Promoting Safe, Secure, Nurturing Relationships

Health providers can promote safe, secure, nurturing relationships through their routine interactions with families. Anticipatory guidance about emotional and relational development starts with the first newborn visit to promote sensitive and responsive caregiving and respect for infants’ emotional experiences.

Providers can:

Use AAP mental health leaderships competencies to practice attuned interactions with families to meet their needs. See Common Factors Approach and AAP Mental Health Leadership Competencies policy statement.
Assess and commend family strengths and protective factors. See example from Learn the Signs. Act Early. Identifying Risks, Strengths, and Protective Factors.
Elicit family priorities and address challenges. Use approaches from Strengthening Families and HOPE.
Seek and use authentic feedback from families. Consider adding a practice family advisor.
Partner with family to share and model guidance on healthy relationships and age-appropriate development. Promote nurturing practices like early literacy and parent-child interactions using approaches like Reach Out and Read, breastfeeding skin to skin contact, serve and return interactions, power of play, and family routines.

Additional Resources

Pediatric providers can promote relationships and healthy development with these resources:

Ages and Stages Questionnaires (ASQ) Social-Emotional (SE)2: Offers many social-emotional development resources including family handouts like the Development Guide and Activities by Age and Development Guide and a screening toolkit.
Brazelton Touchpoints Thirteen touchpoints have been noted in the first three years, beginning in pregnancy, and centered on caregiving themes that matter to parents (e.g. feeding, discipline). Professionals can use the Brazelton Touchpoints as a framework for each encounter with families during the first three years of a child’s life.
Common Factors Approach communication skills common to diverse therapies across multiple diagnoses and foundational to pediatric mental health competencies
Facilitating Attuned Network (FAN) Interactions training program that believes people need to feel connected and understood in order to be open to change
Healthy Outcomes from Positive Experiences (HOPE) positive childhood experiences resources for providers that use the HOPE building blocks of relationships, environment, engagement, and emotional growth.
Keystones of Child Development resident curriculum to promote brain development and help strengthen parent-child relationships
Mt. Sinai Sparks Parenting A video for every well-child check
Nurture Connection a network that promotes strong, positive, and nurturing early relationships to build healthier, more connected communities.
Promoting First Relationships a comprehensive training program designed to support professionals who work with caregivers and young children to equip build nurturing and responsive relationships with children.
Promoting First Relationships in Pediatrics training on framework to support stable and secure early caregiver-child relationships
Reach Out and Read incorporates early literacy and relationships
Small Moments, Big Impact helps pediatric providers have a more meaningful conversation with parents
Talk, Read, Engage, Encourage (TREE) These materials have been developed by the Maryland Chapter, American Academy of Pediatrics. They are designed to help pediatric clinicians promote positive loving connections between parents and their babies.
Vroom Brain Building free, science-based tips and tools help parents and caregivers give children a great start in life
PlayReadVIP relationship-based, individualized parent-child intervention
Well Visit Planner family engagement-based approach to improve the quality and positive impact of early childhood health promotion and preventive services for all children and families

For more resources on early promotion and prevention for healthy development visit the AAP STAR Center.

Support positive parenting programs

All parents want their children to succeed academically; have a safe and healthy childhood; and grow into independent adults. Positive parenting focuses on building safe, stable, and nurturing relationships between parents and children.

Positive parenting programs can help caregivers learn effective skills.

This age can be very challenging but it can help to offer praise and positive feedback. She loves to hear how she is doing well and how much you love her. Positive feedback builds her self-esteem and helps her choose the behaviors you want from her.

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Foster male caregiver engagement

Father involvement in the early childhood years is associated with positive child development. For example, at 3 years of age father-child communication has been shown to be a predictor of advanced language development. Fathers tend to be more likely and more active play partners. Fathers engage in more active play, and their involvement in play with preschoolers predicts decreased externalizing and internalizing behavior problems and enhanced social competence. (References)

Pediatricians are often the first members of the health care team to engage fathers.

