Positive Parenting

Positive parenting focuses on building safe, stable, and nurturing relationships between parents and children. This is particularly critical in a child’s earliest years, as strong emotional bonds develop through sensitive, consistent and responsive parenting. Physical health is linked to these early experiences, and these bonds help infants, children, adolescents and teens develop high self-esteem, seek out social connection and support, and learn how to manage their feelings and behaviors.

This type of strong connection between a child and their parent(s) is known as secure attachment, and helps foster resiliency in children. These emotional bonds are crucial to success later in life, and serve as a buffer when children encounter challenges like poverty, family instability, parental stress, or depression. A recent study of 14,000 US children demonstrated that 40% of children lack strong parental attachments¹. Children who lack secure attachments may have poorer language and behavior before entering school, and these negative impacts can continue to impact children throughout their lifespan.

As children see their pediatrician for an average of 15 well child visits in their first 5 years, this provides an ongoing opportunity to equip parents with tools to support their child’s social, emotional and cognitive development during these routine healthcare interactions.

Together with the Burke Foundation, the New Jersey Chapter, American Academy of Pediatrics is integrating the Mount Sinai Parenting Center Keystones of Development curriculum into the existing NJ Pediatric Residency Advocacy Collaborative (NJPRAC) pediatric residency education program. Piloted in 8 national sites in July 2018, the curriculum has shown statistically significant changes in residents’ knowledge, confidence, and self-reported behaviors related to advising parents on ways to promote child development.

Keystones of Development promotes children’s cognitive and emotional growth by training pediatrics residents to provide parents and caregivers with confidence, skills and satisfaction in parenting. This curriculum equips pediatrics residents to deliver information and model positive behaviors that strengthen parent-child relationships and foster child development within the context of well-child visits. The six developmental keystones that are covered in the curriculum and woven into well-child visits include:

1. Moullin, S., Waldfogel, J., & Washbrook, E. (2014). Baby Bonds: Parenting, Attachment and a Secure Base for Children. Sutton Trust.

A Guide for Pediatric and Family Medicine Residency Programs Using the Keystones of Development Curriculum

This replication guide, released in October 2024, evolved from a collaborative partnership between the New Jersey Pediatric Residency Advocacy Collaborative and the Mount Sinai Parenting Center to promote strong, positive, and nurturing relationships in pediatric settings. Together, they worked to incorporate the Keystones of Development curriculum, along with supplemental learning enhancements, across all nine pediatric and eventually to all 12 family medicine residency programs in New Jersey, with the support of the New Jersey Chapter, American Academy of Pediatrics (NJAAP).

This guide was created to assist residency programs in the US that seek to enhance training on how to promote Early Relational Health and child development with caregivers during well-child visits using the Keystones of Development. While this guide offers learnings and recommendations based on experiences implementing the Keystones curriculum in programs throughout New Jersey using a statewide approach, it is not meant to be prescriptive. Rather, we hope this guide will inspire readers with ways to think about enhancing and strengthening medical education by emphasizing Early Relational Health and child development.

We are grateful to the Burke Foundation for providing the resources that made this guide possible.

Please contact njchapter@njaap.org with any questions.