Partners in Pediatrics, Westlake, Ohio.
School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Pediatrics. 2021 Aug;148(2). doi: 10.1542/peds.2021-052582.
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.
通过关注能够缓冲逆境和培养适应力的安全、稳定和滋养关系（SSNRs），儿科护理正处于可能重新优先考虑临床活动、重写研究议程和调整我们集体倡导的范式转变的边缘。推动这一转变的是发展科学的进步，因为它们更深入地了解了早期生活经历，无论是滋养的还是不利的，如何在生物学上被嵌入，并影响健康、教育和经济稳定的终身结果。这份关于儿童毒性应激的修订政策声明承认存在一系列潜在的逆境，并再次确认了生态生物发育模型对理解成年期表现出的疾病和健康的儿童起源的益处。它还支持向关系健康的范式转变，因为 SSNRs 不仅在逆境发生时缓冲儿童的逆境，而且还促进了未来具有适应力所需的能力。为了将这种关系健康框架转化为临床实践、生成性研究和公共政策，整个儿科社区需要采取一种公共卫生方法，通过与家庭和社区合作来建立关系健康。这种关系健康的公共卫生方法需要垂直（包括初级、二级和三级预防）和水平（包括医疗保健以外的公共服务部门）整合。美国儿科学会断言，SSNRs 是所有儿童的生理必需品，因为它们减轻了儿童毒性应激反应，并通过培养以健康方式应对未来逆境所需的适应技能来积极培养适应力。
