CHICAGO — A teacher turned doctor has made some suggestions about lowering stress levels in students.

Dr. Kavitha Selvaraj of the Ann and Robert H. Lurie Children’s Hospital in Chicago suggested giving teachers a professional support network, strategies to de-escalate charged situations and ways to manage behavior in children with high ACE scores.

“We have worked closely with the American Academy of Pediatrics Association and leadership to create best practices on bully and peer victimization assessment,” said Dorothy Espelage, a psychology professor at the University of Florida in Gainesville, who wasn’t involved in the study.

Pediatricians can help build resilience in both children and teachers to counter the effects of traumatic childhood experiences, poverty and violence, Selvaraj wrote in the journal Pediatrics.

“Before I was a pediatrician, I was a teacher, ” Selvaraj told Reuters Health. “And in my clinic, I hear personal stories about people’s children and families that remind me of stories I heard from my students.”

In the essay, Selvaraj wrote about her own experiences as a teacher in a stressed environment. A seventh grade biology and health teacher in an underserved neighborhood, she wanted to serve as a role model and inspiration. But in her first year as a teacher, she felt extremely underprepared to handle behavioral outbursts — including being punched in the face by a student — and felt like she spent little time teaching.

Selvaraj nearly quit that year, but didn’t. The students began to trust her and they began visiting her classroom outside class time. One confided that he was often hungry and found it hard to concentrate at school. Another said he had nightmares after witnessing a fatal shooting in his neighborhood. Another said she was sexually abused by her stepbrother. Selvaraj was able to help these kids with food pantry referrals, conferences with parents and school counselors and calls to the Department of Child and Family Services, respectively.

“Although I do not recommend getting punched in the face to help children thrive,” she wrote, “the chain of events that unraveled showed me that as a teacher and a caring adult figure, I was in a unique position to limit the long-term effects of toxic stress.”

Toxic situations at home can have an effect on young people.

These adverse childhood experiences, also known as ACEs, and early exposure to poverty can lead to toxic stress in children and negative health problems later in life. They also contribute to a higher chance of heart attack, stroke, mental health problems and substance abuse.

She said pediatricians and teachers can team up to ask students, “What is happening to you?” rather than focusing on, “Why are you behaving this way?” Children with toxic stress have complex educational, behavioral and medical needs that can’t be handled by one industry or one person.

Doctor-school collaborations have been successful for children with development disorders, ADHD, under-nutrition, obesity, food allergies and asthma. Toxic stress can be added to that list, Selvaraj said.

Addressing teacher stress, too, can help with burnout and teacher turnover.

Selvaraj suggests promoting “the seven C’s” of resilience: Competence, confidence, connection, character, contribution, coping and control. This includes teaching emotional self-regulation strategies such as meditation and mindfulness in both the classroom and clinic, she said. Doctors and teachers can also talk regularly about at-risk children and their progress.