War-Related PTSD and Its Impact on Neuroendocrine Function, Immune Dysregulation, and Growth in Children: Implications for Syrian Children

Abstract War exposure and displacement increase the risk of posttraumatic stress disorder in children and may coincide with alterations in stress biology, inflammation, growth, and family functioning, with Syrian populations disproportionately affected. We conducted a targeted review informed by the SAMS 2025 poster bibliography with supplementary searches of PubMed/PMC and Google Scholar (2010–2025). Eligible studies included conflict-affected children/adolescents (0–18 years) with PTSD measures and at least one biological or developmental outcome. Two reviewers screened and extracted data and appraised study quality using JBI/NOS-aligned domains. Evidence included school-based samples within Syria and Syrian refugee cohorts in host countries, alongside mechanistic reviews. Findings showed higher cortisol/HPA-axis activity reported in trauma-exposed pediatric samples, and Syrian refugee studies using hair cortisol suggest associations between war exposure and PTSD symptoms. Mechanistic literature suggests possible elevations in inflammatory markers (e.g., IL-6, CRP) in some contexts, but conflict-specific pediatric biomarker data remain limited. Growth impacts are plausibly mediated by cumulative adversity and nutrition insecurity, with sparse direct Syrian cohort evidence. Syrian conflict-affected children experience a substantial mental health burden, and available data suggest biological embedding of trauma via stress and immune pathways; however, most studies are observational and confounding limits causal inference. Epigenetic and intergenerational findings should be interpreted as preliminary and hypothesis-generating. Future longitudinal studies with standardized measures and careful confounding control are needed.