Parental Reflective Functioning: An Approach to Enhancing Parent-child Relationships in Pediatric Primary Care
There has been an important paradigm shift in the field of pediatrics away from the traditional biomedical approach and toward an ecological health approach that focuses on the broad array of environmental influences—family, society, and social policy. This paradigm shift was highlighted in the January 2012 policy statement and accompanying technical report by the American Academy of Pediatrics (AAP) that discussed the importance of mitigating the effects of toxic stress on the health and development of persons across their life span (Garner et al., 2012, Shonkoff et al., 2012). Toxic stress is defined as the experience of a prolonged stress response in children in the absence of safe responsive caregiving and is considered to be an important risk factor in the development of lifelong disease (Shonkoff et al., 2012). Because negative physiological effects of toxic stress are so extensive and complex, the earlier the stressor/issue is identified and remedied, the better (Shonkoff, 2010). Knowing that a key modifier to the experience of toxic stress is the provision of safe, responsive caregiving to children, pediatric health care providers (HCPs) have been called upon to develop effective strategies to enhance parent-child relationships (Garner et al., 2012). Here, we suggest ways in which pediatric HCPs can enhance parents' capacity for reflective functioning, or the capacity to envision their own and their child's mental states (Fonagy et al., 2002; Slade, 2005). We will first define parental reflective functioning (RF) and describe its role in the parent-child relationship and then provide an overview of the potential use of parental RF in pediatric primary care practice. This approach can be used by HCPs to promote secure relationships and better socioemotional health in routine well-child office visits by helping parents respond sensitively and reflectively to their children.