The Fifth Vital Sign in the First 1000 Days: Early Relational Health

Early childhood development forms the cornerstone for a healthy, fulfilling, and productive life. Research in health psychology and longevity highlights that social relationships are the most significant determinant of lifelong health and development. Among these, early attachment between children and caregivers, bolstered by positive experiences and nurturing environments, is pivotal for optimal growth, development, and well-being. This highlights the need for holistic approaches in healthcare, particularly during the critical first 1000 days of life. To address these needs, comprehensive evaluations must include assessments of childcaregiver interactions alongside biological, psychological, social, and environmental factors. Recognizing this, the American Academy of Pediatrics has embraced the Early Relational Health (ERH) framework, focusing on fostering healthy relationships during this crucial period. The framework encompasses all caregivers, including parents, extended family, and peers. The ERH framework emphasizes a broad assessment of factors affecting health—biological, psychological, interactional, economic, and environmental—within the child and caregivers’ living contexts. The primary objective is not to teach parenting skills but to cultivate safe, stable, nurturing relationships supporting lifelong well-being. The ERH underscores the critical importance of assessing relational health as a “fifth vital sign,” alongside traditional measures such as respiratory rate, heart rate, temperature, and blood pressure, in the first 1000 days. Integrating this framework into health systems can enhance the well-being of children and caregivers, ensuring a robust foundation for lifelong development.

Cite this article as: Ayrancı Sucaklı İ, Yalçın SS. The fifth vital sign in the first 1000 days: early relational health. Turk Arch Pediatr. 2025;60(5):453-461.