The Health Impact of Peer Relationships

Children develop socially through everyday interactions, such as sharing, taking turns, interpreting facial expressions, resolving conflicts, and correcting misunderstandings. These experiences are central to child social development and foster skills that align with both neurodevelopmental processes—like executive function and self-regulation—and key psychosocial strengths, including belonging and self-efficacy. The American Academy of Pediatrics (AAP) notes that social-emotional growth is intricately linked to success in school and life, and stresses the importance of pediatric primary care as a vital resource for supporting early development and promptly addressing behavioral issues that may affect peer relationships.

Peers offer a unique setting for development: unlike adults, peers expect mutual give-and-take. Through peer interactions, children learn to balance personal desires with group expectations, cope with frustration, and develop real-time perspective-taking skills. Positive experiences with peers over time can build a child's competence and self-assurance; however, ongoing negative peer encounters—such as rejection, isolation, or bullying—can increase the likelihood of childhood mental health issues like anxiety, depression, and behavioral problems. Bullying is a widely acknowledged and damaging form of youth violence, making bullying prevention a critical component of pediatric and school-based care. Effective prevention includes promoting empathy and teaching conflict resolution skills that strengthen healthy social skills.

School Readiness and Learning Outcomes

Often, when families wonder whether their child is ready for school, they focus mainly on academic basics like letters and numbers. However, school readiness skills include social and emotional abilities just as much as they do paying attention, following routines, working well with others, and asking for help when needed. The AAP’s policy on school readiness highlights the crucial role of these social-emotional competencies, not only for starting school but also for later academic and life achievements. It also stresses the value of nurturing these school readiness skills early on as part of overall child development.

On a broader scale, there is strong evidence supporting the effectiveness of social-emotional learning (SEL) programs in schools. For example, a major meta-analysis covering 213 SEL programs and over 270,000 students showed that students improved in social and emotional skills, attitudes, behavior, and academics, with an 11 percentile point increase in achievement compared to peers who did not receive SEL programming. Clinically, this is important because doing well in school and feeling connected to peers and teachers support childhood mental health and foster healthy behaviors during adolescence.

Emotional Regulation and Social Competence

Although children may learn polite "rules," lasting social skills are built on managing strong emotions during real-life interactions. Emotional regulation in children—the ability to recognize feelings, control impulsive reactions, and calm down after being upset—underpins skills such as waiting for their turn or resolving disagreements. When emotional regulation breaks down, it may manifest as aggression, withdrawal, shutting down, or quick overreaction to minor problems, any of which can strain peer relationships in children and increase the risk of conflict.

Emotional regulation begins with adults helping children recognize and manage their feelings. With time, kids learn these skills independently. Early social-emotional resources show that children develop emotional and social abilities, such as cooperation and sharing, through ongoing support from adults and peers, reinforcing both children's social development and long-term emotional health.

Recommended Practical Strategies

The following approaches are suitable for well-child visits, school health consultations, and behavioral follow-ups. They are intended to be practical rather than prescriptive.

1) Protect time for peer interaction (and make it structured when needed).

Free play is valuable, but some children do better with predictable activities (board games, building projects, shared sports drills). Suggest short, time-limited playdates for younger children (30–60 minutes) with a clear plan: one shared activity, one snack, one “goodbye routine.” For children who struggle socially, structure reduces cognitive load and supports children's social development without overwhelming them.

2) Teach skills explicitly using “micro-scripts.”

Many children benefit from short, rehearsed phrases they can use automatically to support peer relationships in children:

“Can I play too?”

“Let’s take turns.”

“I did not like that. Please stop.”

“Can we try again?” (repair attempt)

Practice these brief scenarios at home or in the clinic. The main aim isn’t perfection, but making social interactions more accessible, which helps children strengthen social skills through repeated positive experiences.

3) Coach emotion labeling and “body cues.”

Caregivers and educators can help children develop better emotional regulation by identifying and labeling feelings and bodily sensations early on—for example, saying “Your shoulders seem tense; you might be feeling frustrated”—and following up with a coping strategy such as deep breathing, taking a water break, using a sensory tool, or moving around. These practices foster interoceptive awareness and reduce impulsive reactions that may interfere with peer interactions.

4) Reinforce effort, not popularity.

Caregivers may often focus on being "liked," but it's more helpful to view success as practicing new skills: taking the first step, trying to fix a mistake, or handling minor disappointments. This approach supports resilience, healthy child social development, and foundational school readiness skills.

5) Build an environment that supports bullying prevention.

Bullying prevention works best when it takes a systemic, skills-based approach rather than relying only on punishment. According to the Centers for Disease Control and Prevention (CDC), effective prevention involves teaching students safe responses and building important interpersonal skills such as empathy and conflict resolution. National recommendations also support community solutions that combine mental health services with bullying responses and prevention, recognizing the long-term impact of bullying on childhood mental health.

Indicators a Child May Need Support

Shyness, intensity, or slow adjustment can be typical for children. Warning signs include persistent, pervasive patterns that affect functioning. Seek further evaluation or intervention if these patterns appear:

• Ongoing struggles with forming or maintaining peer relationships in children beyond what is expected for their age.
• Consistent conflicts with peers or increasing aggressive behavior during playtime.
• Noticeable avoidance of school or group activities, often accompanied by physical complaints.
• Inflexible or one-sided interaction styles and difficulty reading social cues.
• Regular emotional outbursts triggered by peer interactions, which may reflect challenges with emotional regulation in children.
• Signs of involvement in bullying—whether as a victim, perpetrator, or witness—are associated with negative childhood mental health outcomes.

For children with neurodevelopmental differences such as autism or attention-deficit/hyperactivity disorder (ADHD), anxiety, language disorders, or exposure to trauma, these social challenges may be core issues rather than secondary ones. Early intervention supports healthy child social development and reduces long-term risks.

Clinical Practice Considerations

Busy clinicians can consider this practical approach:

• Begin each visit by asking a focused question, such as “How are friendships going?”
• Normalize variation while assessing for distress or impairment.
• Offer families one or two practical tools to support social skills and emotional growth.
• Collaborate with schools when concerns affect daily functioning, as SEL programs support both behavior and school readiness skills.
• Refer to evidence-based interventions when peer challenges are linked to anxiety, depression, or conduct concerns affecting childhood mental health.

Closing Thought

Children develop social skills much as they do language or movement abilities: through exposure, guidance, practice, and nurturing environments. When healthcare professionals recognize peer relationships in children as a vital component of overall health and support emotional growth and bullying prevention, they play a meaningful role in strengthening children's social development, improving school readiness skills, and promoting lifelong mental well-being.