Promoting Early Relational Health in Primary Care: A Scoping Review of Interventions and Evidence Gaps

Early relational health – the quality of caregiver–child interactions – is foundational for socio-emotional development and long-term wellbeing. The American Academy of Pediatrics has called for a paradigm shift toward relationship-centered care within well-child visits, yet there remains a gap between this vision and practical implementation. Despite advances in evidence-based interventions targeting relational processes, these approaches have not yet been synthesized through an early relational health lens. This review maps early relational health interventions implemented in pediatric primary care, summarizes reported outcomes, and identifies key implementation strategies, barriers, and facilitators. Eighteen studies met inclusion criteria. Interventions varied in setting and format but commonly used anticipatory guidance, multimedia tools, or structured skill-building. Common implementation strategies included integrating interventions into clinical workflows, providing staff training, monitoring fidelity, and fostering community partnerships. Key facilitators were context-responsive delivery, strong relational supports, and alignment with routine care processes. Conversely, barriers often involved small samples, reliance on parent-report outcomes, short follow-up periods, and practical constraints such as limited time and staffing. Overall, early relational health interventions are feasible and promising when embedded into routine care and tailored to family needs. Strengthening methodological rigor and addressing implementation challenges will be key to advancing the AAP’s relational health vision at scale.