Additional research is needed to provide methodological guidance for future studies, especially for studies involving young children and parents' observational reports. As PRO data are increasingly used to support pediatric labeling claims, there will be more information regarding the standards by which these instruments will be judged. The use of PRO instruments in clinical trials and regulatory submissions will help ensure that children's experience of disease and treatment are accurately represented and considered in regulatory decisions.

Purpose Emerging evidence suggests that maternal emotion and cognitive control capacities are critical to the development and maintenance of parenting practices and may be related to parents’ ability to seek and use parenting help. The purpose of this paper is to present a cohesive conceptual framework on the intersection of maternal emotion and cognitive control capacities and parenting based on a review of literature. Methods We conducted a comprehensive literature review of articles published between 2000 and February 2014 that addressed maternal emotion and cognitive control and parenting. The 35 articles identified were assigned a methodological quality score. Results Low maternal emotion and cognitive control capacity is associated with increased risk of engaging in child maltreatment, whereas higher maternal emotion and cognitive regulation is associated with sensitive, involved parenting. Contextual factors, such as SES and household organization, play a complex and not clearly understood role on the association between maternal cognitive control and parenting. A conceptual framework was developed based on the results of the literature review. Conclusions The conceptual framework developed can be used to inform future research and practice. Longitudinal studies that assess the temporal relationship of maternal emotion and cognitive control and parenting are necessary to establish causality. Research that addresses how maternal emotion regulation and cognitive control capacities are related to mothers’ enrollment and participation in parenting and early intervention programs is an important next step to strengthening policy and intervention work.

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Young children who experience toxic stress are at high risk for a number of health outcomes in adulthood, including cardiovascular disease, cancers, asthma, and depression. The American Academy of Pediatrics has recently called on pediatricians, informed by research from molecular biology, genomics, immunology, and neuroscience, to become leaders in science-based strategies to build strong foundations for children's life-long health. In this report, we provide an overview of the science of toxic stress. We summarize the development of the neuroendocrine-immune network, how its function is altered by early life adversity, and how these alterations then increase vulnerability to disease. The fact that early environments shape and calibrate the functioning of biological systems very early in life is both a cautionary tale about overlooking critical periods in development and reason for optimism about the promise of intervention. Even in the most extreme cases of adversity, well-timed changes to children's environments can improve outcomes. Pediatricians are in a unique position to contribute to the public discourse on health and social welfare by explaining how factors that seem distal to child health may be the key to some of the most intractable public health problems of our generation. We consider the challenges and opportunities for preventing toxic stress in the context of contemporary pediatric practice.