changes that occur in response to frightening or threatening events or conditions are severe, they are termed toxic stress. School nurses who understand the causes and impacts of toxic stress in children can help identify, manage and prevent toxic stress.

What causes toxic stress in children?

Children exposed to frightening and threatening events are more likely to experience toxic stress. Any child can become stressed to a toxic level, but children whose families are struggling with financial problems, abuse, medical issues, trauma, and other difficulties may be more likely to struggle with this issue. Managing the COVID-19 pandemic is adding to many families’ stress level and impacting their ability to manage stress.

"There's no question that if you can't buy food or you can't pay your rent … you are experiencing the kind of stress that is going to be toxic to your children."
Phil Fisher, Professor of Psychology, University of Oregon

How does toxic stress impact children?

When experiencing stress, hormones are released that can interfere with neural connection in childhood brains. This makes them neurologically conditioned to overreact to adverse experiences in life. Toxic stress negatively impacts children’s:

  • Behavior
  • Cognitive capacity
  • Brain development
  • Emotional health
  • Physical health


Additionally, cortisol is released during toxic stress which can suppress the immune system and leave stressed children more prone to illness. (Selekman, Shannon and Yonkaitis, School Nursing: A Comprehensive Text, FA Davis, 2019, page 758.)

 How can school nurses help?

The role school nurses play in children's health goes beyond their physical health. School nurses are vital to supporting children’s mental and behavioral health as well. Stressed students often seek out the protective environment of the health office.

  • School nurses can sometimes identify toxic stress and direct a student to the appropriate resources.
  • School nurses can recognize in-school experiences that generate toxic stress responses and advocate to eliminate or manage those experiences.
  • School nurses can work with other school personnel to develop school-wide strategies that help create a positive school climate.


Whether caused by a family’s financial struggles, fear of disease, a recent death in the family, or another other traumatic issue, toxic stress impacts children in many ways, from their immune system to their behavior to their brain development. We all have enough stress in our everyday worlds. The ability to identify, help manage, and maybe even prevent toxic stress for children can change lives.

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