From Adverse Childhood Experiences to Early Relational Health in Canada

By Robin Williams, MD, FRCPC
Chair, Canadian Paediatric Society Early Years Task Force

By the time the Canadian Paediatric Society (CPS) brought together a group of physicians in 2011 to focus on early child development, the evidence was irrefutable that the first few years of a child’s life impact their lifelong health and well-being. Over the years, our collective understanding of early brain development and the importance of a child’s environment in supporting their healthy development has grown more sophisticated, and the need for action to create the conditions in which little kids can thrive has become ever more urgent. 

The mandate of our CPS Early Years Task Force — which includes physicians working in developmental and community paediatrics, public health, and child psychiatry — is to engage clinicians in promoting healthy development and mitigating the risks of stress and adversity and Adverse Childhood Experiences (ACEs) on children’s health and well-being. To achieve this goal, we have focused on supporting children’s social and emotional development and family relationships through strategies such as an enhanced 18-month well-baby visit, early literacy, and positive parenting. 

Most recently, the task force members spent considerable time thinking about how an adult’s childhood affects their capacity to parent. And we asked ourselves, What is the clinician’s role in supporting parents to provide the best possible environment for their little ones? Current paediatric training excels at educating learners to identify patterns of “exceptional” or “abnormal” physical, social-emotional, and cognitive developmental progress, and to use these observations to tailor subsequent treatment and/or intervention. But by prioritizing the relational health of babies and toddlers and their families, we actually promote well-being and health development, helping to mitigate or prevent subsequent problems.

Our search for an optimal approach to support both families and clinicians led us to early relational health (ERH) and Nurture Connection. We invited Dr. David Willis of the Center for the Study of Social Policy to talk with us about this paradigm shift in early childhood care. We recognized that this new way of speaking and thinking about relational well-being of children and families is what many paediatricians already do in practice. This transformed our thinking and resulted in a new position statement called From ACEs to Early Relational Health: Implications for Clinical Practice.

ERH — defined asthe state of emotional well-being that grows from emotional connection between babies and toddlers and their parents and caregivers when they experience strong, positive, and nurturing relationships with each other” — recognizes that emotional connection between a child and their parents/caregivers impacts their ability to grow and develop in healthy ways now and into the future. Safe, stable, and nurturing relationships help ensure flourishing and buffer the negative impact of adversity. By promoting ERH in clinical practice, we can shift the focus from ACEs to Positive Childhood Experiences (PCEs), which evaluate a family’s strengths and assets, and can be incorporated into both well-child and subspecialty care. 

Since the release of the position statement in April 2023, we’ve hosted a series of National Grand Rounds for Canadian physicians, attended by hundreds of paediatricians from across Canada. The feedback revealed a level of enthusiasm and commitment that we are now working to harness and spread.  We’ve held a series of meetings to cultivate and learn from these paediatric leaders, who are promoting this work in their centres and communities. Our members believe this work is not only important but effective as our network continues to grow. 

At CPS, we’re dedicated to transforming healthcare practices to advance equity and honor parents as they love and interact with their children. By joining the movement to promote ERH led by Nurture Connection, we can better support paediatric care providers across Canada in achieving our vision of health and well-being for all. 

Dr. Robin Williams is a paediatrician and public health physician who served as Medical Officer of Health for the Niagara Region for 16 years and was a driving force behind the creation of the Niagara Children’s Charter. A past president of the Canadian Paediatric Society, Dr. Williams is the current chair of the CPS Early Years Task Force.