In response to the commentary,1 we would like to thank the authors for their interest and thoughtful comments.

As a first step toward addressing limitations of measures of child health, Bangma et al.2 shows that the positive child health index (PCHI) is correlated with the Pediatric Quality of Life Inventory (PedsQL), which includes measures of quality of life across physical and psychosocial domains as reported by a parent or guardian. The developed PCHI aims to make a connection on the state of well-being of the child beyond the perception of a parent or guardian. Agreement between the two measures suggests they could be both making inferences on a more complete notion of positive health.

Once determined to be associated with the PedQL, the strength of Bangma et al.2 was the development of a PCHI measure that utilizes disease susceptibility or health to further interrogate aspects of positive child health. There are, however, aspects of positive health that can only be ascertained from the individual directly. In the ongoing evaluation of the ELGAN cohort at 15 years of age, the team is broadening the assessment of positive aspects of health, with measurement of adolescent-reported quality of life, life satisfaction, meaning and purpose, and global health, as well as measures of sleep quality. These assessments will provide aspects of well-being that were not possible to obtain at the 10-year evaluation, and, in conjunction with the PCHI, will provide the necessary components for a truly comprehensive measure of positive heath.

A primary goal of Bangma et al.3 on antecedents of PCHI was to begin the search for factors associated with increased likelihood of positive outcomes that might be targeted as treatments/intervention strategies for all children. It is clear that some of the antecedents are likely to be more easily modifiable than others and thus should be prioritized for future intervention trials.

There are important long-term implications for programs, practices, and policies that could promote positive child health, particularly in relation to children born prematurely. The current research collaborations, made possible by the Environmental Influences on Child Health Outcomes (ECHO) Program, will be enhanced by the opportunity to engage in interdisciplinary collaborations that involve experts in medical and behavioral interventions as well as experts in social determinants of health.

Finally, all research is designed to stimulate additional dialogue about not only the merits of the science but also the advancement of scientific inquiry into a particular topic. We are pleased to see that this paper has begun an important discussion into the myriad of issues inherent in positive child health.