Child and adolescent health and wellbeing: evidence review

5. Nurtured

5.1 Elements within the Nurtured domain

The Nurtured domain is defined as 'Having a nurturing place to live in a family setting, with additional help if needed, or, where possible, in a suitable care setting'. The indicators identified here are around the young person's relationship with their parent or principal carer.

Family relationships

Consultation with young people has highlighted the importance of positive relationships, including those with parents or main carers. Young people want to feel cared for by their family, and spend time with them. Previous research has identified that certain processes of family dynamics, specifically communication with parents, have a clear influence on adolescent development, life chances and health behaviours ^{( xliv)}. Many studies have found healthier behaviours in children and adolescents who have open communication with their parents ^{( xlv)} and perceive them to be emotionally and physically accessible ^{( xlvi)}.

The childhood resilience literature shows that the single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver or other adult ^{( xlvii)}. The ACEs literature highlights the importance of the presence of an always available trusted adult (who may or may not be a parent) in mitigating the negative impact of ACEs. Among people with four or more ACEs, the presence of such an adult more than halved the likelihood of poor mental-wellbeing in adulthood ^{( xlviii), ( xlix)}.

Research has also found that spending time with family makes it more likely that young people will share parental and societal norms and values, protecting them against taking up specific risk behaviours such as excessive drinking ^{( l)} and leading to improved diet quality ^{( li)}. It has also been found that an individual parent or carer can stimulate an interest in education that provides children with a diversion from difficulties in other aspects of their lives, enabling them to feel a sense of achievement and self-esteem. A range of evidence suggests that parental interest in a child's education can support achievements in school, despite problems related to poverty or other family difficulties ^{( lii)}.

It is worth noting that currently available data on family relationships is limited to secondary school ages, although it is known that nurturing family environments from birth and throughout early years and primary school are also associated with positive wellbeing. Children who have experienced sensitive, responsive care-giving are more likely to develop a secure attachment style, which is associated with positive outcomes including self esteem, self confidence, resilience and emotional regulation.

A large proportion of children who have been maltreated develop a disorganised attachment style, which is a strong predictor of later relationship and emotional difficulties ^{( liii)}.

5.2 Current position

5.3 Key points

• The majority of young people in Scotland reported positive family relationships (between five and eight in ten depending on the measure), but a substantial minority did not. Scotland performed poorly on family relationships compared with other countries.
• There is strong evidence that family relationships worsen with age throughout childhood. Older children were less likely to say that their parents know a reasonable amount about them; were less likely to find it easy to talk to their parents; were less likely to talk to their parents if they were worried about something; and reported lower levels of family support. This worsening of relationships is more marked in Scotland than other countries.