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Chapter: Paediatrics: Community child health

Paediatrics: Health surveillance and promotion

Primary prevention: immunizations; accident prevention; dental care.

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


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