Pediatric healthcare providers understand that the early years of children's lives are critical to their health and learning. Babies are born wired for social interaction and through parental nurturing and responsive caregiving, secure attachment is established. 1 Through this attachment, parents' problem-solving skills and parenting styles, infants and young children can learn to regulate their emotions and enable the development of meaningful relationships. 1 Indeed, emotional regulation through attachment is considered to be the cornerstone for ongoing positive mental health. 2

For families, parenting can bring a range of physical, emotional and social changes where mothers often need considerable support, especially from people they are close to. 3 How parents and families manage depends on a range of factors. Some parents acquire knowledge and skills that support health behaviors through education, a supportive workplace or prior exposure to caring for young children. 4 Some families are well supported by extended family and a network of friends and neighbors, which encourages community connection and engagement in early learning and developmental activities. 4 However, other parents are not well supported, feel physically or culturally isolated and have limited access to health services or community resources. 5

A child's needs may be compromised if a mother's responsiveness is affected by anxiety or depression. 6 Further, the stress, anxiety and fatigue experienced by parents can impact their caregiving and undermine their parenting confidence, potentially influencing their child's emotional, attentional and cognitive regulation. 2 In addition, such experiences of stress may result in maladaptive responses between parents, such as taking out their frustrations on each other, further impacting the psychosocial environment. 7 A need for improved approaches in health care to support family functioning has been identified, 8 especially for families managing their child's major health problem 7 and for those living with socio-economic disadvantage. 2 Such evidence highlights the need to support the psychosocial environments of young children and families to enable them to build confidence, connect with others and engage with appropriate community resources. 4

In practice, talking about psychological and social issues with families can be challenging for healthcare providers, especially when children are ill. 9 Parents attending a healthcare facility with their child will put their child's needs first and feel that talking about their worries may detract from the care required for their child. 10 Some parents have reported feeling judged about being unable to cope or believing they are inadequate as parents, which can reduce their likelihood of engaging in conversations with healthcare providers. 9 For healthcare providers, there is reluctance about discussing family issues with parents for fear of opening up a "can of worms" that leads to the potential unfolding of a range of complex problems. 11 However, talking with families is integral to healthcare providers, especially pediatric nurses who provide care for the child in the context of the family. 12 Once psychosocial issues are identified, interventions that promote engagement and community participation include complex social processes. 4 Linking with others and engaging in community activities results in reported benefits to parents' psychological health and confidence-building, 3 improved family access to local services, 4 and enhanced effectiveness of interventions that are based on partnership-building. 13 Whether family-centered or community-centered, each intervention depends on building a partnership that is based on mutual respect and collegiality, and guided by genuine enquiry and reflective listening. 14

This research evidence illustrates a need to implement interventions based on partnership-building and communication about psychosocial issues with young children and families. By focusing research on the issues that matter most to families and ensuring that parents are engaged as equal partners in their children's health, interventions are more likely to be feasible and sustainable. More importantly, such focused enquiry acknowledges family functioning and the caregiving environment as key determinants for the long-term health and developmental outcomes of young children and their families.

In this issue of the JBI Database of Systematic Reviews and Implementation Reports, enquiry focuses on the health of children and the influence of family. In all cases, a psychosocial assessment can enhance parental engagement and present healthcare providers with information that enables them to offer the most appropriate support to parents, leading to the best health outcomes for children.

Declaration

Sally Wilson is a Senior Associate Editor of the JBISRIR.

References