Announcing a Strengths-Based Bonding Screen: A Major Step Toward Supporting Mother-Baby Health in the U.S.

For the first time in America, scientists at the Center for Early Relational Health adapted and validated a strengths-based screen to measure mother-baby bonding.

The Center for Early Relational Health’s first publication of 2026 is a step toward a real-world future of universal Early Relational Health: led by Center faculty Andréane Lavallée, PhD, we validated a strengths-based screen for evaluating mother-baby bonding in the U.S.—with crucial implications for both maternal mental health and long-term child development.

A New Way to Look at Mother-Baby Health in the U.S.

The Center for Early Relational Health has adapted an exciting tool for measuring mother-baby bonding in America: the Revised Postpartum Bonding Questionnaire (PBQ-R). 

A major innovation from prior iterations, this new version of a popular bonding screen is simple, intuitive, and strengths-based: a crucial distinguisher that aligns with the American Academy of Pediatrics’ reorientation toward relationships as drivers of child health and development.

“We know that bonding is associated with key outcomes for both mother and child, including postpartum depression and socio-emotional development,” says Center faculty Andréane Lavallée, PhD, RN, who led the PBQ-R initiative. “Having a reliable way to measure bonding that works for researchers and families is vital to helping us understand this foundational relationship, and how it shapes well-being for moms and babies.”

In 2025, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a landmark consensus report on the current landscape of ERH: a cross-sector endorsement of the need to advance ERH knowledge, in order to transform the systems that support American families. 

Consultant on the report, Dr. Lavallée says the PBQ-R is an exciting example of what’s possible when research takes this approach: “Because we look at relationships from a strengths-based perspective at the Center, our research has this priority embedded from the start—and the tools that emerge from our data, like this new bonding screen, can be truly actionable in moving the field toward knowledge growth, systems transformation, and positive outcomes for families.”

Validating an American Version of a Go-to Bonding Screen 

The original Postpartum Bonding Questionnaire (PBQ) is the most widely-used tool globally to measure mother-baby bonding—yet it had never been validated for use in America. Dr. Lavallée wanted to study whether it actually worked for our U.S. population and found that it did not.

Through rigorous study, her team found that the existing screen was prohibitively long, broken up into multiple sections that interfered with its usefulness, and used language that wasn’t always intuitive to the way American mothers understood or interpreted the questions. Further, it was aimed at identifying problems, rather than strengths, giving higher scores to lower levels of bonding.

The team developed a new version of the screen, with 2 key changes:

  1. They made it less burdensome (and likely more accurate) for both new moms and researchers by shortening it (from 25 to 14 questions, and from 4 sections to 1), to make it more user-friendly
  2. They made it strengths-based, by switching the scoring scale: rather than looking for problems, the new screen gives higher bonding a higher score. Instead of looking for deficits, it looks at what happens when babies are exposed to positive relational experiences.

In a major step forward for the field, the team successfully validated this revised screen, making the new PBQ-R a reliably evidence-based bonding measurement tool, for the first time in America. 

Good News for U.S. Mothers and Children

The team also looked at outcomes of strong bonding during the first 3 years of a child’s life. Comparable to the original PBQ, they found good news: 

Stronger bonding correlates with fewer symptoms of postpartum depression in moms, and more optimal child development across multiple time points:

  • At 6 months, babies whose moms had higher bonding showed better:
    • Communication skills (like squealing, babbling, looking for their parent when they hear that parent’s voice, and repeating sounds parents make)
    • Fine motor skills (like picking up a small toy with one hand)
    • Problem-solving skills (like exploring a toy using multiple senses)
  • At 18 months, these babies showed better personal-social skills, copying activities they see adults doing (like sweeping, combing their hair, or wiping up a spill)
  • At 24-36 months, these children showed fewer internalizing and externalizing symptoms, meaning behaviors associated with tantrums and anxiety (like being withdrawn, clinginess, sleep changes, tummy aches, fear, etc.)

