From adverse childhood experiences to early relational health: implications for clinical practice

Children grow and develop in an environment of relationships. Safe, stable and caring relationships help build resilience and mitigate the impact of negative experiences. Relational health promotion in clinical practice refocuses attention from negative childhood experiences to positive childhood experiences. This approach, which assesses a family's strengths and assets, can be integrated into both regular well-child appointments and subspecialized care. Such interventions are best carried out prenatally or as early as possible before the age of three, but it's never too late to start. This position paper describes how clinicians can take a relational health approach to every medical encounter if they understand what toxic stress is and its effects on the developing brain, family relationships and child development; how positive relationships, experiences and behaviours can mitigate the effects and build resilience; what are the observable signs of relational health and relational risk in parent-child interactions; what are the characteristics of trusting therapeutic relationships with families and how to optimize their benefits through exchange and clinical practice.