The first report entitled Health for all Children was published in 1989 with the aim of reviewing routine health checks for children and making evidence based recommendations on how and when these should be undertaken. Subsequent revisions have emphasised the shift from paternalist medical models of care to an approach that incorporates the child growing within a wider social environment. Along with health professionals the roles of the family, educators and social services are highlighted. The revised fourth edition sets this in the context of recent guidance and publications including Working Together to Safeguard Children and the National Service Framework for Children, Young People and Maternity Services. This edition has 19 chapters covering all the essential aspects of child health in the community. Each chapter opens with a summary of what it sets out to do and ends with a number of recommendations that are usefully cross-referenced with other chapters. In order to make the book manageable in size readers are directed to the website health-for-all-children.co.uk for references and additional reading. The use of clear subheadings, boxes and bullet points to emphasise the key concepts makes important information easier to assimilate. The appendix provides a particularly good summary of policy framework and current legislation including health, education and social care which can otherwise be difficult to understand or find on myriad government websites. So how does the book help with my daily contact with children as a general practitioner? Most of my consultations with children, particularly in the first year of life, are for acute illnesses and concentrate on the presenting problem. Less commonly I see older children and young teenagers brought by their parents or carers for help with chronic illness such as asthma or eczema. The focus, however, is on access to care rather than continuity of care and, apart from immunisation targets, there is little for children in the quality outcomes framework. Add to this the demands of the adult for your attention to their problems (because you are also their doctor) and it becomes apparent that the needs of the child are in danger of taking a back seat. The six-week check is now the only routine physical and developmental check for all children performed by doctors at the surgery. I rely on our practice nurses to deliver the immunisation programme and our health visitors to detect and manage most developmental and behavioural problems in the under fives. One, perhaps unforeseen, consequence of the decrease in routine checks is that it gives parents less opportunity to voice their concerns. However, the book reminds me of the importance of actively seeking concerns (such as language delay secondary to hearing loss) during consultations, and directs me to the areas that may otherwise escape my immediate attention such as iron deficiency anaemia, obesity or assessment of growth. It also reminds me of the need for good liaison with health visitors and school nurses to provide a service based on sound communication and team-work. Significantly, the text reminds me of the crucial role played by nurse colleagues in delivering the vision of care promoted. The current recruitment crisis in London, the subsequent understaffing and an understandable preoccupation with safeguarding issues present a significant challenge to providing a universal programme. There is also an important issue regarding education and training both at undergraduate and postgraduate level. Although the book does not address this in detail, several chapters provide good pointers on the experience and skills required for the proficient practitioner in child health. This will be useful for the development of curricula, particularly as medical education shifts from predominantly hospital settings into the community. As a doctor who provides advice to commissioners on services for children, Health for all Children is a useful resource to back my experience and intuition with up to date and clear information on the evidence. There is often a gap between health professionals who provide services for children in the community and those who commission those services. This publication succeeds in bridging that gap in an accessible and pragmatic way.
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Mar 8, 2016
Ella Bedells + 1
Open Access
