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Cited by 392Child Abuse and TraumaChild and Adolescent HealthResilience and Mental Health

Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health

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Garner, Andrew, Yogman, Michael, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Lavin, Arthur, Askew, George L., Baum, Rebecca A., Berger-Jenkins, Evelyn, Johnson, Tiffani J. +26 more·2021·Pediatrics
DOI 10.1542/peds.2021-052582
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Abstract

By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.

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  • Systems and structures are invisible and visible rules and organizations that can facilitate opportunity for families and influence how the digital ecosystem is built.

    “systems and structures are the invisible and visible rules and organizations that can facilitate opportunity for families32 and influence how the digital ecosystem is built.”

    From Digital Ecosystems, Children, and Adolescents: Technical Report (2026) · cites this paper as [32]

    The “Horizontal Integration Across Sectors at the Community Level” section describes organizations and public policies working together to support families and remove barriers. It does not define systems and structures as “invisible and visible rules and organizations.” The citation follows “families,” so the subsequent claim about the digital ecosystem is not attributed to this source. (LLM, conf=0.78)

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  • Research has also examined how digital media interacts with caregiver-child relationships and behaviors, termed early relational health.

    “In addition to quantity and quality, research has also focused on the interplay between digital media and caregiver-child relationships and behaviors (“early relational health”).32,65,66”

    From Digital Ecosystems, Children, and Adolescents: Technical Report (2026) · cites this paper as [32]

    The Emerging Science of Relational Health section defines relational health through supportive caregiver–child relationships and responsive interactions. The Links Between Relational Health and Resilience section also notes concern that excessive screen time may limit opportunities to develop skills. Neither passage says that research has examined the interplay between digital media and caregiver–child relationships or behaviors, so that part of the attributed claim is unsupported. (LLM, conf=0.82)

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Research works printed but not linked: 8

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  6. [151]151. Wenzel M, Okimoto TG, Feather NT, Pla- tow MJ. Retributive and restorative jus- tice. Law Hum Behav. 2008;32(5):375-389 159.
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Authors
Garner, A., Yogman, M., COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Lavin, A., Askew, G. L., Baum, R. A., Berger-Jenkins, E., Johnson, T. J., Jutte, D., Nasir, A. A., PEDIATRICS, S. O. D. A. B., Smith, P. J., Levine, J., Peralta-Carcelen, M., Poon, J., Spinks-Franklin, A., Zubler, J., Weitzman, C. C., Childers, D. O., Takayama, J., Voigt, R. G., COUNCIL ON EARLY CHILDHOOD, Alderman, S. L., Guevara, J. P., Hashikawa, A. N., Glusman, M., Miller-Fitzwater, A., Navsaria, D., Nelson, B. B., Peacock, G., Vanderbilt, D. L., Shriver, A. E., Sells, J. M., & Mendelsohn, A. L.
Affiliations
  • Case Western Reserve University (US)
  • Harvard University (US)
ORCID
Yogman, Michael
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2021-08-01
Volume
148
Issue
2
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2021-052582
OpenAlex
W3183845599
Cited by
392
References
197
Citations by year
2026: 75 · 2025: 82 · 2024: 91 · 2023: 84 · 2022: 44 · 2021: 12 · 2020: 1 · 2017: 1 · 2015: 1
FWCI
39.47
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Vanderbilt University
  • Harvard University
  • School of Medicine, Case Western Reserve University
  • Society of Pediatric Psychology
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
Keywords
relational health, resilience, childhood adversity, family and community partnerships, generative research, public policy
MeSH terms
Adverse Childhood Experiences, Child, Child Advocacy, Community Participation, Family, Humans, Pediatrics

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