The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology.

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review.

AIMS: Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS: For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS: Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS: ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.

Teaching to Empower: Leveraging the Neuroscience of Now to Help Students Become Self-Regulated Learners.

In his book Descartes' Error, neurologist Antonio Damasio argues that humans do not make decisions by relying exclusively on the rational or reason-oriented parts of their brain (2008). Evidence from patients with brain damage reveal that our abilities to reason and make decisions are greatly influenced by our emotions (Damasio et al., 1990; Saver and Damasio, 1991). In fact, our emotions and how we feel act as a gateway to our thinking and learning by providing "the bridge between rational [prefrontal cortex] and nonrational processes" [brainstem and limbic structures]." (Damasio, 2008). Understanding the ways in which our brain processes sensory inputs and integrates those inputs into our ongoing emotional state is critical for helping students become self-regulated, sophisticated learners. In the following article, I will begin by briefly summarizing the role of emotions in learning and the impact of toxic stress on our students' ability to engage, learn, and thrive. I will then define and present a trauma-informed teaching and learning paradigm with practical strategies that empower students to continue to learn and succeed. I will address a few misconceptions about trauma-informed education. I will conclude by making a plea to you, members of the undergraduate neuroscience community, by presenting a case for the utility and moral imperative of educating our students about the basic functioning of their brains, especially as it relates to emotional regulation and learning.

Childhood Maltreatment and Toxic Stress: What We Have Learned From the COVID-19 Pandemic Era.

Stress is a natural state that emerges due to the dynamics of an individual's life. Children must learn how to effectively manage stress as part of their growth and development. Resolution is possible when children are exposed to stress and receive adequate support from their families. However, when stress is intense, frequent, protracted, or traumatic, as in cases of childhood abuse, it can become toxic and interfere with the development of the child's brain and body. This results in vulnerability, which can have detrimental effects on the child's overall physical, mental, and emotional health. This perspective discusses the impact of childhood maltreatment and toxic stress, drawing on insights gained during the COVID-19 pandemic. We aimed to shed light on the lessons learned from this unique and challenging period and how they inform our understanding of the effects of stress on children's well-being.

Genome-Wide Identification of OsZIPs in Rice and Gene Expression Analysis under Manganese and Selenium Stress.

Zinc (Zn)- and iron (Fe)-regulating transport-like proteins (ZIPs) are a class of proteins crucial for metal uptake and transport in plants, particularly for Zn and Fe absorption and distribution. These proteins ensure the balance of trace elements essential for plant growth, development, and metabolic activities. However, the role of the rice (Oryza sativa) OsZIP gene family in manganese (Mn) and selenium (Se) transport remains underexplored. This research conducted an all-sided analysis of the rice OsZIPs and identified 16 OsZIP sequences. Phylogenetic analysis categorized the OsZIPs predominantly within the three subfamilies. The expression levels of OsZIPs in rice root and leaf subjected to Mn and Se toxicity stress were examined through quantitative real-time PCR (qRT-PCR). The findings revealed significant differential expression of many OsZIPs under these conditions, indicating a potential regulating effect in the response of rice to Mn and Se toxicity. This work lays a foundation for further functional studies of OsZIPs, enhancing our understanding of the response mechanisms of rice to Mn and Se toxicity and their roles in growth, development, and environmental adaptation.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme.

Introduction: Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women's and Children's Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families. Method: Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022. Results: Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment. Conclusion: Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

Trauma-informed care.

In recent years, trauma informed care has become a heavily researched topic; however, it has yet to achieve a universal standard in the field of pediatric medicine. One of the primary tenants of trauma informed care is a clear understanding of the pervasiveness and complexities of childhood trauma, and its intersection with a child and caregiver's physical wellness. A major component of trauma informed care is addressing the way medical providers may be exposed to vicarious trauma, secondary traumatic stress, and compassion fatigue. By taking proactive steps to educate medical providers on the effects of trauma, they are better equipped to assess a family's needs and provide enhanced quality of care for their patients and themselves.

Toxic Stress as a Potential Factor Inducing Negative Emotions in Parents of Newborns and Infants with Cyanotic Congenital Heart Disease.

BACKGROUND: Parents who have a newborn with a congenital heart defect experience negative emotions, which may determine the emotional state of their children. METHODS: The study group included 154 parents of newborns and infants with cyanotic congenital heart disease, before cardiac surgery and after the procedure. HADS m and PSS-10 questionnaires were used to assess parental anxiety, depression, aggression, and the level of stress. RESULTS: High levels of depression, anxiety, total HADS and stress were diagnosed in a large group of parents, regardless of the stage of cardiac surgery treatment. A high level of stress was associated with a higher prevalence of emotional disturbance both in the total HADS (overall) and in all its individual domains. Anxiety and depression were more common in mothers. A high level of stress was a significant predictor of anxiety and depression in parents. CONCLUSIONS: A high level of stress was a significant predictor of anxiety and depression in parents of infants with congenital heart disease. The parents' psychological condition is one of many potential determinants over the course of their child's treatment and recovery.

