Healthcare professionals, neonatal units, hospitals, follow-up teams, and health services
Statement of standard
Peer and sibling relationships are evaluated as part of a standard follow-up programme.
Rationale
The goal is to ensure that children who have problems in peer relationships are identified and their needs met.
Belonging is a fundamental, biologically-based, human need that operates across the lifespan. (1) As children grow up, peers contribute increasingly to both belonging and socialisation. (2) Children who experience difficulties in peer relationships, including those who are bullied, excluded, rejected, and/or disliked by peers, are at significant risk for major developmental difficulties, including mental and physical health problems, academic challenges, absenteeism and truancy. (3,4) The negative impact of poor peer relations is both far reaching, touching virtually all aspects of functioning, and enduring, impacting health and well-being long after the poor treatment from peers has ended. (5,6) Very preterm children are especially vulnerable for experiencing peer difficulties. (7,8) Their increased risk for altered cognitive and physical development contributes to difficulties with interpersonal relationships (7,8) and increases victimisation by peers, even when they do not have obvious motor, cognitive, or sensory issues. (9) Peer relationships characterised by high levels of intimacy and prosocial behaviour play a positive role in children’s health and well-being. (10) Friendships (11) and sibling relationships (12) serve as powerful protective factors against peer victimisation and help mitigate the negative effects of peer abuse.
Using a comprehensive, developmentally appropriate, short screening assessment of socio-emotional development and peer relationships, an annual screening for peer relationship problems from school entry should be developed. (13,14) Children with peer relationship difficulties should be referred to appropriate health and education teams.
Benefits
Short-term benefits
N/A
Long-term benefits
Early identification and referral of very preterm children with mental and physical health problems stemming from peer and sibling relationship problems (7,8)
Provides feedback about peer and sibling relationships (15)
Provides support and advocacy (3)
Reduced risk of secondary mental health, physical health, and academic problems associated with peer and sibling relationship problems (3,13–15)
Increased social integration (3,13,14)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents are informed about and invited by healthcare professionals to attend follow-up programme including peer and sibling relationships.
B (High quality)
Patient information sheet1
Children receive screening for peer and sibling relationship problems. (16–20)
A (High quality)
Audit report2, parent feedback
Parents of children identified at risk for peer and sibling relationship difficulties receive help about appropriate interventions and monitoring of progress. (13–15)
A (High quality)
Parent feedback
For healthcare professionals
A unit guideline on follow-up including peer and sibling relationships is adhered to by all healthcare professionals.
B (High quality)
Guideline
Training on peer and sibling relationships is attended by all responsible healthcare professionals. (16–18)
A (High quality) B (High quality)
Training documentation
Screening for peer and sibling relationship problems using standardised tools is carried out. (16–18)
B (Moderate quality)
Audit report2
For neonatal unit and follow-up team
A unit guideline on follow-up including peer and sibling relationships is available and regularly updated.
B (High quality)
Guideline
For hospital and follow-up team
Training on peer and sibling relationships is ensured.
B (High quality)
Training documentation
For health service
A national guideline on follow-up including peer and sibling relationships is available and regularly updated.
B (High quality)
Guideline
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report” can also be defined as a benchmarking report.
Where to go
Further development
Grading of evidence
For parents and family
Easily available information on peer and sibling relations for families are developed.
B (Moderate quality)
For healthcare professionals
Identify precursors of peer and sibling relationship problems. (3,21)
A (High quality)
For neonatal unit
N/A
For hospital
N/A
For health service
Assess the impact of healthcare providers screening for social development and peer and sibling relations.
B (Low quality)
Getting started
Initial steps
For parents and family
Parents are informed by healthcare professionals about peer and sibling relationships of preterm born infants.
For healthcare professionals
Attend training on the evaluation of peer and sibling relationships.
Raise awareness of the importance of peer relationships for developmental outcomes.
For neonatal unit and follow-up team
Develop and implement a unit guideline on follow-up including peer and sibling relationships.
Develop information material about peer and sibling relationships of preterm born infants for parents.
For hospital and follow-up team
Support healthcare professionals to participate in training on peer and sibling relationships.
For health service
Develop and implement a national guideline on follow-up including peer and sibling relationships.
The importance of social relationships in health and well-being is underscored by a meta-analytic review demonstrating a “50% increase in odds of survival as a function of social relationships”. (22) Social relationships include social network integration, received social support, and perceived social support. Although the quality of caregiver-child relationships has long been emphasised in the promotion of positive cognitive, emotional, and behavioural responses (23), there is strong and growing evidence that peers are an important developmental context that also impacts adaptation across the life span. Bullying (being the target of repeated, intentional abuse by peers who hold more power) is especially problematic for children’s health and development. Bullying begins early in life, when children enter peer groups, contributes to loneliness, sadness, and anger, and is predictive of future peer relationship problems. (24) Bullying peaks around early adolescence (age 10-12) and declines in late adolescence, but never goes away completely. (25,26)
To date, healthcare providers have been at the periphery of efforts to prevent, educate, and address peer relation difficulties despite being important stakeholders in promoting child health. (18,27) Given that poor peer relationships are associated with significant health problems and positive social relationships are associated with wellness, the role of healthcare providers in promoting positive social interpersonal relationships is vital. Many children report being hesitant to disclose problematic peer interactions like bullying to adults because they feel adults will be ineffective, but there is emerging evidence that children would not only disclose to physicians, but that they want physicians to ask them about their peer relationships. (16) Although healthcare providers may not directly observe such interpersonal difficulties, they are often in a position to treat the symptoms of the problem and can identify root causes and contributing factors, including difficulties with peer relationships. Healthcare providers can help children by (a) validating that their social development is an important health issue worthy of attention, (b) being aware of symptoms and signs of peer relationship problems which may prove important for effective treatment of associated conditions, and (c) screening for peer relationship difficulties in clinical settings and intervene if and when needed.
Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995 May;117(3):497–529.
Harris JR. Where Is the Child’s Environment? A Group Socialization Theory of Development. Psychol Rev. 1995 Jul;102(3):458–89.
McDougall P, Vaillancourt T. Long-term adult outcomes of peer victimization in childhood and adolescence: Pathways to adjustment and maladjustment. Am Psychol. 2015;70(4):300–10.
Lereya ST, Copeland WE, Costello JE, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries – The Lancet Psychiatry. Lancet Psychiatry. 2015 Jun;2(6):p524-531.
Takizawa R, Maughan B, Arseneault L. Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. Am J Psychiatry. 2014 Jul;171(7):777–84.
Day KL, Schmidt LA, Vaillancourt T, Saigal S, Boyle MH, Van Lieshout RJ. Long-term Psychiatric Impact of Peer Victimization in Adults Born at Extremely Low Birth Weight. Pediatrics. 2016 Mar;137(3):e20153383.
Day KL, Van Lieshout RJ, Vaillancourt T, Saigal S, Boyle MH, Schmidt LA. Long-term effects of peer victimization on social outcomes through the fourth decade of life in individuals born at normal or extremely low birthweight. Br J Dev Psychol. 2017 Sep;35(3):334–48.
Nadeau L, Tessier R, Lefebvre F, Robaey P. Victimization: a newly recognized outcome of prematurity. Dev Med Child Neurol. 2004 Aug;46(8):508–13.
Berndt TJ. Friendship Quality and Social Development: Curr Dir Psychol Sci [Internet]. 2016 Jun 22 [cited 2018 May 16]; Available from: http://journals.sagepub.com/doi/pdf/10.1111/1467-8721.00157
Hodges EV, Boivin M, Vitaro F, Bukowski WM. The power of friendship: protection against an escalating cycle of peer victimization. Dev Psychol. 1999 Jan;35(1):94–101.
Lamarche V, Brendgen M, Boivin M, Vitaro F, Pérusse D, Dionne G. Do Friendships and Sibling Relationships Provide Protection against Peer Victimization in a Similar Way? Soc Dev. 2006 Aug 1;15(3):373–93.
Taylor RD, Oberle E, Durlak JA, Weissberg RP. Promoting Positive Youth Development Through School-Based Social and Emotional Learning Interventions: A Meta-Analysis of Follow-Up Effects. Child Dev. 2017;88(4):1156–71.
Domitrovich CE, Durlak JA, Staley KC, Weissberg RP. Social-Emotional Competence: An Essential Factor for Promoting Positive Adjustment and Reducing Risk in School Children. Child Dev. 2017;88(2):408–16.
Jones DE, Greenberg M, Crowley M. Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness. Am J Public Health. 2015 Jul 16;105(11):2283–90.
Scott E, Dale J, Russell R, Wolke D. Young people who are being bullied – do they want general practice support? BMC Fam Pract. 2016 Aug 22;17:116.
Lamb J, Pepler DJ, Craig W. Approach to bullying and victimization. Can Fam Physician. 2009 Apr;55(4):356–60.
Moreno MA, Vaillancourt T. The Role of Health Care Providers in Cyberbullying. Can J Psychiatry. 2017 Jun;62(6):364–7.
Wolke D, Baumann N, Strauss V, Johnson S, Marlow N. Bullying of preterm children and emotional problems at school age: cross-culturally invariant effects. J Pediatr. 2015 Jun;166(6):1417–22.
Gladden RM. Bullying Surveillance among Youths: Uniform Definitions for Public Health and Recommended Data Elements. Version 1.0. Cent Dis Control Prev. 2014;
Wolke D, Lereya T, Tippett N. Individual and social determinants of bullying and cyberbullying. In: Vollink T, Dhue F, McGuckin C, editors. Cyberbullying – From theory to intervention. London: Routledge; 2016. p. 26–53.
Bowlby J. Attachment and loss. 2nd ed. New York: Basic Books; 1999. 1 p.
Social Relationships and Mortality Risk: A Meta-analytic Review [Internet]. [cited 2018 May 16]. Available from: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316
Barker ED, Boivin M, Brendgen M, Fontaine N, Arseneault L, Vitaro F, et al. Predictive validity and early predictors of peer-victimization trajectories in preschool. Arch Gen Psychiatry. 2008 Oct;65(10):1185–92.
Cook CR, Williams KR, Guerra NG, Kim TE, Sadek S. Predictors of bullying and victimization in childhood and adolescence: A meta-analytic investigation. Sch Psychol Q. 2010;25(2):65–83.
Vaillancourt T, Trinh V, McDougall P, Duku E, Cunningham L, Cunningham C, et al. Optimizing Population Screening of Bullying in School-Aged Children. J Sch Violence. 2010 Jun 29;9(3):233–50.
Vaillancourt T, Faris R, Mishna F. Cyberbullying in Children and Youth: Implications for Health and Clinical Practice. Can J Psychiatry Rev Can Psychiatr. 2017 Jun;62(6):368–73.
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Vaillancourt T, Hymel S et al., European Standards of Care for Newborn Health: Peer and sibling relationships. 2018.
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