Features

Health for all children

06 September 2019

Alan Emond, senior editor of this vital child health reference book, reveals what’s new in the fifth edition.

Health for all children was originally published in 1989 as the report of a multidisciplinary working party chaired by Professor David Hall, and the book subsequently became known as the ‘Hall report’. The original report reviewed the evidence for screening and health surveillance of children and made evidence-based recommendations for a universal child health surveillance programme.

Subsequent editions in 1992, 1996 and 2003 expanded the evidence base and shifted emphasis onto health promotion and primary prevention. The revised fourth edition, published in 2006, had a significant influence on child health policy across the UK, informing the design of the National Service Framework for Children in 2007, and the child health programmes in the four devolved nations – the Healthy Child Programme in England (NHS England, 2009), Healthy Child, Healthy Future in Northern Ireland (Department of Health NI, 2010), the Scottish Child Health Programme (NHS Scotland, 2012) and Healthy Child Wales (Welsh Government, 2016).

Why is a new edition needed?

An update of this important reference book is now overdue. In the past 13 years, the evidence base to support clinical practice in child health surveillance and health promotion has expanded, and the range of professionals engaged in delivering care to young children has widened. The commissioning of services for children outside hospital has changed, especially in England, and in the past decade child health services have been competing with other priority groups for resources in times of austerity. The world is now digital, and evidence-based recommendations for practice need to be web-based and linked to e-learning.

What’s new?

In the latest edition, the review of evidence starts in pregnancy and runs until age seven. The book takes account of different government policies and different models of delivery of the child health programme in the different UK administrations. Evidence from all over the world is critically appraised, but referenced to UK policy and practice, using an approach based on ‘proportionate universalism’. The fifth edition of Health for all children is available as an interactive online book as well as an e-book and a paperback.

The foundations of health and wellbeing are laid down in pregnancy and the early years. The fifth edition takes a life course approach to child health, starting in pregnancy and extending to the age of seven years, to include transition into school and to cover the early years in education. The scope of the book is to summarise evidence supporting preventive healthcare, health promotion and an effective community-based response to the needs of families and children. The book contains 35 chapters divided into five sections (see box, Health for all children sections). Each chapter summarises evidence of effectiveness in the topic area, in health promotion and in universal and selective interventions.

It includes new chapters on, for example, safeguarding, gypsy/traveller health, migrant and refugee children, and school readiness and transition into school.

Learning links and recommendations

The book summarises evidence about ‘why’ and ‘what works’ in health promotion and health surveillance with children and families. Where possible it gives guidance on ‘how’ to implement and quality-assure a programme and the competencies needed – but does not conclude ‘who’ should provide the service. Each chapter includes ‘learning links’ to online training materials and e-learning for health, or to resources freely available to practitioners.

Recommendations are made for commissioners of child health services, provider organisations and trusts, and practitioners. Each recommendation is made on the basis of evidence, and a weighting of the strength of that evidence is attached to each recommendation. The strength of recommendations is determined by the balance between the quality of evidence, variability in values and preferences, desirable and undesirable consequences of alternative strategies, and resource use.

Key messages for community practitioners

The review and its recommendations will be of special interest to community practitioners. It will also be relevant to managers of 
child health programmes, and trainees and students from a range of professional backgrounds.

Here are some highlights:

  • The evidence base is getting stronger supporting the importance of pregnancy and the first 1000 days in shaping health, psychological and developmental trajectories through childhood into adulthood.
  • The strong evidence for the impact of the mental health of the parents in pregnancy and infancy on the developing child requires all practitioners to take action in families with depression, anxiety and inter-personal violence. A perinatal mental health coordinator is recommended for all trusts to develop care pathways and ensure that action is taken on practitioners’ concerns.
  • Antenatal care is now focused on mothers’ health in pregnancy and on the safe delivery of a healthy baby. ‘Preparation for parenthood’ needs to be reinvigorated, especially for first-time parents.
  • To reduce inequalities in health and life chances, a child health programme based on proportionate universalism requires both targeted and enhanced services in addition to universal provision. Targeted services can be commissioned for special groups, but enhanced services require comprehensive holistic assessment of families by skilled community practitioners – in the home as well as in clinic and in children’s centres.
  • No new universal contacts are recommended, but a flexible approach to the opportunistic identification of growth, developmental and behaviour problems is emphasised.
  • Practitioners need to be trained and supported in distinguishing delayed from atypical development, with a clear pathway for referral to a single point of entry for further assessment.
  • For children in nursery settings, a joint health/nursery assessment with the parents at 27 to 30 months is endorsed.
  • The aim of the child health programme should be to promote children ‘ready to learn by two, ready for school at five’ and school readiness is strongly supported as the outcome of the programme.
  • Enhancements to the child health programme, such as Flying Start, A Better Start, Family Nurse Partnership and MECSH are critically reviewed.

The editors and authors of the new edition are not receiving fees – all royalties will go to the Royal College of Paediatrics and Child Health to be invested in future updates of the book.  

Alan Emond is a clinical academic paediatrician with more than 40 years’ experience of community paediatrics, and emeritus professor of child health at the University of Bristol.  


Health for all children sections

  1. Introduction: philosophy and principles
  2. Pregnancy, perinatal period and preparation for parenthood  
  3. Primary prevention and health promotion in childhood                                                                
  4. Secondary prevention – screening and identification of impairments
  5. Children with additional needs and children in special circumstances
  6. Components of a child health programme
  7. Implementation of a child health programme

Time to Reflect:

How might you use the latest review of the evidence to improve your practice with children aged under seven and their families? Share any insights and join the conversation on Twitter @CommPrac #Health4all


Resources:

  • The fifth edition of Health for all children is published by Oxford University Press and available as a paperback, online book and e-book in Kindle. Order the paperback at bit.ly/Emond_OUP and enter AMPROMD9 to save 30%. Or talk to your manager or librarian about online access for your team.  
  • An Early Intervention Foundation report looks at programmes for 0 to 5-year-olds and their families bit.ly/EIF_start  
  • Harvard University offers a resource library bit.ly/Harvard_library

References:

 

NHS England. (2009) Healthy Child Programme. See: http://www.healthychildprogramme.com (accessed 24 July 2019).

NHS Scotland. (2012) Child Health Programme. See: https://www.isdscotland.org/Health-Topics/Child-Health/Child-Health-Programme/ (accessed 24 July 2019).

Welsh Government. (2016) Healthy Child Wales Programme. See: https://gweddill.gov.wales/topics/health/publications/health/reports/healthy-child/?lang=en (accessed 24 July 2019).

Department of Health Northern Ireland. (2010) Healthy Child, Healthy Future. See: https://www.health-ni.gov.uk/publications/healthy-child-healthy-future (accessed 23 July 2019).


 

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