The relationship between social factors and health is of great interest to clinicians, health system leaders, and policy makers.1 Although it may seem intuitive to infer a relationship, identifying the underlying pathway(s) and defining prevention, mitigation or intervention strategies has proven to be difficult. The scholarly field is relatively new and one of the founders was Dr. Nancy Adler, a pioneering health psychologist who studied the relationship between socioeconomic factors and health outcomes.2 Various instruments have been developed to assess and measure social factors but there is no clear consensus on the best instrument. More recently, the identification of biomarkers has generated interest in the development of tests and indices which could be applied in the clinical setting. To date, the focus of biomarker research has been inflammatory and neuroendocrine factors but additional areas are emerging. The urgent need to define standard measures is highlighted by the Centers for Medicare & Medicaid Services’ recent initiative, in partnership with other organizations, to implement new quality measures, many of which require screening patients for health-related social needs.3 To implement widespread screening, it is essential to define the most accurate instruments and the most reliable biomarkers.

What does this mean for children and pediatricians? The application of new quality measures and tests to pediatric populations is often challenging, sometimes because the measures have not been adequately tested among children, the types of biomarkers require invasive sampling or other issues. For decades, researchers have documented the impact of a variety of social stressors on child health,1 but it has been difficult to understand whether specific events are especially detrimental, whether the timing of stressful events is significant, and how the impact of such experiences might vary by race/ethnicity, age, family structure, community characteristics or another factor. While some events, such as the loss of a parent or loss of home, may be universally stressful and/or traumatic, the impact of other events may be variable. Similarly, should social risks or vulnerabilities be considered as individual measures or as part of a multifactorial measure? In terms of biomarkers, it is not clear if the physiologic response to social influences is similar for adults, infants, children or adolescents. These are critical issues to evaluate before the pediatric community should embrace screening and testing for social risk factors or social needs. In any system of screening or intervention, it is essential to approach the process from the perspective of respect and humility; although a provider may have a good intention in evaluating social risk, the screening experience may elicit feelings of shame or reluctance to disclose sensitive information.1