Child Health Nurses Research Articles

Maternal and Child Health nurse's preparedness to respond to women and children experiencing intimate partner violence: A cross sectional study

BackgroundIntimate partner violence victims regularly seek health care and support. Health care providers need to understand the complexities of partner violence and how to safely respond to clients. Policy guiding nurse identification and responses exist, yet practices and education are lagging. Maternal and Child Health nurses are required to address intimate partner violence, yet their knowledge and preparedness to undertake this work is under-explored. The most effective methods of provider training are unknown. Objectives1) To assess the level of Maternal and Child Health nurse intimate partner violence training and nurse preparedness to address partner violence and 2) compare group differences in preparedness by nurse location, role and level of training. DesignA cross sectional research design. ParticipantsAustralian community based Maternal and Child Health nursing workforce. MethodsOnline survey conducted in June 2018. Survey questions explored nurse characteristics, knowledge and ‘preparedness’ to complete intimate partner violence work and previous violence training. Descriptive analysis involved reporting proportions within categories. Proportional group differences were analysed using Chi square test of independence. Statistical significance was set at p < 0.05. ResultsSurvey response rate was 65% (735/1125). Nurses feel well prepared to complete intimate partner violence practices, although differences were seen across groups. Rural nurses feel less prepared than metropolitan colleagues, especially conducting safety assessments and documentation. Nurse co-ordinators are the most prepared. A dose response relationship is seen between training and preparedness: nurses with greater (>10 h) and more recent training (within 5 years) report being more prepared for intimate partner violence work. ConclusionsGreater systems supports are needed for sustainable nurse intimate partner violence work. In particular, opportunities are needed for rural nurse training, delivered locally and tailored to rural needs and context. Nurse co-ordinators are key leaders to achieving sustained nurse intimate partner violence practices.

Heidegger and parenthood: A theoretical and methodological shift from instrumental to ontological understanding.

Parenthood and parenting are concepts central for child and family health nurses and professionals. They are foundational to numerous nursing philosophies such as 'family-centred care' and 'parent participation'. Yet our understanding of the meaning of being a parent remains difficult to articulate and is often operationalised as collections of assessable techniques and skills. We propose an alternative understanding of parenthood, based on the work of Martin Heidegger and his turn to poetry, that is more ontologically focused on the meaning of being a parent and valuable to nurses seeking to understand or research the existential core of this complex relationship. Alternative ways of understanding parenthood will help nurses grasp the complexities of family relationships they will encounter in practice. Researchers may also frame their investigations and explorations of parenting and parent-child-professional relationships in ways that do not rely exclusively on 'technologies' of parenting skills and techniques. Heidegger's thinking opens up valuable ways of exploring, understanding and researching parenthood that can benefit nurses in clinical practice, education and research. In its ability to challenge the most fundamental of assumptions and to propose challenging alternatives, Heideggerian approaches to understanding the meaning of parenthood can help advance child and family nursing research and practice.

Child Health Nurses' experiences of addressing psychosocial risk factors with the families they meet.

AimTo examine how child health nurses perceive the routine assessment of psychosocial risk factors in the family environment as well as their self‐reported competence and the present organisational conditions in this context.MethodA mixed‐methods design was used, including three focus group interviews and a web‐based survey. Qualitative data were analysed using systematic text condensation. Quantitative data were analysed at the descriptive level.ResultsNurses expressed that identifying psychosocial risk factors was both important and relevant to their work. They had little formal training and education on most psychosocial risk factors, and they lacked structured methods to address them. In areas where nurses reported more formal education and a structured methodology (depression, parental stress), they rated to a higher degree that they possessed sufficient skills and sense of security. The nurses perceived that they seldom came into contact with families with financial problems, hazardous alcohol use or intimate partner violence.ConclusionsThere is a gap between the nurses’ attitudes regarding the importance of helping families in need and their ability to do so with the current level of training and methodological support. The results suggest that, in many cases, psychosocial problems remain undetected.

