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Dr. Winter Berry

Upstate pediatricians to participate in Harvard research to study effects of toxic stress on children

The pediatrics department at Upstate University Hospital will soon be participating in a novel national research project with Harvard University to study how toxic stress (or early childhood adversity) affects children and their development.

For the last several years, Upstate Pediatric and Adolescent Center – a resident-based primary care clinic – has participated in the HealthySteps program, which can provide additional health, development, parenting and support resources for families living in low-income communities. The program aims to improve childrens’ school readiness and overall well-being. Upstate’s participation in HealthySteps provided an opportunity to be a part of this new study by the Center on the Developing Child at Harvard.

Pediatrician Winter Berry, DO, who oversees the HealthySteps program at Upstate, applied to participate in the Harvard study, which is being conducted by the JPB Research Network on Toxic Stress. The study will look at how biological information can indicate an individual child’s sensitivity to stressors in childhood that can affect development and the effectiveness of interventions to help or correct those issues. This biologic information will measure each child’s levels of substances such as stress hormones, signs of inflammation and the effects of stressors on the child’s genetic material.

Starting this spring, Upstate pediatricians will begin asking families to participate in the non-invasive, confidential study. The request will be part of a well-child visit and the research methods are intentionally basic to allow for wider and easier data collection when the project is eventually scaled to reach more children, Berry said.

Participating child patients will undergo a cheek swab and donate a small lock of hair, which will be submitted to the Harvard researchers. The child’s caregivers will also participate in several iPad-based screenings to learn more about the child’s developmental skills, home life, environment and potential exposure to stressors such as poverty, housing instability and violence to name a few. All of the information is gathered and submitted to Harvard anonymously. Participating families will be compensated with a book and a gift card, Berry said.

The study is looking to have between 200 and 300 children, age 4 months to either 3 or 5 years old participate through Upstate (the age range is still being determined). Researchers hope to create a database of biological baselines that could indicate the effects of stressors and how this risk of resilience varies in individual children. This study is looking to include a diverse sample population to create a broader database of biological norms, Berry said.

The research is novel and could have long-term benefits for healthy childhood development.

“What they are shooting for is that eventually you have an objective, concrete way to assess when there’s a group of kids that are exposed to similar stressors, which of them respond with resilience in the face of those stressors, which are more susceptible to biologic, – executive functioning, social and emotional – consequences,” Berry said. “With more patient-specific information you can prioritize, you can triage, you can individualize the supports they get and potentially also follow their response to those interventions.

“Right now we largely have qualitative and somewhat quantitative measures of these kinds of outcomes, but this would be novel to have biomarkers to follow.”

With data collection expected to run from April 2020 to June 2021, Harvard researchers have not said if any of the data will eventually be returned to Upstate. Berry said she’s hopeful Upstate’s participation now will also help its chances of participating in later phases of the study, which could include data back to parents to help them make shared decisions with their pediatrician about their child’s personal response to stressors.

“If we were able to know who was most affected by toxic stress and whether they are responding adequately to the interventions we’re giving, we can tailor the supports for people who really need them in a way that we can check in on whether it’s effective or not,” Berry said. “That’s a practical approach, and a step in the right direction in my opinion, to tackle these issues because there’s never a one-size-fits-all solution to these multifaceted problems.”

About 9,000 patients account for 27,000 visits to Upstate Pediatric and Adolescent Center providers every year and 85 percent of patients are Medicaid eligible. About 200 families participate in HealthySteps, Berry said. Those families will be a good starting point for participants in the Harvard study but this research will involve more than just HealthySteps patients and families.

“The things that challenge our families are exactly why we are well poised to be a study site for this,” she said. “I think we have diversity in patients we’re enrolling and diversity in life experience and our poverty statistics put us in the center of exactly where there’s opportunity to make change.

“It’s really cool research and the opportunity to participate in this stage will make Upstate a place where patients and families are on the cutting edge of informed decision making about positive outcomes for their children.”

Caption: Pediatrician Winter Berry, DO, who oversees the HealthySteps program at Upstate, made the connection to participate in the Harvard study, which will look at how biological information can indicate an individual child’s sensitivity to stressors in childhood.