Good parenting and the relationship between parent and child is critical to the development and health of the child and future outcomes throughout childhood and as an adult. More specifically, bonding, attachment and attunement between parent and child from birth has critical implications throughout life for the health and wellbeing of the child and future adult.
The ability to make a relationship with a child is not innate but is a reflection of the type of relationships the parent has experienced in the past and currently. Where the parent has had difficult childhood relationships and is now lacking good support from a partner, family or friends making a secure relationship with the baby is harder but with support, parents can learn to be nurturing and sensitive to the baby’s needs .
Responsibility for encouraging, supporting and nurturing good parents falls both to the early years workforce and to wider society. The expertise and experience of the community and voluntary sector is crucial to this area of the early years agenda and working in partnership is essential.
Parenting and Health Inequalities from 3-5 years
Sensitive and appropriate responses from parents to children's needs remain key during this time, while communication and negotiation through speech gain importance as language skills develop.
Targeted supports for specific problems and vulnerable families, pre-school education and positive home learning environments can help mitigate health and social inequalities.
Quick Links:
- What are health inequalities?
- Policy context
- What do we mean by 'Positive Parenting'?
- How do inequalities relate to parenting in 3-5s?
- Inequalities and attachment styles
- Promoting positive parenting for parents of 3-5s
- Identifying those at risk
- Providing information and support to parents
What are health inequalities?
The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."
For a general discussion of health inequalities and the early years, please see Inequalities in the Early Years.
Policy context
Activity in this area is consistent with commitments and priorities detailed in The Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, a range of NHS Scotland's Quality Indicators and is relevant to Scotland's national practice model for child-centred services - Getting it Right for Every Child (all external links).
Under the terms of the Disability Discrimination Act, public sector service providers must discharge their Disability Equality Duty to promote equality of opportunity for people with disabilities, including those with communication support needs or communication disabilities.
What do we mean by 'Positive Parenting'?
Parents are the primary caregivers for a child, whether birth parent, adoptive parent, foster carer or corporate carer such as in local authority care.
The UN Convention on the Rights of the Child asserts that:
'...the child, for the full and harmonious development of his or her personality,should grow up in a family environment, in an atmosphere of happiness, love and understanding.'
Under the age of about eighteen months, the main focus of parenting should be on sensitive attunement and recognition of the child’s needs for nurturance and responsiveness. At about eighteen months children begin to be more active in asserting their wishes. While responsiveness and sensitive nurturance remain important, children now need support to manage their behaviour and to start to develop emotional self-regulation
The National Parenting Strategy (external link) considers positive parenting in the following way:
‘Loving children doesn't mean always letting them have their own way. It involves providing a positive role model, setting appropriate boundaries and applying them consistently, all of which is integral to a secure, safe and nurturing home environment. This also helps children learn what's acceptable behaviour and what's not, how to get along with people and how to resolve differences in an appropriate way - essential life skills that can all be learned by families doing basic activities such as talking and listening, eating together, doing chores together and critically, playing together.’ (p.12)
The Getting it Right for Every Child (external link) approach introduced by the Scottish Government provides a checklist parents can use to measure the wellbeing of children and which is re-iterated by the National Parenting Strategy:
- Safe - protected from abuse, neglect or harm
- Healthy - experiencing the highest standards of physical and mental health, and supported to make healthy safe choices
- Achieving - receiving support and guidance in their learning, boosting their skills, confidence and self-esteem
- Nurtured - having a nurturing and stimulating place to live and grow
- Active - offered opportunities to take part in a wide range of activities, helping them to build a fulfilling and happy future
- Respected - to be given a voice and involved in the decisions that affect their wellbeing
- Responsible - taking an active role within their schools and communities
- Included - receiving help and guidance to overcome social, educational, physical and economic inequalities; accepted as full members of the communities in which they live and learn.
How do inequalities relate to parenting in 3-5s?
A range of factors related to inequalities can impact on parents' ability to meet the needs of their children.
These are influenced by the social, economic and political structures of a society and consequent access to resources.
Though not to be mistaken as direct causes, a useful list of influencing factors can be found on p32, Evidence Summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years) (external link)).
Another aspect of parenting which can be affected by inequalities relates to the impact the quality of the home learning environment can have on speech, language and communication development.
For a fuller discussion, please see our sections on Speech, Language and Communication Development (SL&CD) and Health Inequalities from 3-5 Years.
Inequalities and attachment styles
By the age of 3, a child will have developed its 'attachment style', though it will continue to be influenced by his or her interactions with parents and other caregivers.
For a brief discussion on attachment and its relationship to inequalities, please see the section on Inequalities and attachment styles in 0-3s.
For a fuller overview, please consult the 2012 Health Scotland briefing paper A Brief Guide to Attachment (external link) which summarises available evidence in this area.
Promoting positive parenting for parents of 3-5s
On a broad level, effective interventions include home visiting of vulnerable children, by suitably skilled health professionals (e.g. health visitors), high quality childcare and education and enhanced specialist programmes for those identified as experiencing difficulties.
A review of research evidence by Health Scotland, Evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to 5 years) (external link) found that the following interventions are associated with improved outcomes (parent-child interaction, secure attachment, child cognitive and social development):
- media-based parenting programmes
- group-based parenting programmes.
Guidance and interventions for parents on the following topics is effective in improving outcomes:
- sleep
- promoting 'time-out' as an alternative to physical punishment
- video-taped parent-child interactions with professional feedback.
Where specific problems have been identified in older children behaviour problems, parental drug addiction or where parents have a recognised learning disability, there is evidence that targeted training and professional supports improve outcomes.
When targeted at 'at risk' groups, well-resourced early childhood development programmes that include centre-based and home visiting supports improve child and longer term health and development outcomes.
A good example of a targeted approach in current use with young mothers in Scotland is the Family Nurse Partnership.
Other examples used widely with parents are 'Triple P'(external link) over children over three and Mellow Parenting (external link)
Identifying those at risk
Because those at risk can be difficult to identify, it's important to link with other professionals who may know more about the family and their circumstances, e.g. Speech and Language Therapists, carers, GPs, social workers, health visitors, nursery school and other childcare staff, and voluntary sector agencies.
NICE PH40 Social and emotional wellbeing - early years (extrnal link) recommendations suggest that EY professionals develop trusting, non-judgemental relationships with families, which focus on the child’s needs.
Identification of risk factors should include consideration of things that affect the parent’s capacity to provide a loving and nurturing environment e.g. mental health, family circumstances.
Identification of risk should be part of ongoing developmental assessment and take into account emerging risk factors e.g. withdrawn or unresponsive, delayed speech or poor language skills, behavioural problems or indifferent or harsh behaviour from a parent towards a child.
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.
Providing information and support to parents
The 2012 Health Scotland paper Exploration of the information support needs of parents (external link), was the result of in-depth work with 132 parents from across Scotland.
It found that parents preferred 'personal, empathetic support from individuals in dealing with their specific needs for information and support on child health and parenting'.
Three overarching themes emerged:
- Parent information/support is undermined when parents feel marginalised
- ‘Trust’ shapes how information is sought, received and used
- Parents respond most positively to personalised information and support.
Among its recommendations, the report emphasises the need for:
- continuing professional development for staff to enable them to present more personalised information and support
- alternative formats, products and services that more fully take account of the needs, views and preferences of young mothers, fathers and parents with literacy issues
- increased opportunities for face-to-face peer support and virtual social networks.
Many of these actions may require additional support and resources for frontline staff from management - see advice for service managers and commissioners.