Promoting healthy weight for all young children: a mixed methods study of child and family health nurses\u2019 perceptions of barriers and how to overcome them

BackgroundChildhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth.MethodsThis mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported.ResultsCFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members.ConclusionsCFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents’ understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time.

The care ethics of child health nurses in Danish asylum centers: An ethnographic study

Abstract Background Asylum-seeking children have often been on a harrowing journey with potentially grave consequences for their health and well-being. As little is known about how child health nurses enter into engaging and caring partnerships with asylum-seeking families to meet their children's healthcare needs - despite challenges pertaining to culture and language - our objective is to examine how child health nurses navigate, negotiate and respond to the range of challenges, needs and circumstances that affect their nursing care practices. Methods We report on ethnographic fieldwork from four Danish Red Cross asylum centers, where child health nurses have their first encounters with asylum-seeking families. The fieldwork included participant observations of child health consultations and interviews with 6 child health nurses and 11 asylum-seeking families. We coded and analyzed the empirical material thematically to identify emerging and crosscutting themes. Results The care performed by the child health nurses was characterized by five ethical care practices. One, their care was driven by compassion, exhibiting intrinsic beliefs, values and personal motivations to care for asylum-seeking children. Two, they provided responsible care, building on their humanitarian and professional roles as child health nurses within Red Cross. Three, they showed flexibility, drawing on past experience and recognition of the families' complex needs. Four, they were collaborative, working in partnership with parents. Five, the child health nurses' care was empowering asylum-seeking families by encouraging parents to be autonomous and acknowledging their own efforts in caring for their children. Conclusions The confluence of the five ethical care practices enables child health nurses to promote and safeguard the health and well-being of asylum-seeking children. We argue that these practices are constituent parts of person-centered care for asylum-seeking and refugee children. Key messages We identified five ethical care practices, which enable child health nurses’ care of asylum-seeking children and their families. Our study provides an empirical understanding of how person-centered care is critical to asylum-seeking families.

Curriculum framework for advanced practice nursing in sub-Saharan Africa: a multimethod study

ObjectivesThe implementation of advanced practice nursing (APN) programmes in sub-Saharan Africa (SSA) has been difficult due to lack of SSA-specific curriculum frameworks or benchmarks to guide institutions in developing and...

“Improving Access to Early Childhood Developmental Surveillance for Children from Culturally and Linguistically Diverse (CALD) Background”

Introduction:Developmental vulnerabilities in pre-school aged children from culturally and linguistically diverse (CALD) backgrounds with low English proficiency are less likely to be identified through universal developmental surveillance. Barriers include low parental health literacy and low rates of attendance to mainstream child and family health services. Late detection of developmental vulnerabilities can have lifelong impacts on life trajectory.Method:Integrated outreach early childhood developmental surveillance was trialled in South East Sydney by local health services with non-government organisations (NGO) delivering early childhood education and support. NGO staff were trained in Parents Evaluation of Developmental Status (PEDS), a validated developmental screening tool to explore parental/carer and provider concerns [1]. Families with children identified with developmental concerns by NGO staff were referred to co-located or visiting Child and Family Health Nurses (CFHN), community child health, speech pathology or developmental services for developmental screening, assessment and/or care planning.Results:Integrated health and NGO services improved access to developmental surveillance for CALD families in a non-threatening environment enabled by co-locating CFHN, or through visits by paediatric medical/speech pathology staff to participating playgroups.Conclusions and discussion:Integration supported vulnerable families from CALD backgrounds to access developmental surveillance through child and family health services but required flexibility and adjustments by all involved.

Child and family health nursing: A workforce profile.

To develop a profile of registered nurses working in Child and Family Health services across the Northern Sydney Local Health District to inform workforce strategic planning. Child and family health nurses (CFHNs) are registered nurses holding recognized qualifications in child and family health. To date, information regarding Child and family health nurses has been very limited. The survey was conducted using a self-administrated online questionnaire between March-June 2017. Just over 75% of the respondents were aged over 50years. Job satisfaction and feeling valued are enablers for remaining in current positions and not feeling valued can contribute to leaving employment. Nearly, one-third of respondents are currently a carer. This study provides an insight into the demographics of Child and family health nurses in Northern Sydney Local Health District, including roles as carers. It also examines factors influencing Child and family health nurses to remain or leave current positions. This survey has drawn attention to the need for managers to urgently develop strategies, for example succession planning, to ensure that shortages of these experienced Child and family health nurses do not occur. The inability to staff Child and Family Health could potentially impact on the ability to provide services and meet key performance indicators.

