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This study examined emotional and behavioral regulation and salivary cortisol responses in preschool\u2010aged children who underwent cardiac surgery in infancy, and explored the parent\u2013child relationship as a source of co\u2010regulation and buffering support. In this prospective cohort, 22 preschoolers with CHD and their parents participated in a hospital\u2010based laboratory visit. Child salivary cortisol was collected at three time points. Observed parent\u2013child interactions were coded using the Emotional Availability Scales, and parent\u2010reported Child Behavior Checklist (CBCL) scores assessed emotional and behavioral regulation. Mixed\u2010effects models examined associations between cortisol response, CBCL scores, and relationship quality. Significant individual variability in cortisol response was observed. Lower cortisol levels were associated with greater emotional and behavioral difficulties and higher parent\u2010reported traumatic stress at the time of their child's surgery. Longer hospital stays predicted blunted cortisol responses. Children in lower quality relationships displayed flatter cortisol profiles. Findings highlight the impact of early medical stress on stress physiology and suggest emotionally available relationships may buffer HPA axis dysregulation. Results identify potential intervention targets to support psychosocial development and parent\u2013child relationships and contribute to the emerging use of stress biomarkers in CHD research.<\/jats:p>","DOI":"10.1002\/dev.70200","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:53:51Z","timestamp":1789455231000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Childhood Emotional, Relational, and Stress\u2010Related Outcomes Following Infant Cardiac Surgery"],"prefix":"10.1002","volume":"68","author":[{"given":"Tamera A.","family":"Clancy","sequence":"first","affiliation":[{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"},{"name":"Brain and Mind Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina de","family":"Weerth","sequence":"additional","affiliation":[{"name":"Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Muscara","sequence":"additional","affiliation":[{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"},{"name":"Brain and Mind Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"The Royal Children's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid","family":"Jordan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics University of Melbourne  Melbourne Victoria Australia"},{"name":"Brain and Mind Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Manual for the ASEBA Preschool Forms & Profiles","author":"Achenbach T. 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