Child Health Promotion Programme

The Children's NSF launched the Child Health Promotion Programme which has replaced the Child Health Surveillance Programme. The core Child Health Promotion Programme includes:¹

• Childhood screening
• Immunisations
• A holistic and systematic process to assess the individual child's and family's needs
• Early interventions to address those needs
• Promotion of healthy children

The UK core Child Health Promotion Programme for all children is summarised below, with suggestions for health promotion activities:

• There are no screening tests for many speech, language, developmental, and congenital disorders.
• If a parent suspects a problem with their child, they are often right.
• Take the views and concerns of parents and other carers seriously. If in doubt, refer.
• Children at high risk of certain conditions may need additional screening tests.

Antenatal care

Usual antenatal care aims to:

• Prevent, detect, and treat pregnancy complications.
• Create a relationship between the primary health care team and the family.
• Ante-natal screening and a preliminary assessment of child and family needs.
• Provide advice on breast-feeding and general health and well-being, including healthy eating, alcohol, drugs and smoking cessation where appropriate.
• Good baby care (promote local parentcraft classes).
• Identify parents who may need extra support in caring for a child, e.g. parents with learning disability or mental health problems.

Soon after birth

• Physical examination (ideally within 24 hours) with particular emphasis on eyes (mainly to detect cataracts), heart and hips. Also check weight, head circumference, tone, spine, genitals, testes, femoral pulse, palate. Look for hernias, jaundice, large organs, dysmorphic features.
• Administration of vitamin K (if parents choose vitamin K drops, these are administered during the first week after birth).
• Review any pregnancy or birth complications, feeding, risk factors for hip dysplasia (breech, family history, foot deformity, torticollis), and risk factors for hearing loss (family history of permanent deafness starting in childhood, congenital infection, ototoxic drugs, dysmorphic cranio-facial features, meningitis, admission to neonatal ITU for >48hrs).
• Health promotion
  • Breastfeeding
  • Sleeping position and other advice to reduce sudden infant death
  • Dangers of passive smoking
  • Assess need for BCG or hepatitis B immunisation
• Automated hearing screen (ideally within first 7 days)
  • This test is likely to be phased in following pilot schemes in certain areas.
  • It will replace the distraction test which has been performed for many years at age 8-9 months.
• The Guthrie 'heal prick' blood screening test (at 5-7 days)
  • For congenital hypothyroidism and phenylketonuria.
  • Screening for cystic fibrosis and haemoglobinopathies are likely to be phased in.

The 6-8 week review

• Physical examination
  • Main emphasis on heart, hips, eyes (cataracts), and testes.
  • Also check weight, head circumference, tone, spine, genitals, femoral pulse, palate.
  • Look for hernias, jaundice, large organs, dysmorphic features.
• Review of general progress and delivery of key messages about parenting and health promotion.
• Identification of post-natal depression or other maternal health needs.
• Consider any other parental concerns.
• Health promotion:
  • Immunisation
  • Breastfeeding, and other advice on feeding and weaning
  • Sleeping position and other advice to reduce sudden infant death
  • Dangers of passive smoking
  • Dental health: sugar-free medicines, avoid sugary drinks, sugar on dummies, etc
  • Car safety and other injury prevention strategies

Age 2, 3, and 4 months

• Immunisation - DTP/HiB, polio, MenC
• Check weight
• Health promotion as for 6-8 week check

8 month, 2 year, and 3-4 year developmental and health reviews

• These have been performed routinely in many areas for a number of years. However, they are no longer recommended as a routine part of the core programme for all children.
• It is thought that primary health care teams will take a flexible approach and offer health reviews and health promotion advice for children and families most in need, or most 'at risk'. Also, to respond to parents who have concerns about their child's development.

By the 1st birthday

• Systematic assessment of the child's physical, emotional and social development and family needs by the health visiting team.
• The hearing distraction test at 8-9 months is likely to be phased out as the automated hearing screen in the newborn period is phased in.

Age 12-15 months

• Immunisation - 1st MMR
• Take opportunity to discuss injury prevention: stairgates, fireguards, small toys, etc.

Age 3-4 years

• Immunisation - 2nd MMR and pre-school DT booster

Age 4-5 years

A review at school entry provides an opportunity to check that:

• Immunisations are up-to-date.
• Children have access to primary and dental care.
• Appropriate assessment and interventions for any physical, developmental or emotional problems.
• Provide children, parents and school staff with information about specific health issues.
• Check the child's height and weight.
• Administer the sweep test of hearing.
• National orthoptist-led programme for pre-school vision screening to be introduced.

Foundation stage profile

• Assessment by the teacher to include a child's:
• Personal, social and emotional development
• Communication, language and literacy
• Physical development
• Creative development

School entry - about the age of 5 (by school nurse)

• Height and weight
• 'Sweep' hearing test
• Vision test is likely to be phased out as the pre-school vision check by orthoptist is phased in
• Review of immunisation status

• Access to school nurse at open sessions/drop-in and clinics by parents, teachers or through self-referral.
• Provision for referral to specialists for children causing concern.
• Children and young people with medical needs and disabilities may receive nursing care within the school environment according to their needs.
• Immunisation when indicated. (BCG aged 10-14 if heaf negative; booster tetanus/diphtheria and polio aged 14-16).
• Some areas perform a vision check, and a colour vision test, in older children or teenagers. This is under review and may be phased out as routine screening tests for all children.