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Grand Rounds: Beyond Toxic Stress: What, Why and How


By Andrew Garner, MD, PhD, FAAP , Primary Care Pediatrician with Partners in Pediatrics, University Hospitals Medical Practices, Clinical Professor of Pediatrics, CWRU School of Medicine, Cleveland, OH

Objectives (Educational Content) :

1. Define toxic stress and describe how it helps to elucidate 'the problem'. 2. Define relational health and describe how it helps to elucidate 'the solution'. 3. Describe three different lenses that inform efforts to operationalize relational health.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

New methods to recognize and treat toxic stress.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:


Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.


The speaker, Andrew Garner, MD, PhD, has the following commercial/financial relationship to disclose: American Academy of Pediatrics: Nominal royalties for an AAP-published book that is used as a reference. The commercial/financial relationship listed for this individual has been mitigated.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.


Bethell et al., 2019. Health Affairs 38:729-737.

National Survey of Children’s Health, 2016-7, ages 6-17.

Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health, Garner and Saul, 2018.

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