2019-20 TOW #8: Promoting First Relationships in Pediatric Primary Care (PFR-PPC)

We’ve been fortunate to offer training to residents in a relationship-based parenting approach called Promoting First Relationships (PFR). PFR was developed at UW and has been shown to improve caregiver responsiveness and child outcomes, especially for children in foster care. Huge thanks to the team who helped adapt PFR for our residency training.

Materials for this week:

Take-home points:

  1. Why are early relationships so important to children’s development? Research in neurodevelopment, toxic stress, adverse childhood experiences, early child and brain development, and infant mental health continues to demonstrate the critical nature of the early caregiver-child relationships as a driver of physical, social, and emotional wellbeing.
  2. What are the fundamental infant and early childhood mental health concepts that inform the PFR approach? 1) Importance of early attachment and parental attunement and reciprocity, 2) responsive caregiving including noticing and understanding child cues and how they help children regulate, 3) need for caregivers to provide co-regulation for children’s big emotions, especially those emerging at 9-24 months of life, 4) reframing challenging behavior as stemming from unmet physical, social or emotional needs
  3. How can we as pediatricians help with developing children’s primary caregiver relationships? We are uniquely positioned to influence early relationships from our knowledge of child development, our trusted relationship with families, and the frequency of wellness visits during early childhood. Pediatric care providers are often the only service provider that sees new families in the first year of life. We can observe attachment and relationships in the office and provide positive feedback to parents about how they are helping their children through attunement, response, understanding, and co-regulation.
  4. What are the PFR strategies and why are they used? PFR strategies include Joining, Positive Feedback, Positive Instructive Feedback, and Supportive Reflective Capacity. These strategies are designed to help medical providers increase parent or caregiver’s feelings of competence, confidence and joy, so they are better able to support their child’s social emotional development. One of the reasons I really appreciate this program is the focus on developing parents’ strengths and joy in their parenting. I have noticed I enjoy visits more when I am attuned to the relationships and “catching them doing well” in modeling effective approaches with their children.

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