Implementación de intervenciones que aborden las experiencias adversas en la infancia en atención primaria: una revisión exploratoria

Introducción: La vivencia de experiencias adversas en la infancia (EAI) se asocia a mayor riesgo de presentar conductas de riesgo y enfermedades crónicas a largo plazo. A nivel mundial, se han comenzado a pesquisar y abordar en las atenciones de salud. Sin embargo, en Chile aún no existe una sugerencia a nivel nacional para incorporarlo. El fin de este artículo es proveer de información y recomendaciones a la práctica clínica. Métodos: Se realizó una revisión exploratoria en PubMed, LILACS y PsycInfo usando el marco metodológico del Joanna Briggs Institute para identificar la literatura disponible sobre implementación de intervenciones en detección y abordaje de EAI dentro de un sistema de salud, con foco en atención infantil ambulatoria. Resultados: Se encontraron 34 estudios atingentes al tema, los que muestran que implementar mecanismos de detección y abordaje de EAI es factible y aceptable, tanto para el personal de salud como para los usuarios, pero debe ser realizado dentro de un modelo de cuidado que incorpore a las familias y comunidad, además de trabajar con los equipos en capacitación, gestión del cambio, implementación y evaluación. Conclusiones: La Atención Primaria de Salud (APS) resulta ser un lugar privilegiado para su implementación dada la cercanía y relación de confianza que se establece con las familias. Este estudio muestra que es posible implementar un modelo de detección y abordaje de EAI en APS, lo que resulta crucial dentro de su rol preventivo-promocional si se quiere generar un impacto en la salud de niños, niñas y adolescentes ahora y en el futuro.

Introduction: Adverse childhood experiences (ACEs) are associated with an increased risk of developing risky health behaviors and chronic diseases in the long term. Screening for ACEs is beginning to be implemented worldwide in healthcare settings due to their known impact on present and future health. However, in Chile, there are no recommendations to incorporate ACEs screening into usual care. Methods: A scoping review was conducted using the Joanna Briggs Institute methodological framework to identify available literature on the implementation of interventions aimed at the detection and management of ACEs within a health system, specifically pediatric primary care. The search included PubMed, LILACS, and PsycInfo databases. Results: A total of 34 studies were included. They show that screening for ACEs is feasible and acceptable for both health care providers and users. However, it must be implemented as a part of a model of care that considers families and communities, besides working with health teams in training, change management, implementation, and evaluation. Conclusions: Primary Health Care (PHC) is a privileged setting for screening implementation because of the longitudinal and trust relationships established with families. This study concludes that it is possible to implement a model for detecting and managing ACEs in PHC, which will be crucial for its promotional and preventive role if there is a desire to generate an impact on infant and adolescent health now and in the future.

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

Abstract Objective: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. Methods: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. Results: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). Conclusion: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

Toxic stress on a pediatric population during the COVID-19 pandemic / Estresse tóxico em uma população pediátrica durante a pandemia de COVID-19

Abstract Objective: The aim of this study was to analyze the impact of social isolation as a result of the coronavirus-19 disease (COVID-19) pandemic in children and adolescents aged 0-17 years in Southern Brazil. Methods: This is a cross-sectional study in which 542 questionnaires answered by parents or legal guardians of children and adolescents aged 0-17 years residing in the Brazilian South region, through Google Forms®. Questionnaires answered incompletely or from children outside the stipulated age group and from other regions of the country were excluded from the research. The collected data were organized into descriptive and association tables containing absolute and relative frequencies, medians, averages, standard deviations, quartile deviations, average, and proportion estimates in the form of 95% confidence intervals and the result of the chi-square test of independence. Data analysis was fulfilled with the application aid of Microsoft Excel 2016 and Epi Info version 7.2.1.0 of 01/27/2017. Statistically significant associations were considered when p<0.05. Results: There was an increase in the perception of nervousness (62.7%), anxiety (67.7%), and sadness (51.3%) in children and adolescents during the pandemic period. This study evidenced a high prevalence of screens overuse (50.9%) and sedentary lifestyle (39.1%) in this age group during the period. Furthermore, the occurrence of regressive behaviors occurred more frequently in the age group of 3-6 years (57.1%) and between 7 and 10 years (44.6%). Conclusions: It is inferred from this study that one of the implications resulting from the pandemic period is the increase of toxic stress in the pediatric population.

