Systematic review of parent–child attachment security in pediatric physical chronic illness

Abstract Objective Pediatric physical chronic illnesses present unique challenges for children and families, often disrupting developmental processes and family functioning. Parent–child attachment security may play a central role in shaping resilience, coping, and adjustment in this high-risk population. However, relatively little is known about the relationship between attachment security and pediatric physical chronic illness. Methods A systematic search using PRISMA 2020 guidelines was conducted in February 2025 to synthesize existing literature on parent–child attachment security and its associations with child outcomes in pediatric physical chronic illness populations. Twenty-three studies with cross-sectional and longitudinal designs were included. Attachment was assessed using structured observations, interviews, and parent/child self-report measures. Results Across studies three main findings emerged: (1) There were no consistent mean-level differences in attachment security (when measured dimensionally) between clinical and healthy groups; however, some illness-specific groups displayed higher rates of insecure classifications, (2) insecure attachment was consistently associated with greater emotional, behavioral, and psychosocial difficulties, while secure attachment appeared to buffer children against stress and facilitate treatment adherence, and (3) parent-level factors influenced child attachment and illness-related outcomes. Conclusions Findings highlight attachment security as both a potential protective and risk factor for children navigating chronic illness. Future research should address methodological limitations and examine illness-specific features to inform attachment-based clinical interventions for this high-risk population.