Training maternal and child health nurses in early relational trauma: An evaluation of the MERTIL workforce training

BackgroundParents who experience relational trauma may inadvertently create contexts of care that undermine secure beginnings to life for their young children. Universal health services such as Maternal and Child Health (MCH) services offer a unique whole-of-population platform for prevention through early detection and intervention. To date however, relevant workforce training has been minimal. ObjectivesWe report on an evaluation of state-wide workforce training to support MCH nurses to identify and respond to early relational trauma within parent-child dyads. DesignProcess and learning evaluation data were obtained at baseline (N = 1450), exit (n = 734) and follow-up (n = 651). Settings and participantsSpecialist training was developed and delivered to 1513 MCH staff in Victoria, Australia, via a 20-hour program of online learning and clinical skills workshops. ResultsAt baseline, across eight measures of confidence in recognizing and responding to relational trauma, 30–49% of nurses rated their confidence as low. Significant increases in all areas of self-rated learning were found post-training. Three months post-training, gains in confidence and capability were sustained, with no significant variations by participant role or setting. Overall program satisfaction was >90%. Continuing concerns at follow-up focused on pragmatic concerns about inadequacy of referral networks and appropriate intervention pathways. ConclusionsIn this evaluation of a state-wide training program for nurses working with early relational trauma, we found excellent uptake and program satisfaction, and results support learning impact and retention. Findings are discussed with regard to translation potential across early childhood settings.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study

ObjectiveThe purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids.MethodsMother-infant dyads (n = 1035) were recruited into the “Healthy Smiles Healthy Kids” study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks.ResultsThe median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14–0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33–4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child’s first birthday (OR = 0.54, CI95 0.30–0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21–0.84 and OR = 0.30, CI95 0.12–0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49–3.66).ConclusionsWomen who are younger, single mothers, those not working by the time of child’s first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.

Exploring the role-based challenges of providing culturally inclusive health care for maternal and child health nurses: Qualitative findings.

AimsTo explore how maternal and child health nurses (MCHNs) working in a specific regionally located service perceive and experience delivering health care to a diverse population.DesignQualitative exploratory study.MethodsQualitative interviews were conducted with MCHNs (N = 6) working in a particular regionally located service. Data were selectively coded, categorized and interpreted through a process of argument writing influenced by poststructuralist thought and Foucauldian conceptualizations of power.ResultsThe data analysed were interpreted into the following categories: (a) system‐level expectations of the maternal and child health role; (b) what these system‐level expectations mean for the role and practice of MCHNs; and (c) what MCHNs themselves report prioritizing in their work. The analysis suggests that a substantial hindrance to the development and support of culturally safe, inclusive and quality maternal and child health care lies in the very ways contemporary health institutions seek to discipline the routine practices of MCHNs.

Mentalisation Amongst Maternal and Child Health Nurses Using the Newborn Behavioural Observations With Infant-mother dyads: A Qualitative Study

PurposeThis study explored Maternal and Child Health Nurses' (MCHN) mentalisation processes towards infant-mother dyads when using the Newborn Behavioural Observations (NBO) system in practice. Design and methodsTen Australian MCHNs (female; aged 31–66 years), who had used the NBO clinically within the last 12 months, were recruited from a database of NBO-trained practitioners. Interpretative phenomenological analysis of one-on-one semi-structured interviews explored MCHNs experiential meaning-making. ResultsAnalysis of the data produced four main themes: reflections regarding the dyad, personal reflections, reflection into action, and professional identity and future practice. MCHNs reported that the NBO's focus on the pre-verbal infant provided them with an added dynamic to consultations outside of the practitioner-caregiver relationship. Thus, they were able to provide holistic and collaborative relationship support to infant-mother dyads. Emotional satisfaction and pride in profession were also reported; in current literature, these factors have been found to reduce burnout in primary care providers. ConclusionsThe NBO appears to promote practitioner mentalisation, offering MCHNs a framework and confidence to apply infant mental health theory practically. Practice implicationsThe NBO offers potential benefits to child and family health nursing practice, and other primary care providers, who offer infant mental health and relationship support as part of their work with families in the first three months. The NBO also provides a means to shift from prescriptive to mentalisation-based, infant-inclusive, and individualised practice.

