Relationship-centred care in CHD: promoting belonging, psychosocial adaptation, and family well-being.

Abstract

Background: CHD is the most common congenital anomaly worldwide. Advances in paediatric cardiology and cardiac surgery have transformed survival, shifting attention towards long-term psychosocial adaptation, neurodevelopment, quality of life, and relational well-being for children and their families.

Methods: This narrative review examines the psychosocial, developmental, familial, and relational dimensions of childhood CHD. Literature was identified through PubMed, Scopus, and Google Scholar, with thematic synthesis of evidence relating to psychosocial adaptation, parental mental health, neurodevelopment, resilience, belonging, peer relationships, and models of family- and relationship-centred care.

Results: Childhood CHD is associated with repeated hospitalisation, developmental disruption, emotional distress, and lifelong uncertainty, with psychosocial effects extending beyond the child to parents, siblings, grandparents, peers, schools, and healthcare professionals. Families frequently experience anxiety, depression, chronic vigilance, and posttraumatic stress symptoms, while children and adolescents face challenges related to identity, belonging, and social participation. Supportive relationships, multidisciplinary psychosocial care, educational integration, peer support, and developmentally informed interventions may strengthen resilience and improve long-term adaptation. Patients with advanced heart failure requiring ventricular assist devices or heart transplantation, and their families experience additional uncertainty and psychological burden that warrant dedicated psychosocial support.

Conclusion: Psychosocial outcomes in CHD are shaped not only by medical care but also by the quality of the relationships surrounding the child. Relationship-centred care builds upon established family-centred care by recognising the broader relational ecosystem that influences development, resilience, participation, and quality of life. Future paediatric cardiology care should integrate longitudinal psychosocial, developmental, educational, and relational support alongside advances in medical treatment.