RESUMO Objetivo: Analisar o impacto do isolamento social em decorrência da pandemia associada ao coronavírus 2019 (COVID-19), em crianças e adolescentes de zero a 17 anos da Região Sul do Brasil. Métodos: Trata-se de um estudo de corte transversal em que foram obtidos 542 questionários, respondidos por pais ou responsáveis legais de crianças e adolescentes de zero a 17 anos residentes da Região Sul brasileira, por meio do Google Forms®. Questionários respondidos de maneira incompleta ou de crianças fora da faixa etária estipulada e de outras regiões do país foram excluídos da pesquisa. Os dados colhidos foram organizados em tabelas descritivas e de associação contendo frequências absolutas, relativas, médias, medianas, desvios padrão, desvios quartílicos, estimativas de média e de proporção em forma de intervalos com 95% de confiança e resultado do teste do qui-quadrado de independência. A análise dos dados foi realizada com o auxílio dos aplicativos Microsoft Excel 2016 e Epi Info versão 7.2.1.0, de 27 de janeiro de 2017. Foram consideradas associações estatisticamente significativas quando p<0,05. Resultados: Houve aumento da percepção de nervosismo (62,7%), ansiedade (67,7%) e tristeza (51,3%) em crianças e adolescentes no período da pandemia. O estudo evidenciou alta prevalência de uso excessivo de telas (48,2%) e de sedentarismo (39,1%) nessa faixa etária durante o período. Ademais, a ocorrência de comportamentos regressivos ocorreu de maneira mais frequente nas faixas etárias de 3-6 anos (57,1%) e de 7-10 anos (44,6%). Conclusões: Infere-se deste estudo que uma das implicações do período da pandemia é o aumento do estresse tóxico na população pediátrica.

Toxic stress, epigenetics and child development

Abstract Objectives: To describe the concept of toxic stress, present the basics of epigenetics and discuss their relationship with child development. Data source: Narrative literature review through a search in the SciELO, Lilacs, Medline databases using the terms Adverse Childhood Experience OR Early Life Stress, Epigenomic OR Epigenetic, Child Development OR Infant Development. Data synthesis: Continuing stress response, known as toxic stress, can occur when a child experiences intense, frequent, and/or prolonged adversity-such as physical or emotional abuse, chronic neglect, for example-without adequate adult support. This toxic stress can have harmful effects on learning, behavior, and health throughout life. Epigenetics, an emerging scientific research area, shows how environmental influences affect gene expressions and explains how early experiences can impact throughout life. Conclusions: Toxic stress causes changes in the human body response systems that can be explained in part by epigenetic changes, which can be temporary or long-lasting. Pediatricians must be aware of these mechanisms and their consequences, seeking to prevent them and thus promote the health, well-being, and quality of life of children, contributing to their full development.

Pobreza, traumas tempranos, déficit atencional y deserción educacional: un círculo de daño. Lecciones aprendidas en el Programa Soymás, La Pintana / Poverty, early trauma, attention deficit and educational dropout: a circle of harm. Lessons learned in the Soymás Program, La Pintana

El antecedente de maltrato infantil y el Trastorno por Déficit de Atención e Hiperactividad (TDAH), son condiciones que tienen una alta prevalencia en los jóvenes de sectores vulnerables. Analizamos su relación con deserción escolar, que también es mayor en tales contextos. La deserción es un fenómeno multifactorial, influenciado por factores propios del estudiante, de la institución, del contexto familiar y del entorno social. Presentamos hallazgos en la Fundación Soymás, institución de formación para madres adolescentes, localizada en La Pintana, una de las comunas con mayor pobreza en Chile, donde la deserción en 2022 fue 45%. De acuerdo a la encuesta ACES de 10 eventos traumáticos en la niñez, 50% de las estudiantes sufrió 3 o más, y 21% 7 o más. Al menos un 40% de la población cumplía criterios de TDAH y un 30% adicional manifestaba síntomas sugerentes (versus 4,5% de TDAH reportado en adolescentes del país). Constatamos una asociación directa entre las tres variables: Maltrato, TDAH y Deserción. Estos hallazgos deberían ser considerados en políticas públicas, reforzando la necesidad de colaboración entre Salud y Educación.

