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Continuing the mandation of the universal 5 health visiting checks

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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.

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  1. Comment by Sarah Neill posted on

    It is good to know that these five checks are being retained. It is, though, something of a minimalist approach when you compare with other EU countries. For example in Finland expectant mothers are seen between 9 and 14 times before the birth and the baby is seen 9 times during the first year. It is no surprise then to find they have better child health outcomes than the UK.

  2. Comment by Jenny murray posted on

    Our local authority are not doing 1 or 2 year checks unless you have a concern about your child so they surely are not meeting this compulsary requirement?

  3. Comment by Sam Thackery posted on

    Haven't heard back from my Health visitor since the 6 weeks appointments called her but phone is off. In Europe, children have a paediatrician. In Spain during he first year the babies do have a paediatrician they see regularly. Not surprised us in the UK are so behind when it comes to healthy children.The one year review was a bit of a joke really.

  4. Comment by Susan Palmer posted on

    My son is now 18 months old and hasn’t seen a health visitor since he was 6 weeks old.
    I called them to ask for him to be weighed before he started weaning so I could ensure he was putting on weight but they said no, they’d be out again for his next check at 8 months and made it seem like I was asking a lot of them and shouldn’t be doing so. Low and behold, I haven’t heard a thing from them.
    I am a first time mum so would have appreciated a little extra support to ensure my son was doing as well as he could be and to give me confidence that he was hitting milestones etc but have felt that they have absolutely no interest in his development. I also suffered badly with PND but thankfully, I have a supportive husband and parents that helped me get the help I needed and I have a happy and thriving little boy.
    I will be refusing any visits they may request in the future.

  5. Comment by Rosemary Ross posted on

    Health visitors do not see babies after their 6 week check. The 10 month and 2 year development reviews are done by the nursery nurse. Further support for weaning, sleep support and behaviours etc are all supported by band 4 nursery nurses. We are now a 0-19 team, but again this change has only impacted on the band 4 role. Health visitors in my area still only do birth visits and 6 week checks. Most parents do not want a antenatal. We do not have much safeguarding in our area. The hv implementation has to be looked at again to make delivery better for families beyond 6 weeks of age and nursry nurses workload easier and fairer to deliver a good service.