Leveraging Pediatric Primary Care to Support Early Relational Health and Enhance Early Child Development: A Review.

Several decades of converging research in the fields of pediatrics, child development, and neuroscience demonstrate that the first years of life set the stage for children's school readiness and have lasting impacts on health, learning, and well-being across the lifespan. Early childhood is therefore an ideal time to deliver preventive interventions to reduce disparities in child development that emerge due to poverty, toxic stress, and other adversities. Early Relational Health (ERH), which includes parent-child interactions and relationships supports child development and can serve as a protective factor in the pathway between poverty/early stress and child outcomes. It is also the focus of recent policy statements and recommendations from key experts and leaders within the early childhood landscape. In the current paper, we describe interventions and strategies that use primary care alone or as a point of entry to other programs to promote ERH in order to enhance early child development. Primary care offers early contact and relationship building with families, provides near universal reach, and is low cost compared to other platforms, and layering and linking programs helps to address diverse family needs and preferences. We highlight challenges and bright spots in these endeavors and note the need for additional advocacy for the promotion of ERH that leverages a strong evidence base and converging policy recommendations.