The Care Ethics of Child Health Nurses in Danish Asylum Centers: An Ethnographic Study

Child health nurses play an important role in promoting the health and well-being of children and families seeking asylum. However, little is known about how they establish caring partnerships with families in asylum centers. In this article, we examine the ethical care practices that child health nurses within Danish asylum centers adopt to overcome barriers, related to culture, language and migration history, in delivering care. We conducted ethnographic fieldwork in four Danish Red Cross asylum centers, involving participant observation and individual interviews with 20 families and six child health nurses. A thematic analysis of the material reveals five ethical care practices; compassionate care, humanitarian care, flexible care, collaborative care, and supportive care. We show how the confluence of these types of care enables child health nurses to promote health and well-being of children seeking asylum, and discuss the enabling role of the humanitarian culture that prevails within the asylum centers.

Usability and Feasibility of an Innovative mLearning Approach for Nurses Providing Option B+ Services in Manica and Sofala Provinces, Mozambique.

The scaling of Option B+ services, whereby all pregnant women who test HIV positive are started on lifelong antiretroviral therapy upon diagnosis regardless of CD4 T-cell count, is ongoing in many high HIV burden, low-resource countries. We developed and evaluated a tablet-based mobile learning (mLearning) training approach to build Option B+ competencies in frontline nurses in central Mozambique. Its acceptability and impact on clinical skills were assessed in maternal child health nurses and managers at 20 intervention and 10 control clinics. Results show that skill and knowledge of nurses at intervention clinics improved threefold compared with control clinics (p = .04), nurse managers at intervention clinics demonstrated a 9- to 10-fold improvement, and nurses reported strong acceptance of this approach. "mLearning" is one viable modality to enhance nurses' clinical competencies in areas with limited health workforce and training budgets. This study's findings may guide future scaling and investments in commercially viable mLearning solutions.

Weight management across pregnancy and postpartum care: The need for interprofessional education and collaboration

The journey from pregnancy to caring for a new infant is a significant experience for many women and crucial period for obesity prevention. During this time, a large portion of care is allocated to midwives and maternal and child health nurses (MCHN). These professions have the potential to play a crucial role in supporting women with weight management across pregnancy and postpartum; however, both midwives and MCHNs report barriers to doing this. Upskilling achieved through midwifery and MCHN education that equips midwives and MCHNs with the skills and knowledge to provide evidence-based advice for weight management could assist in addressing some of these barriers. Interprofessional collaboration should be fostered so healthy lifestyle messages and support are reinforced consistently by midwives and MCHNs throughout pregnancy and postpartum.

Training community health nurses to measure parent-child interaction: a mixed-methods study.

BackgroundThis study aims to determine whether the Parental Responsiveness Rating Scale (PaRRiS) completed at child age 24–30 months can be used by community child health nurses (CCHNs) to reliably measure the quality of parent–child interactions in practice.MethodsA mixed-methods design was used involving CCHNs working in public health settings. Five CCHNs recruited from the North-East of England were trained to use PaRRiS. Thirty parent–child dyads attending their routine 24–30-month check were observed. Nurses rated parent–child dyads during 5 min of free-play using PaRRiS. The free-play sessions were video recorded and rated blind by the first author to the nurse observation. Semi-structured phone interviews were conducted with the five CCHNs once observations of parent–child interactions were complete. Interviews were audio-recorded, transcribed, anonymized and thematically analyzed.ResultsTwo-thirds of participating parents were mothers. Half the families (15/30) were from the 10% most deprived areas based on the English Index of Multiple Deprivation. The average PaRRiS score was 3.03 [standard deviation (SD) = 0.8; all ratings were <5.0]. Reliability between the first author (‘gold standard’) and CCHNs was excellent [Intra-class correlation coefficient (ICC): 0.85; 95% confidence interval (CI): 0.67–0.93]. CCHNs found PaRRiS aligned well with current practice and was acceptable to parents. There was no evidence of a relationship between social disadvantage and PaRRiS scores.ConclusionsWith further development and evaluation work, PaRRiS could potentially be incorporated into existing universal health services to provide child health nurses with an additional tool for identifying families most likely to be in need of parent–child interaction interventions.

