Early Relational Health Building Foundations for Child, Family, and Community Well-Being (2025) / Chapter Skim
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Pages 1-7
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This committee was asked to review the early relational health drivers of future health and well-being for infants, children, and families, focusing on future directions for research, policy, and practice to advance early relational health across health care, early care and education, and other community settings. In this report, the committee spotlights the current state of knowledge on early relational health as it pertains to early childhood and human development, infant and early childhood mental health, early childhood physical health, education, and learning.
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It is experienced differently by each individual and manifests in person-, family-, and community-specific ways. The committee identified research to date that encompasses a multitude of constructs related to early relational health; these constructs include secure attachments; emotional connection; caregiver sensitivity; emotional availability; caregiver behavioral predictability/unpredictability; co-regulation and bonding; shared attunement; biobehavioral synchrony; family resilience and connection; positive or benevolent childhood experiences; and safe, stable, and nurturing interactions.
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Building on a public health approach, supports for early relational health include societal, universal supports for promoting healthy relationships; preventive and targeted interventions across sectors; and indicated treatments in case of difficulties.
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Interpersonal connection includes, for example, developmentally and culturally appropriate play and interactive activities, such as those offered by Reach out and Read and PlayReadVIP. Support for familial connections includes home visiting, peer and family caregiving supports, and mental health supports.
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As a major payer of child and adult health care, Medicaid is a policy linchpin and a programmatic strategy. Opportunities to advance early relational health within Medicaid include refocusing from the individual to the relationship through relational reimbursement; supporting team-based care models of primary care; modernizing Early and Periodic Screening, Diagnostic, and Treatment benefits and rules; financing community-based perinatal supports, including doulas and group pre- and postnatal supports; supporting perinatal substance use disorder treatment and peer supports; and braiding funding streams for family support and home visiting (e.g., Medicaid; the Maternal, Infant, and Early Childhood Home Visiting Program; the Temporary Assistance for Needy Families program; Title IV and V funding)
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Policy opportunities to enhance families' economic security include poverty-reducing tax credits such as the Earned Income Tax Credit and the Child Tax Credit, policies to increase minimum wage, and expanded support for early care and education. Programs such as the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children can also reduce food insecurity and support early relational health.
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FINAL THOUGHTS Ensuring early relational health for every child demands an expansion from focusing on preventing harm to investing in strengthening relationships and the contexts within which children and families thrive. It demands a reorientation from assessing a wide array of risks toward recognizing, uplifting, and supporting the strengths of families and communities.
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