A history of child abuse and Attention Deficit Hyperactivity Disorder (ADHD) are conditions that have a high prevalence in young people from vulnerable sectors. We analyze its relationship with school dropout, which is also higher in such contexts. Dropout is a multifactorial phenomenon, influenced by factors specific to the student, the institution, the family context, and the social environment. We present findings at the Soymás Foundation, a training institution for adolescent mothers, located in La Pintana, one of the counties with the highest poverty in Chile, where dropout in 2022 was 45%. According to the ACES survey of 10 traumatic events in childhood, 50% of the students suffered 3 or more, and 21% 7 or more. At least 40% of the population met the criteria for ADHD and an additional 30% manifested suggestive symptoms (versus 4.5% of ADHD reported in adolescents in the country). We found a direct association between the three variables: Abuse, ADHD and Desertion. These findings should be considered in public policies, reinforcing the need for collaboration between Health and Education.

The potential impact of the COVID-19 pandemic on child growth and development: a systematic review

Abstract Objective This was a systematic review of studies that examined the impact of epidemics or social restriction on mental and developmental health in parents and children/adolescents. Source of data The PubMed, WHO COVID-19, and SciELO databases were searched on March 15, 2020, and on April 25, 2020, filtering for children (0-18 years) and humans. Synthesis of data The tools used to mitigate the threat of a pandemic such as COVID-19 may very well threaten child growth and development. These tools — such as social restrictions, shutdowns, and school closures — contribute to stress in parents and children and can become risk factors that threaten child growth and development and may compromise the Sustainable Development Goals. The studies reviewed suggest that epidemics can lead to high levels of stress in parents and children, which begin with concerns about children becoming infected. These studies describe several potential mental and emotional consequences of epidemics such as COVID-19, H1N1, AIDS, and Ebola: severe anxiety or depression among parents and acute stress disorder, post-traumatic stress, anxiety disorders, and depression among children. These data can be related to adverse childhood experiences and elevated risk of toxic stress. The more adverse experiences, the greater the risk of developmental delays and health problems in adulthood, such as cognitive impairment, substance abuse, depression, and non-communicable diseases. Conclusion Information about the impact of epidemics on parents and children is relevant to policy makers to aid them in developing strategies to help families cope with epidemic/pandemic-driven adversity and ensure their children's healthy development.

The formation of citizens: the pediatrician's role / A formação do cidadão: papel do pediatra

ABSTRACT Objective: This review article aims to define the fundamental role of the pediatrician in the formation of citizens in the 21st century. Source of data: Significant bibliographical contributions produced by neuroscience, ecology, and epigenetics in the early childhood scenario. Synthesis of data: Many diseases that impair the lives of adults result from severe and often uncontrollable disorders that occur in early childhood, an irreplaceable period for the safe construction of the human brain, personality, and intelligence. There is noteworthy scientific evidence that has become unquestionable, according to which abuse and neglect and other forms of violence to which children are exposed during the the course of their lives, are the genesis of many physical ailments and other mental diseases, including depressive morbidity and schizophrenia. Conversely, it is also emphasized that healthy practices such as reading and listening to/playing music are able to intensively contribute to the exercise of cognitive capacity inherent to this period of life, as a prerequisite for the acquisition of learning indispensable to the high educational performance during the schooling period. Conclusion: In the light of the disclosed scientific evidence, the pediatrician emerges as the most differentiated professional to provide preventive and curative care indispensable to the skilled formation of a healthy citizen.

RESUMO Objetivo: O presente artigo de revisão científica tem por objetivo configurar o papel fundamental do pediatra na formação do cidadão do século XXI. Fontes dos dados: Contribuições bibliográficas importantes produzidas pela neurociência, ecologia e epigenética no âmbito da primeira infância. Síntese dos dados: Grande número de doenças que desqualificam a vida de pessoas adultas resulta de sérios, e muitas vezes incontroláveis, distúrbios, que ocorrem na primeira infância, período insubstituível para a construção segura do cérebro, da personalidade e da inteligência humana. Destaca-se a evidência científica que se tornou inquestionável, segundo a qual os abusos e negligência e outras formas de violência, às quais a criança é exposta durante o ciclo de vida de mais complexa dinâmica existencial, estão na gênese de várias enfermidades físicas e outras de natureza mental, inclusive as morbidades depressivas e a própria esquizofrenia. Ressalta, por outro lado, as práticas saudáveis como a leitura e a música, capazes de contribuir intensamente para o exercício da capacidade cognitiva inerente a esse período de vida como prerrequisito para aquisição da aprendizagem indispensável à alta performance educacional no período da escolaridade. Conclusão: À luz das evidências científicas arroladas, o pediatra emerge como o profissional mais diferenciado para a prestação dos cuidados preventivos e curativos indispensáveis à estruturação qualificada de um cidadão saudável.

Evaluation of child development: beyond the neuromotor aspect / Avaliação do desenvolvimento infantil: além do neuromotor

Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.

Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.