Forging Ahead: AAP calls for Pediatricians to Partner with Families and Communities to Promote Relational Health

This week, the American Academy of Pediatrics (AAP) released a strong and unequivocal statement entitled Preventing Childhood Toxic Stress: Partnering  with Families and Communities to Promote Relational Health, that urges the field of pediatrics to commit to early relational health.[i] The National Early Relational Health (ERH) Coordinating Hub at the Center for the Study of Social Policy (CSSP) applauds this effort to translate the relational health framework into transformed clinical practice, generative research, and public policy.

Our ERH work has been grounded on the knowledge that the foundational relationships babies and toddlers experience with their caregivers provide the stability and supports needed for  health, development, and well-being—now and for a lifetime.[ii] The AAP  statement authoritatively illustrates how this concept of supporting safe, stable, and nurturing relationships (SSNR’s) builds on interdisciplinary research from the study of neurodevelopment, neurobiology, early childhood development, social-emotional development, mental health, resilience, and trauma.

The statement highlights that importance of focusing on opportunities for a positive, strengths-based, and solution-oriented response to mitigate toxic stress and a risk-based screening approach that has emphasized the potential negative biological consequences in the absence of supportive social and emotional buffers. Whereas the statement advances anew that relational health provides opportunities for a positive, strength-based, and solution-oriented response. The AAP writes: “Even more importantly, a strengths-based, relational health framework leverages those SSNRs [safe, stable, and nurturing relationships] to proactively promote the skills needed to respond to future adversity in a healthy, adaptive manner.”

In our ERH national survey—which included more than 500 responses from pediatricians and early childhood professionals and providers in public agencies, early childhood systems, and community coalitions across the nation—we learned much from the field.[iii] Responses indicated that people were knowledgeable about the concept of Early Relational Health and saw opportunities to increase focus on ERH through policy work, trainings, and practice needs. As an indication of interest and readiness, more than half of the respondents expressed enthusiasm in joining an action lab or ongoing opportunity for shared learning about ERH. 

The work of the Early Relational Health Coordinating Hub is grounded in an understanding of the importance of co-designing solutions and ensuring meaningful partnership with families and communities.[iv] Advancing ERH requires placing families in the lead and honoring the resiliency, strength, culture, and history of all families and communities. We must also directly address the structural and systemic barriers and policies that impede families’—especially those historically marginalized in society—ability to thrive in their parenting roles. The AAP statement calls for fostering strong, trusted, respectful, and effective collaborations with families and community partners. As they say: “Doing so will require all health professionals to address their implicit biases, develop cultural humility, and provide culturally competent recommendations.”

The work of CSSP’s National ERH Initiative is committed to advancing the recommendations and concepts in this important and timely new AAP policy statement. We are committed to advancing early relational health strategies for child health practice transformation, early childhood system building, and community change. In the coming months and years, our top goal is to advance communication and adoption of practices to strengthen early relational health in the child health field, with families and in communities, delivering:

  • A national consensus about emerging strategies that support foundational relationships within transforming child health practices and resilient communities as they face the challenges of supporting young families post-COVID.
  • Support for parent leadership and respect for families’ lived experiences, including co-designed approaches that advance equity and tackle systemic racism.
  • Trainings, materials, and resources in response to an urgent need for improved practices and systems that strengthen early relationships, particularly in the face of the COVID-19 public health emergency and its
  • New knowledge related to ERH, along with expanded communication strategies to share this knowledge widely.

As we forge ahead, we will partner with AAP to advance the principles, knowledge, and recommendations put forth in this new statement. Our work will seek to transform child health practice using the relational health frame and apply the knowledge we have about what works to promote life-long health and well-being.

[i] Garner A, Yogman M, and AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, COUNCIL ON EARLY CHILDHOOD. Preventing Childhood Toxic Stress: Partnering  with Families and Communities to Promote Relational Health. Pediatrics. 2021;148(2):e2021052582

[ii] Frameworks Institute. Building Relationships: Framing Early Relational Health.  Prepared in collaboration with the Center for the Study of Social Policy. May 2020. Available at:

[iii] Willis D, Chavez S, Lee J, Hampton P, Fine A. Early Relational Health National Survey: What We’re Learning from the Field. Center for the Study of Social Policy. May 2020. Available at:

[iv] Willis D and Robinson E. Advancing a Family-Centered Community Health System: A Community Agenda Focused on Child Health Care, Foundational Relationships, and Equity. Center for the Study of Social Policy. September 2020. Available at: