Pre-school Check (CHS)

Since the first Hall report in 1989,¹ there has been a steady move in child health surveillance away from limited routine development checks towards a more holistic, educational and problem solving approach to the needs of the child and family. There remains some concern that an end to routine child health/development surveillance may lead to a failure of early detection of some children with developmental disorders and thus failure to start effective interventions at an early stage.²

More detailed, structured psychometric tests (either general, e.g. Griffith's scales, or specific, e.g. Reynell Developmental Language scale) are used in situations where there are concerns about the child's development.

There is little evidence for much of the short, unstructured pre-school testing in terms of specificity, sensitivity and in improving outcomes.^3,4 However for certain groups (e.g. foster children and those children in social service care), pre-school checks do at least ensure that there is some contact with primary health care teams and an opportunity to record the child's health needs. The importance of this is recognised in the fact that such health assessments are a statutory responsibility.⁵

The Children's NSF includes a Child Health Promotion Programme to replace the current Child Health Surveillance Programme:⁶

• Check that immunisations are up-to-date.
• Ensure children have access to primary and dental care.
• Ensure appropriate interventions are available for any physical, developmental or emotional problems that had previously been missed or not addressed.
• General development should be assessed. Listening, talking and observation are often as important as any assessment tool used.
• Gross motor development:
  • By 4, stands on one leg, jumps up and down
  • By 5, skips, broad jumps
• Fine motor development:
  • By 4, draws a circle and a cross
  • By 5, dress themselves, copies a square and a triangle
• Social development: separates from mother easily, uses knife and fork.
• Language development: talks clearly, uses adult speech sounds, has mastered basic grammar.
• Bladder and bowel control.
• Behavioural difficulties: including advice for mild-moderate behavioural disorders, including tantrums, feeding difficulties and sleep difficulties.
• Provide children, parents and school staff with information about specific health issues, e.g. safety, dental hygiene, diet.
• Growth measurement including weight and standing height. These should be carefully plotted on appropriate charts. Physical assessment may also include heart sounds and descent of testes.
• Hearing screening: sweep test.
• In addition, a national orthoptist-led programme for pre-school vision screening is to be introduced.
• At school entry an assessment by the teacher, called the Foundation Stage Profile, will include personal, social and emotional development; communication, language and literacy; physical development, and creative development.

• Management of minor illnesses themselves, using community pharmacists where appropriate.
• Access to appropriate services when necessary.
• Participation in their own care planning and delivery.

The Child Health Screening Subgroup of the UK National Screening Committee⁷ has been asked to advise the UK National Screening Committee on the implementation, development, review, modification, and where necessary, the cessation of UK childhood screening programmes.