Pediatricians can be more inclusive to fathers by:

Welcoming fathers and express appreciation for their attendance.
Offering flexible hours for all caregivers to attend well child visits
Addressing fathers’ unique concerns regarding their children.
Recognizing that mothers and fathers may not always agree on how best to raise a child. Parents may disagree on the approach to discipline or positive parenting.
Emphasizing how children look to their fathers as role models for behavior and are likely to imitate behaviors.
Stressing the unique role many fathers play in encouraging age-appropriate active play and modeling physical activity
Promoting fathers awareness about the practicalities of breastfeeding and how to support mothers’ nursing.

You are a great playmate for your child! They love laughing with you and learning how to play from you. You can help your child build skills to get them ready for kindergarten. Games like freeze dance, Simon says, and red-light green light all build control of their bodies and asks them to pay attention-important skills for school.

Your child learns so much from you. What are some things you like to teach her?

Resources

AAP Policy Statement, Fathers’ Roles in the Care and Development of Their Children: The Role of Pediatricians
Childhood Looks Better When Dad is in It

Encourage developmentally appropriate play

Play builds brain structure and promotes executive functioning. It also supports shared communication and attunement between the child and their caregiver, supporting early relationships and protective factors.

It is helpful for parents to have strategies for engaging their child in play that is responsive and developmentally appropriate. You can share this play milestones resource with families

Get eye level with your baby during baby time. Tummy time strengthens her head and neck muscles to get ready for crawling and sitting up. Getting eye level will give you a chance to connect, smile, and laugh together.

Playing together can be a good time to enjoy each other’s company but also give him time to share how he is feeling and thinking. You have probably noticed him acting moments of his day or interactions out during play.

Resources

Discourage screen time

For better or worse, young children use screen time often and regularly. With the widespread use of screens throughout our normal lives, it is expected that young children would be exposed and introduced to screens themselves. However, the concern remains how much of their time is spent in front of a screen and how early they are being introduced to a screen.

Did you know Recent studies show that 68% of children under the age of 2 use screen media in a typical day, and that average screen time was 2.05 hours per day.

Parents want what’s best for their children—but they also lead busy lives. It can be hard to work, cook, clean and get kids to bed. Many parents choose to offer screen time because they believe media content is educational. They believe their child is learning. Parents have also admitted to not limiting screen time to avoid conflict or to entertain or distract their children. All very relatable reasons for busy parents.

However, screentime has often been shown to reduce the amount and quality of interactions with caregivers and families.

Pediatricians and other providers can support families with realistic goals for reducing screen time and encouraging time for families to connect with their child. For example:

Build healthy family routines! Help families remember how much their child loves them and wants to spend time with them. More than they want to spend in front of a screen. Support families to protect their time with their child and identify a regular time for play and connecting that may work for them. Even if it isn’t everyday.

Build screentime routines and boundaries: Our habits start early! This includes screen time. Support families to identify what their boundaries should be in the early years related to media use and time in front of a screen. The AAP offers a family media plan to help families get started.

Avoid screens before bedtime: Media use before bed can affect how well a child sleeps. Suggest families avoid screen time use at least 30 minutes (confirm this #) before beginning their bed routine.

Remove screens in the bedroom: Limiting screentime can be extremely challenging for busy families. Keeping a screen out of their child’s bedroom can be a more realistic goal and a great start.

Your child loves spending time with you! They learn so much from you and want to share their day with you. What are some things you enjoy playing together?

After a busy day, a regular bedtime can be a great way for you and your child to relax. His day has been busy too! Bath, brush, book, bed is a great start.

Find more resources on the AAP media and children webpage

Promote shared book reading

Family involvement in early literacy supports language development, school readiness, and social emotional development including resilience. Shared book reading offers opportunities for caregivers to model positive interactions and communicate with their child. Visit the AAP early literacy page for strategies for implementing early literacy into practice.

Support grieving children

More than 140,000 US children have lost a primary or secondary caregiver due to the COVID-19 pandemic (NIH 2021). The death of someone close to a child has profound and lifelong effects. Pediatricians can offer assistance and support to children and families including:

Exploring and confirming the child understand what has occurred and what death means
Helping to identify reactions such as guilt, fear, worry, or depressive symptoms that suggest need for further services
Reassuring children who become concerned about their own health or those of family members
Sharing local resources
Offering advice on funeral attendance on children

Promoting Safe, Secure, Nurturing Relationships

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