HEALTH FOR ALL CHILDREN 4: GUIDANCE ON IMPLEMENTATION IN SCOTLAND 2005

Neonate - first 24 hours

• Full clinical examination, including:
• • Examination of the palate
  • Hip test for dislocation (Ortolandi and Barlow manoeuvres)
  • Inspection of eyes and examination of red reflex
  • Thorough check of cardiovascular system for congenital heart disease
  • Check genitalia (undescended testes, hypospadias, other anomalies) and record testicular descent
• Check femoral pulses
• Plot and record birth weight
• Record head circumference
• Record length (only if abnormality suspected)
• Record length of pregnancy in weeks
• Record problems during pregnancy/birth
• Record feeding method at discharge
• Vitamin K administration, following discussion with parents
• Review any problems arising or suspected from antenatal screening, family history or labour
• Neonatal hearing screening (being phased in)
• Health promotion - discuss:
• • Baby care
  • Reducing SIDS risks
  • Feeding
  • Jaundice, Hepatitis B and BCG Vaccines
  • Smoking cessation
• Discuss any parental concerns
• Identify parents who might have major problems with their infant (e.g. domestic violence, substance abuse, learning difficulties, mental health problems)

• Provide information about local support networks and contacts for additional advice or support when needed

Early discharge

Where a mother and baby are discharged within 24 hours, arrangements should be made to ensure that the full neonatal examination is completed.

Neonatal hearing screen

HDL(2001)51, which issued in June 2001, advised the service about the introduction of universal newborn hearing screening. NHS Boards are expected to implement the screening programme in 2005.

Vitamin K

Each NHS Board area should have a single protocol for the administration of Vitamin K, with which every member of staff involved with maternity and newborn is familiar.

Screening

Advise that no screening test is perfect. Details of signs and potential emerging problems in PHCHR and who to contact if concerned.

Within first 10 days of life

• Plot and record weight (where appropriate on clinical suspicion)
• Blood spot test for - phenylketonuria, hypothyroidism & cystic fibrosis
• Record feeding method
• Record whether there are smokers in the household
• Record diagnoses or concerns (coded):

Cystic fibrosis screening

HDL(2001)73, which issued in October 2001, advised about the introduction of a newborn screening programme for cystic fibrosis using the existing blood spot test. The programme was introduced across Scotland in February 2003.

PKU and congenital hypothyroidism

HDL (2001)34, which issued in April 2001, provided guidance on the organisation of newborn screening for phenylketonuria and congenital hypothyroidism.

Haemoglobinopathies

Assessment work in relation to screening for haemoglobinopathies is currently underway. No decision has yet been taken in relation to a screening programme in Scotland.

Screening advice

Advise that no screening test is perfect. Details of signs and potential emerging problems in PHCHR and who to contact if concerned.

Frequency of visits

Visits to the family home are usual on several occasions within the first 10 days of life. Some new parents may need to be seen more frequently than others. In particular, additional support should be provided for babies who have special needs or who needed treatment in the neonatal intensive care unit.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

• Impairment/abnormalities in infant
• Parents' health and wellbeing
• Discussion of birth registration
• Health promotion - discuss:

• Discuss any parental concerns
• Identify parents who might have major problems with their infant (e.g. domestic violence, substance abuse, learning difficulties, mental health problems)
• Provide information about local support networks and contacts for additional advice or support when needed

6-8 weeks - must be completed by 8 weeks

• 2 months - DTaP/ IPV/ Hib & MenC immunisation
• Repeat hip test for dislocation (Ortolandi & Barlow manoeuvres)
• Repeat inspection of eyes and examination of red reflex
• Repeat thorough check of cardiovascular system for congenital heart disease
• Repeat check of genitalia (undescended testes, hypospadias, other anomalies) & record testicular descent
• Check femoral pulses
• Check blood spot result
• Plot and record head circumference
• Plot and record weight (and note state of dress)
• Length (only in infant who had a low birth weight, where disorder is suspected or present, or where health, growth or feeding pattern causing concern)
• BCG considered/been done? (For targeted population)
• Record smokers in household (Pre-school)
• Record feeding method
• Diagnoses/concerns (coded):

Immunisation

Whoever is responsible for immunisation must be able to deal with questions about vaccines.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

Head circumference

If no concern at this stage, no further routine measurement required.