These results are a powerful example of why it’s so important to build the scientific foundation of of Early Relational Health. Our earliest measure of relational health, bonding is a key component of the origins of individual and dyadic (two-way) health: while bonding only talks about mom’s feelings, it has clear downstream effects on the child. And there are real-world implications in the postpartum period, for both families and clinicians: 

“When you have a new baby, those changes in hormones and family dynamics can bring a lot of mixed emotions,” says Dr. Lavallée, whose early career was as a NICU nurse. “There’s a wide spectrum of normal there, and this is one thing the PBQ-R can help us understand better. It’s strongly correlated with postpartum mental health—so when these mixed emotions move outside the normal variation, bonding can be an early way of detecting postpartum depression. The more we normalize talking about these experiences, the more moms are willing and able to get help when they need it.” 

Implications for Practice and Policy

The better we understand bonding and its long-term impacts on development, the closer we get to developing strengths-based ways to support both mom and child in the clinical setting.

In recent years, there’s been a strengths-based paradigm shift in the field of pediatrics: optimizing healthy development through promoting strong early relationships. The American Academy of Pediatrics’ (AAP) 2021 call for this pivot catalyzed momentum for the scientific field of Early Relational Health (ERH). 

So in 2022, Dr. Lavallée led a meta-analysis to survey the landscape of ERH interventions, with shocking results: there is currently not enough data to support implementing any dyadic interventions to improve health or development outcomes long-term. Center director Dani Dumitriu, MD, PhD, says this points to a critical gap in the field: “While the American Academy of Pediatrics’ stance remains critical, the fact is: as pediatricians, we simply do not have the tools to do what the AAP wants us to do—yet.”

“Ultimately,” says Dr. Lavallée, “this comprehensive evaluation demonstrates a critical need to develop, validate and implement universal tools to set every family up for future positive outcomes. But to do that, we have to dig deeper to uncover the scientific mechanisms of early relationships, and that starts with honing the tools to measure different aspects of relationships.”

With this growing support in the field for a relational paradigm, there is a real need to measure ERH clinically, across populations. Broadly, ERH has been shown to improve outcomes, but we still don’t know specifically why or how—crucial pieces of the puzzle for developing evidence-based interventions. Now that it’s a shorter measure, the PBQ-R could potentially be included in the series of questions asked at doctor visits for mom and baby, while simultaneously generating better results in research studies, helping us build this understanding and bridge the gap between research and practice. 

Individual measures like this help us understand which ERH constructs (such as bonding, attachment, and emotional connection) matter for which outcomes (such as school readiness, social-emotional development, and neurodevelopment), and at what ages they make the biggest difference. That’s information we need for evidence-based care and policy change, toward a future of embedding strengths-based ERH into universal pediatric practice.

The Center for Early Relational Health has become a leader in generating this vital science. The PBQ-R marks a significant step toward making screeners less burdensome for doctors and researchers, and more intuitive for patients and research participants, with significant potential to build more robust usage in clinical care. 

How Does Bonding Fit Into This Fuller Picture of Early Relational Health?

While terms like bonding, attachment, and emotional connection are often used interchangeably to describe early relationships, from a scientific perspective, they are actually separate constructs with distinct impacts on future outcomes. 

For example, while bonding looks at a mother’s feelings about her baby, attachment describes a child’s response to their parent during and after a stressful situation. Untangling these constructs from each other is key to harnessing the unique contributions each one makes to a family’s ability to thrive.

A field-leader in the study of parent-child synchrony, Dr. Lavallée is working to build this “taxonomy” of ERH constructs, toward a future where pediatricians and families have the tools they need to help every child flourish. As Principal Investigator of the Interpersonal Synchrony and Connection (InSynC) lab, she leads novel research looking at how all known ERH constructs correlate with each other (or don’t, as preliminary results with bonding, emotional connection, and maternal sensitivity show—suggesting potential for future targeted interventions).

In order to get from validated screens to validated interventions, clinical change, and policy transformation, we need a comprehensive understanding of all the constructs that make up ERH, including bonding. 

Building this future of strong relationships for every family hinges on first teasing apart the many ERH constructs to understand how they individually and synergistically shape specific aspects of health and development. Streamlined individual measures like the PBQ-R are essential to getting us there, by advancing our ability to predict and improve outcomes for families.

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