Paediatrics: Health surveillance and promotion

Health surveillance and promotion

Disease prevention includes the following:

•   Primary prevention: immunizations; accident prevention; dental care.

•   Secondary prevention: screening for inherited conditions.

•   Tertiary prevention: reducing impairments and disabilities, e.g. hip dislocation in CP, hypothyroidism and hearing problems in children with Down syndrome.

Primary prevention programmes

These are designed to reduce the number of new cases of disease and disorder presenting within the community.

Examples of primary prevention programmes

•   Reducing the incidence of infectious diseases—immunization programme

•   Reducing the risk of sudden infant death

•   Reducing parental smoking

•   Preventing accidents and poisonings

•   Improving nutrition—breastfeeding promotion

•   Preventing dental disease

•   Promoting child development

•   Preventing child abuse

There is also a range of early intervention programmes designed to pro-mote child development, reduce the risks of child abuse and accidental injury, and improve parents’ mental health. Children’s centres provide a variety of services to preschool children and their families, and often are a base for different organizations and services.

Primary prevention programmes may be aimed at parents and the family (e.g. poor housing, poverty, illness, disability). Many programmes are also targeted towards at-risk groups (e.g. LBW babies, mothers with postnatal depression, families living in poverty).

There are well established group parenting support programmes on offer which focus on behaviour management particularly. Some are intensively delivered by skilled professionals for at-risk young first time mothers.³

Secondary prevention

These programmes reduce the prevalence of disease. The Child Health Promotion Programme in the UK has been the remit of the primary care team, and recent government guidance² recommends a much more focused universal approach, with additional services for those with specific needs and risks

Antenatal screening is a very important component of this, beginning in early pregnancy and is universal at 28wks gestation with an increased focus on those women at higher risk or families requiring extra support or services.(Table 27.1).

Other opportunities for health professional contact include immuniza-tions. Early detection of health problems is achieved by:

• Follow-up of babies at risk (e.g. low birth weight, premature).

• Follow-up of children with neurological problems or post-trauma.

• Targeted observation or follow-up of children with a strong family history of genetic disorders, e.g. hearing, vision, dislocated hips, learning difficulties, familial hypercholesterolaemia.

• Detection by parents or health professionals (i.e. neglect).

• Detection by professionals in the course of their work (particularly playgroup, nurseries, and schools, as well as health professionals).

Within each district the preschool programme will vary according to what families need and will be targeted to those who are ‘high risk’.

Particular concerns for preschool programmes

•   First pregnancies and first time mothers

•   Isolated mothers

•   Mother with postnatal depression

·  Unsupported, young parent living in poverty

•   Domestic violence; drug or alcohol abuse

•   Parents with learning disability

•   Concern about child neglect or abuse

•   Infant with difficult feeding, sleeping, or temperament

•   Premature baby or child who is disabled

•   Refugee families

•   Smoking (pregnancy or postnatal)

•   Obesity in parents

Poor attachment and inconsistent care