{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T09:36:15Z","timestamp":1781688975216,"version":"3.54.5"},"posted":{"date-parts":[[2026,1,24]]},"group-title":"Pediatrics","reference-count":53,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Early relational health (ERH) is thought to buffer the association between early life stress (ELS) and child psychopathology, but limited work has directly tested this hypothesis.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We evaluate mother-infant emotional connection, a facet of ERH, as a buffer of combined and individual impacts of specific ELS exposures (maternal mental health and interpartner conflict) on child psychopathology.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants included mother-infant dyads (n=100) followed longitudinally in the COMBO cohort, a convenience sample recruited during the COVID-19 pandemic. ERH was assessed via a remote mother-infant face-to-face interaction at ~4mo postpartum coded for emotional connection. An ELS Index was estimated using measures of maternal self-reported postpartum anxiety, depression, stress, and inter-partner conflict. Mothers rated emerging signs of child psychopathology symptoms at 2-3yrs on the Child Behavior Checklist for Ages 1\u00bd\u22125 (CBCL\/1\u00bd\u22125). Main and interactive effects of ELS and ERH on emerging signs of child psychopathology were tested in generalized linear models.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Greater ELS Index scores were associated with a higher rate of emerging psychopathology symptoms (aRR=1.32, p&lt;.001), but this association was moderated by a significant interaction between the ELS Index and emotional connection (aRR=0.99, p=.03), such that at higher levels of emotional connection, the association of ELS with child psychopathology symptoms was weaker (aRR=1.16,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;.001).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Parent-infant emotional connection may buffer the impact of ELS exposure in infancy on child emerging symptoms of psychopathology in toddlerhood, supporting efforts to invest in pediatric interventions that target ERH.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.01.23.26344636","type":"posted-content","created":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T04:45:11Z","timestamp":1769316311000},"source":"Crossref","is-referenced-by-count":1,"title":["The quality of early relational health modifies the effect of early life stress on child emerging psychopathology"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-5126","authenticated-orcid":false,"given":"Jennifer","family":"Warmingham","sequence":"first","affiliation":[{"name":"Center for Early Relational Health, Columbia University Irving Medical Center, New York, NY"},{"name":"Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY"},{"name":"University of Rochester, Mt. 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