CONCLUSION Now You Can WEAVE (Wind Everything All together Very Effectively)! It is becoming clear that the work of pediatrics is very much the work of promoting resilience and responding to trauma. What we once thought were isolated physical, developmental, and behavioral diagnoses can, more oft en than we would like, turn out to be signs and symptoms of the balance between interpersonal stressors and supports early in life. Th ese stressors, if unbuff ered by the attach- ment relationships designed to provide safety and a secure base for healthy development, can have profound and long- lasting impacts. Th ese biological impacts fundamentally change the brain and body in ways that can profoundly aff ect the health of children and adults interfacing with the health care system. X Th ey alter brain development so the achievement of safety, driven by primitive lower-level brain structures, comes at the cost of healthy social, emotional, and physical development. X Th ey alter immune, hormonal, and organ systems, aff ecting physical health and the body’s sensitivity to stress, resulting in functional changes, pain, and acute and chronic illnesses. In this way, they aff ect our perceptions of our bodies. X Th ey alter the mental maps of one’s self and the world, changing the ability to trust and engage in healthy relationships, including the most fundamental attachment relationships. X Th ey alter the perception of past events and expectations about the future, aff ecting behaviors and the interpreta- tion of life events, the future, effi cacy, and hope. But the good news is that we can support and infl uence relationships for the better. With the families we care for and with our practice partners, we can WEAVE. As pediatric professionals, we can promote attachment (the warp thread on our loom), regulation, and effi cacy in our young patients and in their caregivers. We can help weave the THREADS of resilience together, recog- nize when children are being FRAYED, and promote caregiver SEAMs skills. All of this work occurs in the FABRiC of the family, their broader social context, and their culture, which infl uences and is infl uenced by traumas. Th is process requires an organized approach to trauma- and resilience-informed care, in which we (1) build our knowledge and skills in this type of care so we can engage families and learn about the contexts of their lives within their culture, (2) forge trusting relation- ships with families in which we can promote wellness and healing from trauma, (3) build care teams that work collaboratively and support the integral contributions of all team members, and (4) embed within our practices, programs, and organizations the supports, training, and systems necessary to ensure that we are supported in bearing the weight of the stories and needs of the families we serve. We are not alone in these eff orts. In addition to the biologi- cal, foster, and kinship families we work with, our eff orts are joined by mental health colleagues and a community of allied professionals in schools, early childhood education, child care, child welfare, law enforcement, recreation, and the courts. However, pediatric providers have a unique and privileged role. Our expertise in physiology underlies our understanding of how to practically and eff ectively promote the relationships that protect children and build their resil- ience. Knowing how to respond to youth and families who are aff ected by trauma equips and empowers us to show others how to WEAVE so the network that supports all children and their families can be a tapestry, reinforcing and building the strengths and vibrancy of all. 199 CTAR BOOK.indb 199 5/16/21 2:54 PM
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