What happens in pregnancy and early childhood impacts on a child’s physical and emotional health all the way into adult life.
One of PHE’s priorities is to ensure that all children are ready to learn at two and ready for school at five. To establish vital foundations for good health and development, it is crucial that families receive the right support during the first few years of their child’s life.
Health visiting services are the lynchpin of that support. This week, the government announced its intention to continue the requirement for local authorities to commission five universal health visiting checks for families.
The first check happens at 28 weeks of pregnancy, and the rest continue up until the age of 2 and a half, forming part of the Healthy Child Programme (the national child public health programme).
These visits originally became mandatory when the commissioning of the Healthy Child Programme transferred from the NHS to local authorities in Oct 2015. The arrangements made it clear that health visitors were best placed to carry out the checks and the contract would continue until March 2017.
Now it will be mandatory for these checks to be delivered by local authorities for the foreseeable future.
So what are the five universal contact points, and what happens during each visit?
First visit - At 28 weeks pregnancy: Health Promoting Visit
The antenatal check is the first time that the health visitor will meet with parents. Together they will complete the health needs assessment covering physical health (such as not smoking and the benefits of breastfeeding), mental and emotional health. The health visitor will also discuss the transition to parenthood, how to enhance the parent-child bonding experience and how parents can help their baby’s early development.
Second visit – At 10-14 days after birth: New Baby Review
This is the first check made by health visitor at home after the baby is born. The health visitor will check on the health and wellbeing of the parents and baby, provide support with feeding and give important advice on keeping safe. They will also discuss early bonding with the baby, talk about feeding, check the baby is putting on weight appropriately, explain the immunisation programme and talk about important safety measures like as car seats. At this point parents also often seek advice on establishing a routine as well as sleep, crying and colic.
Third visit - At 6-8 weeks old: 6-8 week assessment
This check is crucial for assessing the baby’s growth and the health of the parents, whilst particularly looking for signs of postnatal depression. It is a key time for discussing how breastfeeding might be going, immunisations, and other specific issues such as sleep. As well as this check, health visitors will also provide details about local child health resources whilst also assessing whether extra help is needed, such as for babies with special needs.
Fourth visit - At 9-12 months old: One year assessment
This check will look at development, growth and immunisation status. It provides an opportunity to discuss with parents how to respond to their baby’s needs. It is also a vital time to discuss child safety, as well as and nutrition and dental health.
Fifth visit: - 2-2½ years old Two to two and a half year review
This check happens at a key time when specific behaviour, speech and language problems may become evident in children. It presents an opportunity for parents to discuss how their child is developing with the health visitor, and flag any developmental issues that can be identified at this age. This will support early planning as the health visitor can link up with other services to ensure processes are in place to support the child and family for preparing for school.
Why do these visits matter?
Health visitors and school nurses have been called the ‘child public field force’. Through work with communities and families they have an important role to play in the delivery of other government priorities such as tackling childhood obesity, reducing smoking (smoking in pregnancy and passive smoking impact on children) and improving the mental health of new mothers.
These universal health visiting points of contact are vital to ensure that all parents are supported to give children the best start in life, and as highly trained specialist nurses, health visitors are ideally placed to provide help early on when additional problems arise.
Find more information and resources on this subject in Health Matters: Giving Every Child the Best Start in Life.