CHILD HEALTH PROMOTION AND CHILD HEALTH SCREENING

Child Health Promotion and Child Health Screening

Child Health Promotion and Child Health Screening

Introduction:

Child health screening programmes aim to prevent disease, detect physical and developmental abnormalities, and promote optimum health and development. There is growing evidence over the past decade that early intervention can change the life course for disadvantaged children. The emphasis has shifted from detecting developmental problems to preventing them and, in recognition of this change, the term “child health screening programme” has given way to “child health promotion programme”. Putting this programme into practice calls for awareness of the evidence as to what works. The evidence supports the need for a universal preschool service for all families and targeted intensive home visiting for high risk children. Preschool intervention and education benefit all children but particularly those at risk of educational failure. Children's Centres may offer the opportunity to provide a more effective integrated service. The shift from screening to promotion requires paediatricians to play several roles in a larger multidisciplinary and multi-agency team, contributing to health promotion as well as facilitating early identification and providing expert diagnostic and management services.

The current interest and investment in the promotion of optimum health and development for children is the result of emerging evidence that outcomes and life chances can be improved by preschool intervention programmes, coupled with growing concerns about health inequalities, educational under achievement, juvenile crime, and social exclusion. (Fegusson, 2004) Such concerns are not new; efforts to address their root causes date from the 19th century when there was a major public investment in sanitary reform and other environmental improvements. In the first half of the twentieth century, the major health concerns were nutritional deficiencies and infectious diseases. As these scourges came under control, more attention could be devoted to child rearing issues, behavioural problems, chronic disorders, and preventive medicine.(Blair, 2003) Routine well-child examination schedules evolved that also included nutritional advice and immunisation; the whole package was designated the Child Health Screening (CHS) programme.(Butler, 1989) Its focus was on the under-5s and the three main aims were disease prevention, health promotion, and early detection and intervention for physical and developmental abnormalities (fig 1).

Over the past 20 years the content of the CHS programme has been reviewed and updated four times by the UK Joint Working Parties on Child Health Screening.(Hall, 2003) Their reports take an evidence based approach and argue that, while these three aims are as important as ever, the investment in routine examinations to detect occult disorders should be rationalised and reduced, whereas health promotion deserves a much greater commitment. This analysis is endorsed by the National Service Framework for Children, Young People and Maternity Services (NSF),(dept of Health, 2003) published in 2004 by England's Departments of Health and of Education and Skills, which proposes that the term CHS be replaced by “Child Health Promotion Programme”. The details of this new programme are set out in Standard One of the NSF.

The NSF programme emphasises the importance of implementing what is already known ...