The U.S. healthcare system is built largely to respond after illness appears. A new consensus paper from the American Academy of Nursing argues that children’s health could improve dramatically if prevention became the organizing principle of care. The proposed approach moves beyond clinics and hospitals, treating families, schools, childcare centers, neighborhoods, environmental conditions, and community organizations as interconnected parts of a child-health ecosystem. Its authors say this shift could influence not only childhood illness, but also health outcomes across the entire life course.
The paper, led by school nurse expert Erin Maughan and colleagues in the academy’s Child, Adolescent and Family section, presents a nurse-led framework for redesigning systems around prevention, strengths-based care, and collaboration. Rather than defining children primarily by diagnoses or risks, the framework emphasizes protective factors, positive relationships, family capabilities, and community resources. In technical terms, it applies an ecological and life-course perspective: health is shaped by interacting biological, social, developmental, and environmental conditions that accumulate over time.
“ A person’s health is impacted by specific contexts during childhood that have a lasting impact,” Maughan said. The authors argue that healthcare systems should therefore identify and reinforce the conditions that help children remain healthy, rather than waiting until problems require intensive medical treatment. These conditions may include stable relationships, safe housing, supportive schools, access to nutritious food, clean air, responsive caregivers, and opportunities for social connection. By strengthening these protective factors early, prevention could reduce later disease and improve developmental outcomes.
The proposal responds to what the authors describe as an implementation gap. Research has produced substantial knowledge about child development, disease prevention, family support, and environmental health, but that knowledge has not been consistently translated into everyday practice. Evidence-based interventions may exist without adequate funding, trained personnel, data-sharing systems, or coordination between institutions. The consensus paper calls for policies that connect scientific evidence with the places where children actually live and grow, including schools, childcare settings, homes, primary-care practices, and community programs.
A central recommendation is to expand access to family-focused interventions and home-visiting programs from pregnancy through adolescence. These programs can provide developmental guidance, health education, screening, and support for caregivers during periods when early intervention may have the greatest effect. The authors also support stronger public investment in childcare and after-school care, expanded health coverage, and strengthened child and dependent tax credits. Such measures address social determinants of health, which are the economic and environmental conditions that influence exposure to risks and access to protective resources.
The framework gives school nurses a particularly important role. The authors recommend that every school have access to a full-time, bachelor’s-prepared registered nurse, supported by increased funding for coordinated school-health and school-nursing programs. Schools are among the few institutions that routinely interact with large numbers of children over many years, making them essential sites for prevention, early identification, health education, and care coordination. A school nurse can monitor chronic conditions, recognize emerging physical or emotional concerns, connect families with services, and help translate medical recommendations into practical support within the classroom.
The paper also highlights environmental exposures that can affect children’s health. It recommends child-specific air-quality standards with continuous monitoring in schools and childcare facilities, along with mandatory use of certified, nontoxic green cleaning products. Children breathe more air relative to their body size than adults and may be particularly vulnerable to respiratory irritants and chemical exposures during development. Monitoring indoor air and reducing hazardous compounds could help limit triggers for asthma and other respiratory problems, while also producing data that schools and public-health agencies can use to guide interventions.
Technology is another component of the proposed redesign. The authors call for policies that encourage affordable and accessible health-information sharing across healthcare and community settings, including schools, childcare centers, and local organizations. When appropriate privacy protections are in place, coordinated information systems can reduce fragmented care and help professionals understand a child’s needs in context. A pediatrician, school nurse, social worker, and family-support program could then work from compatible information rather than relying on isolated records, repeated assessments, or delayed communication.
The consensus paper connects these recommendations to early relational health and positive childhood experiences, or PCEs. Positive relationships with caregivers and other trusted adults can influence stress regulation, emotional development, learning, and later health behavior. By combining relational health and social health with traditional nursing, developmental, and medical models, the authors describe a paradigm shift from health protection after illness to health protection before illness. They argue that policy changes across multiple systems could create a cascade of benefits, because improvements in one setting—such as school nursing, housing stability, or family support—may strengthen outcomes in others.
“Redesigning ecosystems for all children to enhance health and well-being: An American Academy of Nursing consensus paper” was published in the July–August 2026 issue of Nursing Outlook. The paper’s authors include Erin Maughan, Sonja J. Meiers, Susan M. Breitenstein, Jean S. Coffey, Kay J. Cowen, Cynthia A. Danford, Catherine Dodd, Simmy King, Donna M. O’Malley, Cheryl-Ann Resha, Mary C. Sullivan, and Susan K. Lee. The authors contend that making prevention a shared responsibility across families, schools, communities, environmental systems, and healthcare could help children lead healthier lives now while reducing avoidable health burdens in the future.
Subject of Research: Child health prevention and the redesign of family, school, community, environmental, and healthcare systems
Article Title: Redesigning ecosystems for all children to enhance health and well-being: An American Academy of Nursing consensus paper
Web References: https://www.sciencedirect.com/science/article/abs/pii/S0029655426001545?dgcid=author; https://doi.org/10.1016/j.outlook.2026.102831
References: Nursing Outlook, 1 July 2026, DOI: 10.1016/j.outlook.2026.102831
Keywords: Children, child health, prevention, school nursing, nursing, positive childhood experiences, early relational health, social determinants of health, public health, healthcare systems, family-focused interventions, home visiting, environmental health, school health, life-course perspective
