Building Momentum to Transform Pediatric Care: Center Scientists Contribute to a Landmark NASEM Report Establishing the Importance of Early Relational Health

The National Academies of Sciences, Engineering, and Medicine (NASEM) has released a landmark consensus report: Early Relational Health: Building Foundations for Child, Family, and Community Well-Being

Developed by a committee of experts, including Center for Early Relational Health director Dr. Dani Dumitriu, the NASEM report lays a crucial foundation for propelling the field of Early Relational Health (ERH) forward: it both establishes the current landscape of ERH knowledge and offers evidence-based opportunities to strengthen supportive early relationships through research, clinical practice, and policy. 

This decisive cross-sector consensus endorsement of Early Relational Health emphasizes the importance of advancing ERH for families, communities, and broader systems transformation.

In this relational work, collaboration is key

Consensus reports like NASEM’s not only help us get our bearings in understanding a burgeoning field like ERH; they can act as unifying guideposts for the many scientists, physicians, policymakers, and field leaders working together to make a difference for children and families.

For example: one critical aspect of doing this work in a way that will actually benefit families is listening to the families themselves. That’s why NASEM outlines “participatory research that centers families and communities” as a guiding principle for the future of this work. 

Dr. David Willis, a committee member for the report (and founder of the ERH impact network Nurture Connection at Georgetown University’s Thrive Center) says: “With the new National Academies report and the AAP’s earlier statement about relational health, we’re seeing an exciting paradigm shift in health systems, public policy, and community services. There’s a recognition of the importance of partnering with families and communities to reimagine child and community services—with ERH at the core.”

In fact, Nurture Connection’s ERH Learning Community was expressly designed to lift up the voices of parent leaders from communities all across the country. Through this Learning Community, and in further partnership with Reach Out and Read, we are actively building parents’ lived experience into the foundations of our ERH research design. By bringing this science directly into the communities we seek to serve, we’re helping ensure that this work meaningfully understands, and ultimately meets, their real-world needs.

Dr. Dumitriu is excited about the future of this field, and the collaborations at its core: 

“It was a privilege to dig into this important content with Dr. Andrew Garner, Dr. David Willis, Emily P. Backes, our center’s own Dr. Andréane Lavallée, and many more field-leading academics. We hope this NASEM consensus report can be a useful resource on the road to making a difference for children and families across the country.”

Building momentum to transform pediatric care for families everywhere

This kind of interdisciplinary consensus elevates the collaborative progress the scientific community has made since the American Academy of Pediatrics’ 2021 policy statement, by Dr. Andrew Garner. That seminal statement urgently called for a paradigm shift in the field of pediatrics: toward relationships as a central health-promoting strategy in early childhood. 

4 years later, we have made tremendous strides in elevating Early Relational Health as a foundational field of science worthy of investment and long-term study. Together, we elucidate the role of early relationships as a viable and vital avenue to nationwide well-being for families. 

As we look toward this future of thriving through social connection, the NASEM report sets forth a set of principles and a research agenda to enable a transformation in pediatric care: to be less transactional and more relational, in service of better outcomes for children and families. 

Why Early Relational Health has so much potential for the future of medicine 

Currently, the field of pediatrics understands much more about adverse childhood experiences (ACEs) than we do about positive experiences. Dr. Garner says this “reflects the fact that we’ve approached childhood adversity from a biomedical perspective, which is very reductionistic in trying to figure out what went wrong—but doesn’t necessarily tell you a lot about what’s strong and what makes things right. So this is a really important pivot.” 

Dr. Dumitriu, who had the privilege of serving alongside Dr. Garner on the committee, is resolute that a strengths-based pivot in pediatrics is essential to achieving universal primary prevention. “We've had a hundred years of really important progress in deep scientific knowledge of the mechanisms of disease,” she says. “Now, we're bringing the social, relational, and human aspect back into medicine, as we focus on the mechanisms of health promotion from the very beginning of a child’s life.”

At the Center for Early Relational Health, we’re privileged to be part of this community of field leaders propelling a new wave of Pediatrics forward with cutting-edge science.

Key scientific takeaways on the current state and future of Early Relational Health 

So what are we focusing on to advance the science and impacts of ERH? The NASEM report establishes 3 critical points for the field, each of which is a key area of study in the center’s work:

1. Relationships aren’t just a “nice-to-have,” they’re a biological need

Social connection has historically been thought of as “mushy” science. But social experiences have concrete impacts on our human biology and should be considered a key avenue toward well-being. 

While we are actively researching how early relationships shape specific health outcomes, the NASEM report confidently asserts that relationships are “biologically necessary for healthy development, well-being, and flourishing.” 

The Center’s scientific initiatives take a truly comprehensive look at social connection as a foundational pathway to health in human beings, and specifically young families—both inside each person’s body and brain and, crucially, between people in relationships. 

2. There is a sensitive early life period for relationships in the 0-3 years

This new report affirms that early relational experiences “shape brain architecture, regulate stress physiology, and scaffold emotional, behavioral, cognitive, and physical development.” During these sensitive early years, strong relationships are an essential component of current and future learning, health, and well-being.

A pediatrician and neuroscientist, Dr. Dumitriu says that “up until about three years of age, a child’s brain is extraordinarily plastic.” That means these early years are an unparalleled opportunity to establish healthy developmental trajectories, including through relationships: because social connectedness becomes developmentally embedded early on, early relationships have the potential to alter the trajectory of a child’s (and therefore, a family’s) entire life.

3. It is crucial to study all the many constructs of Early Relational Health

In setting out a research agenda, the report highlights the need to look at how different constructs of Early Relational Health influence long term child & family outcomes (such as school readiness); as well as studying “intergenerational mechanisms of healing and ensuring health and well-being.”

Our work in building the evidence base for the growing field of ERH includes comprehensive science to tease apart every known construct of ERH (bonding, attachment, emotional connection, and more). Led by Dr. Andréane Lavallée, this pioneering work is an essential aspect of establishing consensus around how we scientifically define Early Relational Health.

Studying how these constructs interact with each other, and how each one maps onto distinct outcomes in development and health, is crucial to uncovering the mechanisms of early relational health—and harnessing them in universal pediatric care.

A promising future for relational family medicine

“Over the last hundred years, medicine has focused on treating disease,” says Dr. Dumitriu. “And we’ve had some absolutely tremendous results as a function of that, including the ability to cure formerly deadly diseases, like most childhood leukemia. But if we think about medicine for thousands of years before this focus on treatment, a lot of the healing was relational healing. They didn't have many medicines to cure disease, and yet doctors throughout history did do some healing. This work is really meaningful, because it's bringing that back around: uniting treatment with prevention and health promotion—including through strong early relationships, when they matter most.”

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