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Left unchecked, mediators of physiologic stress become toxic, alter both genome and brain, and lead to a vicious cycle of chronic stress. This so-called \u201ctoxic stress\u201d results a wide array of behavioral attempts to blunt the stress response, a process known as \u201cbehavioral allostasis.\u201d Although behaviors like smoking, overeating, promiscuity, and substance abuse decrease stress transiently, over time they become maladaptive and result in the unhealthy lifestyles and noncommunicable diseases that are the leading causes of morbidity and mortality. The biology of toxic stress and the concept of behavioral allostasis shed new light on the developmental origins of lifelong disease and highlight opportunities for early intervention and prevention. Future efforts to minimize the effects of childhood adversity should focus on expanding the capacity of caregivers and communities to promote (1) the safe, stable, and nurturing relationships that buffer toxic stress, and (2) the rudimentary but foundational social-emotional, language, and cognitive skills needed to develop healthy, adaptive coping skills. Building these critical caregiver and community capacities will require a public health approach with unprecedented levels of collaboration and coordination between the healthcare, childcare, early education, early intervention, and home visiting sectors.<\/jats:p>","DOI":"10.1542\/peds.2013-1021d","type":"journal-article","created":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T16:20:01Z","timestamp":1383322801000},"page":"S65-S73","source":"Crossref","is-referenced-by-count":113,"title":["Home Visiting and the Biology of Toxic Stress: Opportunities to Address Early Childhood Adversity"],"prefix":"10.1542","volume":"132","author":[{"given":"Andrew S.","family":"Garner","sequence":"first","affiliation":[{"name":"University Hospitals Medical Practices, and Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,11,1]]},"reference":[{"issue":"12","key":"2021120903460396300_B1","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1001\/archpedi.160.12.1232","article-title":"Effect of early childhood adversity on child health.","volume":"160","author":"Flaherty","year":"2006","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"3","key":"2021120903460396300_B2","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.acap.2008.11.003","article-title":"Adverse childhood exposures and reported child health at age 12.","volume":"9","author":"Flaherty","year":"2009","journal-title":"Acad Pediatr"},{"issue":"1","key":"2021120903460396300_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2011-2663","article-title":"The lifelong effects of early childhood adversity and toxic stress.","volume":"129","author":"Shonkoff","year":"2012","journal-title":"Pediatrics"},{"issue":"3","key":"2021120903460396300_B4","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1007\/s00406-005-0624-4","article-title":"The enduring effects of abuse and related adverse experiences in childhood. 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