Abstract
This paper presents the findings of a systematic review undertaken to assess how effectively health visitor-led child health clinics (‘baby clinics’) contribute to the promotion of preschool child health and the reduction of health inequalities. Despite the widespread presence of baby clinics across the UK, there is little published research about the service model, its purpose or effectiveness. The initial search produced 559 articles, after removing duplicates, 175 abstracts were assessed against the inclusion criteria and 24 qualitative studies were identified as relevant to the review. No studies were excluded based on quality issues; however, the quality of studies was variable. Thematic analysis was used to organise and interpret the data. Although the review presents a synthesis of research over the last 30 years, there is a lack of evaluative research about the structure, process and outcomes of baby clinics, which makes it impossible to draw any conclusions about the effectiveness of the service offer. Findings suggest research on the value and purpose of baby clinics is now needed and while good evaluation studies with clear outcome measures are sought, it is clear that the theoretical processes through which positive outcomes are promoted need to be established first.
Highlights
The first child health clinics were set up in the UK in the late 1800’s, primarily to supply uncontaminated modified cow’s milk and support mothers with infant feeding and nutrition
Whilst the value of Health Visitors in providing this service was acknowledged in the Sheldon Committee report into the function of the child health clinic in 1967, their contribution was subsumed by the emerging wider medical remit of the clinics which focussed on immunisations, screening and growth monitoring
The move from a national programme of child health surveillance to an approach based on primary prevention through health promotion engendered significant professional reflection and development of the health visiting service, which in turn led to a reduction in the level of screening and physical growth monitoring by health visitors (Healthy Child Programme 2009, updated 2015)
Summary
The first child health clinics were set up in the UK in the late 1800’s, primarily to supply uncontaminated modified cow’s milk and support mothers with infant feeding and nutrition. Whilst the value of Health Visitors in providing this service was acknowledged in the Sheldon Committee report into the function of the child health clinic in 1967, their contribution was subsumed by the emerging wider medical remit of the clinics which focussed on immunisations, screening and growth monitoring. The move from a national programme of child health surveillance to an approach based on primary prevention through health promotion engendered significant professional reflection and development of the health visiting service, which in turn led to a reduction in the level of screening and physical growth monitoring by health visitors (Healthy Child Programme 2009, updated 2015). A continued focus on weighing at clinics (Barlow & Coe 2011, Burgess-Allen 2010, Russell 2008, Sparrow 2005, Sachs 2005, Plews and Bryar 2002), against a backdrop of professional progress towards more holistic approaches to health promotion raises the question of whether a focus on weight monitoring at clinics is preventing this service element from evolving in line with the rest of the Health Visiting Service offer
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