Client experiences with antenatal care waiting times in southern Mozambique

BackgroundAntenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling.MethodsThis study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software.ResultsClients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts.ConclusionsFindings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.

Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study.

To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse. Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking. Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour. In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem. The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse. Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.

First-time fathers' experiences of professional support from child health nurses.

Nowadays, in Sweden, fathers are expected to be active in their father role and to share caring responsibilities for their children equally with mothers. This active role of a father in a family can be challenging, especially for the first-time fathers. Child health nurses' support is an important factor for fathers to become confident caregivers. The Father Perceived Professional Support scale (FaPPS scale) can be used in nursing practice for better understanding father's needs of professional support. The aim of this study was to describe first-time fathers' experiences of the professional support received from child health nurses and to validate the instrument: 'FaPPS scale'. A qualitative design, with inductive and deductive approaches, was used in this study. Twelve first-time fathers participated in the semi-structured interviews, thereafter grading the FaPPS scale items and commenting on them. The fathers experienced nurses' support positively when nurses provided practical information and stimulated them to be involved in care of their children. In contrast, the support was experienced negatively because of nurses' lack of commitment, availability and adaptation to the fathers' individual needs. The fathers also felt inequality between the support received by fathers and by mothers. Although some fathers perceived it as negative, others considered it fair, believing that mothers needed more support. In addition, fathers expect nurses to actively offer support to them and supervise them in childcare. The fathers also needed meeting other parents, for example in parental groups. This study also indicates that FaPPS scale can be used both in research and clinical practice, though still needing further development.

Family-centred oral health promotion through Victorian child-health services: a pilot.

Maternal and Child Health Services (MCHS) provide ideal settings for oral disease prevention. In Victoria (Australia), child mouth-checks (Lift-the-Lip) and oral health promotion (OHP) occur during MCHS child visits. This study trialled Tooth-Packs (OHP resources, toothbrushes, toothpastes) distribution within MCHS to (i) assess the impacts of Tooth-Packs distribution on child and family oral health (OH) behaviours and knowledge, including Maternal and Child Health Nurses (MCHN) child referral practices to dental services, and (ii) determine the feasibility and acceptability of incorporating Tooth-Packs distribution into MCHN OHP practices. A mixed-methods evaluation design was employed. MCHN from four high-needs Victorian Local Government Areas distributed Tooth-Packs to families of children attending 18-month and/or 24-month MCHS visits (baseline). Families completed a questionnaire on OH and dietary practices at baseline and 30-month follow-up. Tooth-Packs distribution, Lift-the-lip mouth-checks and child OH referrals were conducted. Guided discussions with MCHN examined intervention feasibility. Overall, 1585 families received Tooth-Packs. Lift-the-lip was conducted on 1493 children (94.1%). Early childhood caries were identified in 142 children (9.5%) and these children were referred to dental services. Baseline to follow-up behavioural improvements (n = 230) included: increased odds of children having ever seen an OH professional (OR 28.0; 95% CI 7.40-236.88; p < 0.001), parent assisted toothbrushing twice/day (OR 1.76; 95% CI 1.05-3.00; p = 0.030) and toothpaste use >once/day (OR 2.82; 95% CI 1.59-5.24; p < 0.001). MCHN recommendations included distribution of Tooth-Packs to at-risk children <12-months of age. MCHS provide an ideal setting to enable timely family-centred OHP intervention and adoption of good OH behaviours at an early age.