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Strengthening early relational health: strategies and system-level considerations for pediatric primary care

Sarah Behrens1, Brenda Salley1

  • 1Department of Pediatrics, Division of Developmental and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States.

Frontiers in Pediatrics
|June 22, 2026
PubMed

Insights

Early relational health (ERH) is vital for child development. Pediatric primary care can integrate ERH support through practical strategies, despite existing system barriers.

Area of Science:

  • Child Development
  • Pediatric Primary Care
  • Public Health

Background:

  • Early relational health (ERH) is foundational for social-emotional development, learning, and lifelong well-being.
  • Responsive caregiver-child relationships impact brain architecture, stress regulation, and resilience to adversity.
  • The American Academy of Pediatrics (AAP) recommends systematic ERH support in pediatric primary care.

Purpose of the Study:

  • To synthesize evidence on integrating ERH promotion into pediatric primary care.
  • To highlight practical strategies for enhancing ERH within this setting.
  • To address system-level barriers hindering universal ERH support.

Main Methods:

  • Review and synthesis of emerging evidence on ERH interventions.
  • Identification of practical strategies for pediatric primary care settings.
  • Analysis of system-level barriers and potential policy reforms.

Main Results:

  • System-level barriers (time, training, referrals, reimbursement) impede universal ERH support.
  • Practical strategies include caregiver coaching, strengths-based observation, social-emotional screening, and digital tools.
  • Interdisciplinary teams and community linkages are crucial for effective ERH integration.

Conclusions:

  • Integrating ERH into pediatric primary care requires practice transformation and cross-sector collaboration.
  • Policy reforms are necessary to support scalable, relationship-centered models of care.
  • Strengthening family capacity through ERH enhances child developmental trajectories.

Keywords:
caregiver-child relationshipsearly childhood developmentearly relational healthpediatric primary caresocial-emotional development

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