Early Years as Central Area of Action for Prevention

Attachment research examines the effects of attachment relationships on a child’s physical, psychological, and social development, based on longitudinal studies, among others. Findings of such studies clearly show that a key protective factor, responsible for buffering risk factors, is a stable, reliable, and emotional relationship with a primary caregiver. Attachment experiences made within this relationship shape the child’s attachment system in the long term [1].

An infant has an innate motivational tendency to connect with others in a social envi-ronment and form relationships with them. From birth, they experience numerous interactions, particularly in regulating physiological needs such as hunger or fatigue. Through these experiences, specific patterns are formed in the child, which are crucial for the development of attachment behaviour both in childhood and later in adulthood [2].

Parental sensitivity in interactions is a prerequisite for the development of secure attachment. In turn, secure attachment promotes the infant’s ability to think empathetical-ly about themselves, others, and their environment. Within parent-child interactions, there is a mutual regulation of emotions [3]. While newborns are completely dependent on their caregivers to regulate their emotions, older infants and toddlers can regulate mild emotional distress themselves, though they still need coping support from their caregiv-ers. Active seeking of the caregiver, following them, holding on, and crying are common-ly observed expressions of attachment behaviour in infants and toddlers. If young children are unable to cope with physiological arousal and stress caused by emotions such as fear, sadness, anger, joy, or surprise, they may experience dissociation [2].

Deprivation, experiences of violence such as abuse, or severe loss are particularly pathogenic experiences in early childhood. If these experiences are predominant, attachment disorders can persist even through changes such as moving to a new home or family system, for example, through adoption. Similarly, parents or caregivers who have experienced pathogenic or traumatic events in their own childhood may exhibit dissocia-tive or trauma-specific behaviours when, for instance, the child’s crying triggers their own past trauma, as it reminds them of their own crying. Dissociative behaviour of caregivers relates to the development of disorganized attachment between parents and children. Especially unresolved trauma experiences of parents are reenacted with their own children, and transgenerational consequences of early childhood experiences can be assumed [2,4]. Recent research on Positive Childhood Experiences (PCEs) shows that a stable environment has a long-term positive impact on a child’s development. Factors such as good parental quality of caregiving, i.e., secure, stable, and nurturing relation-ships and environments, have a protective effect and positively influence long-term health and quality of life. High social support, good parental relationship quality, or at least an available, receptive caregiver in the immediate environment of the child can lead to positive outcomes—even in difficult starting situations. Positive relationships, a nurturing environment, and social support trigger beneficial physiological and hormonal responses, strengthening resilience and reducing the negative effects of chronic stress. It is suspected that PCEs can counteract the negative effects of Adverse Childhood Experiences (ACEs) [5,6].

In an inventory of effective measures to promote health equity, the WHO describes investments in early childhood development and intervention as highly relevant both from a health and economic perspective [7]. These investments offer the opportunity to stop the transmission of health inequalities from one generation to the next and to leverage the great potential of early childhood for lifelong health. The WHO guideline “Improving Early Childhood Development” refers to the right of children to achieve their full developmental potential; the health sector plays a key role in supporting “nurturing care for childhood development” [8].

Since children’s development primarily unfolds within relationships with their key caregivers, interventions for infants and toddlers from vulnerable families are most effective when they integrate intensive support for these caregivers, following a “two-generation program” approach. Health and social equity can especially be promoted when the focus is on improving the living situation and strengthening the opportunities and capabilities of parents and other key caregivers. Indicated programmes are designed to aim at stabilizing the family’s financial situation and strengthening the psychosocial health, parenting skills, and selfregulation abilities of caregivers. Such interventions can also interrupt or at least mitigate the transgenerational transmission of health inequalities.

As most families respectively mothers are in contact with the healthcare system before and during pregnancy, the medical sector plays a particularly important role in identify-ing any (mental) health risks. Screenings of mothers for mental health conditions are ideally conducted at several points during pregnancy as well as after childbirth [9]. International examples of the implementation of preventive medical services that consider psychosocial components can be found in Austria, where screenings on psychosocial risks or other risks such as domestic violence will be implemented in the standardized medical care for pregnancy and early childhood. Besides medical doctors, some of these screenings are provided by non-medical professionals, such as midwives. They are intended to serve as a work aid for health practitioners in evaluating the support needs of families and refer as vulnerably assessed families to support programmes as the Frühe Hilfen programme in Austria. The programme aims at pregnant women and families with children up to the age of 3. The concept for this programme was developed considering scientific evidence and practical experiences in 2015 and has ever since been rolled out nationally. The underlying concept was developed on the assumption that health is shaped by the interplay of various social, material, and individual factors, and that the healthy development of children is primarily influenced by the environment in which they grow up. For this reason, the programme Frühe Hilfen supports families in creating suitable conditions for healthy child development. They build on the existing system and integrate the variety of specific services available (such as counselling, therapies, daily support, etc.).

None.

None.

1. Grossmann K E, Grossmann K (2007) Die Entwicklung psychischer Sicherheit in Bindungen — Ergebnisse und Folgerungen fur die Therapie. Zeitschrift Fur Psycho-somatische Medizin Und Psychotherapie 53(1): 9-28.
2. Brisch K H (2020) Bindung, Trauma und Bindungsstorungen. Grundlagen, Intervention und Pravention. In K.H. Brisch, W. Sperl & K. Kruppe (Hrsg.) Early Life Care. Frühe Hilfen von der Schwangerschaft bis zum 1. Lebensjahr. Das Grundla-genbuch pp. 107-133.
3. Asisi V (2015) Entwicklungsbedingungen im Kontext der Eltern-Kind-Beziehung. Chancen und Risiken in der Interaktion mit Mutter und Vater.
4. Overfeld J, Buss C, Heim C (2016) Psychische und körperliche Krankheitsanfäl-ligkeit. Die Bedeutung fruher traumatischer Lebenserfahrungen. InFo Neurologie & Psychiatrie 18: 30-40.
5. Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R (2019) Positive childhood experiences and adult mental and relational health in a statewide sample: associations across adverse childhood experiences levels. JAMA Pediatr 173(11): e193007.
6. Daines CL, Hansen D, Novilla MLB, Crandall A (2021) Effects of positive and negative childhood experiences on adult family health. BMC Public Health 21(1): 651.
7. WHO (2013) Review of social determinants of health and the health divide in the WHO European Region: final report. World Health Organisation, Copenhagen.
8. WHO (2020) Improving early childhood development: WHO guideline. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO
9. Zechmeister-Koss (2023) I Perinatal and infant mental health care in Austria. A mapping report of existing prevention, screening and care structures, with a specific focus on Tyrol. AIHTA Project Report pp. 151.