Neglect and cortisol levels

As paediatricians our roles can range from that of physiologist to social worker. Studies that link these disparate aspects of our work are particularly fascinating. It has been known for many years that chronic stress, including that brought on by neglect in early childhood, can have a profound effect on the function of the hypothalamic-pituitary-adrenal (HPA) axis. This can result in ‘blunting’ of normal diurnal variation of cortisol levels. A study from the US went further, demonstrating that effective interventions to support families of neglected children can actually help normalise HPA function (Bernard K et al. JAMA Pediatr 2014. doi:10.1001/jamapediatrics.2014.2369). They recruited 115 children aged 46–70 months who had been referred to Child Protective Services for neglect, but were still living with their birth families, and randomised them to either standard intervention, or a more intensive Attachment and Behavioral Catch-up (ABC) scheme. ABC involved teaching parents over 10 sessions to develop nurturing skills and emotional responsiveness, using trained coaches in the home. Waking and bedtime salivary cortisol levels were measured. Three months after the intervention, bedtime levels did not differ, but the intervention group …