• Gross motor:
• • Pull to sit
  • Ventral suspension
  • Handling
• Hearing and communication:
• • Response to sudden sound
  • Response to unseen mothers voice
• Vision and social awareness:
• • Intent regard mothers face
  • Follow angling object past midline
  • Social smile
• Where used, enter national special needs system when clinical diagnosis recorded
• Health promotion - discuss:

• Parents' health and wellbeing
• Discuss any parental concerns
• Provide information about local support networks and contacts for additional advice or support when needed
• Review family's circumstances and needs to make an initial plan with them for support and contact over the short to medium term. Identify high risk situations and carry out a risk assessment

3 months

• Immunisation - DTaP/ IPV/ Hib & MenC
• Plot and record weight (and note state of dress)
• Health promotion - discuss:

Immunisation

Whoever is responsible for immunisation must be able to deal with questions about vaccines.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

• Discuss any parental concerns
• Provide information about local support networks and contacts for additional advice or support when needed

• Review family's circumstances and needs

4 months

• Immunisation - DTaP/ IPV/ Hib & MenC
• Plot and record weight (and note state of dress)
• Health promotion - discuss:

Immunisation

Whoever is responsible for immunisation must be able to deal with questions about vaccines.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

• Discuss any parental concerns
• Provide information about local support networks and contacts for additional advice or support when needed
• Review family's circumstances and needs

13 months

• Immunisation - MMR
• Plot and record weight (and note state of dress)
• Health promotion - discuss:

Immunisation

Whoever is responsible for immunisation must be able to deal with questions about vaccines.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

Gait

Whenever a child is seen for the first time after s/he begins to walk, s/he should be observed walking to check that the gait is normal.

• Discuss any parental concerns
• Provide information about local support networks and contacts for additional advice or support when needed
• Review family's circumstances and needs

3-5 years

• Immunisation - dTaP, IPV or DTaP/ IPV & MMR
• Plot and record weight
• Health promotion - discuss:

Immunisation

Whoever is responsible for immunisation must be able to deal with questions about vaccines.

Weight

Whoever is responsible for weight measurement must be able to deal with questions about the interpretation of the weight chart.

Vision screening

Where pre-school orthoptist vision screening cannot be implemented immediately, children should instead be screened on school entry.
As a minimum, training and monitoring should be provided by an orthoptist or optometrist.

• Discuss any parental concerns
• Provide information about local support networks and contacts for additional advice or support when needed
• Review family's circumstances and needs
• Vision screen performed by an orthoptist at 4-5 years

Entry to primary school

• Record height
• Plot and record weight
• Record Body Mass Index ( BMI) for public health monitoring purposes only
• Sweep test of hearing (continue pending further review)
• Identify children who may not have received pre-school health care programme for any reason
• Identify any physical, developmental or emotional problems that have been missed and initiate intervention
• Check that pre-school vision screening undertaken and make appropriate arrangements where not
• Ensure all children have access to primary health and dental care
• Dental check at P1 through the National Dental Inspection Programme
• Oral health promotion:
• • Dentist registration and attendance.
  • Twice daily supervised brushing
  • Reducing sugary food and drink consumption

Height

The 1990 nine-centile charts have been agreed as the standard measurement of height by the Royal College of Paediatrics and Child Health.

Physical examination

There is no evidence to justify a full physical examination or health review based on questionnaires or interviews on school entry.

Vision testing

Vision testing on school entry should only be undertaken where a universal pre-school orthoptic vision screening programme is not in place.

Dental checks

The National Dental Inspection Programme identifies children at greatest risk of oral disease and is used to inform the school health plan.

Primary 7

• Dental check through the National Dental Inspection Programme
• Oral health promotion:
• • Dentist registration and attendance
  • Twice daily supervised brushing
  • Reducing sugary food and drink consumption

Dental checks

The National Dental Inspection Programme identifies children at greatest risk of oral disease and is used to inform the school health plan.

Health promotion

Development of an effective core programme of health promotion in schools is premised on the roll out of Health Promoting Schools.

Body Mass Index

To be recorded for public health monitoring purposes every 3 years from 2007/08. This will be triggered by the Child Health Surveillance School System.

• Other health promotion activity should include:

Secondary school

• Age 10-14 years - BCG immunisation
• In areas where vision is checked at 11 years old, this should continue pending further review by the National Screening Committee. If not being undertaken, it should not be introduced
• Age 13-18 years - Td/ IPV immunisation
• Dental check at S3 through the National Dental Inspection Programme
• Oral health promotion:
  • Dentist registration and attendance
  • Twice daily supervised brushing
  • Reducing sugary food and drink consumption
• Other health promotion activity should include:

Dental checks

The National Dental Inspection Programme identifies children at greatest risk of oral disease and is used to inform the school health plan.

Health promotion

Development of an effective core programme of health promotion in schools is premised on the roll out of Health Promoting Schools.