Health Visitors

The Healthy Child Wales Programme (HCWP) sets out what planned contacts children and their families can expect from their health boards from maternity service handover to the first years of schooling (0-7 years). These universal contacts cover three areas of intervention: screening; immunisation; and monitoring and supporting child development (surveillance).

The Welsh Government expects that every child and family will be offered the HCWP. The programme underpins the concept of progressive universalism and aims to identify a minimum set of key interventions to all families with pre-school children, irrespective of need. For some families there will be a need to increase intervention to facilitate more intensive support. The implementation of the HCWP ensures a commitment to support the health and welfare of all children aged 0-7 years and aims to achieve the following key priorities:

• To deliver key public health messages from conception to 7 years, so that families are supported to make long term health enhancing choices.

• To promote bonding and attachment to support positive parent-child relationships resulting in secure emotional attachment for children.

• To promote positive maternal and family emotional health and resilience.

• To support and empower families to make informed choices in order to provide a safe, nurturing environment.

• To assist children to meet all growth and developmental milestones enabling them to achieve school readiness.

• To support the transition into the school environment.

• To protect them from avoidable childhood diseases through a universal immunisation.

• To ensure early detection of physical, metabolic, developmental or growth problems through an appropriate, universal screening programme.

The Healthy Child Progamme continues to be delivered and supported by School Nursing teams once your child starts school.

If you have any worries about your baby’s or toddler’s development talk to your health visitor, even if it is some time since the last regular visit, or some time since you’ve been to a clinic. Health visitors can come to your home to talk through any concerns you have and can put you in touch with the people who can help if there are problems.

What can I expect from my health visiting team?

There are key times which you can expect to have contact from your health visiting team. This universal service offered to every family includes:

During the second trimester of pregnancy, Midwives will be expected to inform Health Visitors of any pregnant woman who is a first time mother or who may require additional support. The criteria will include the following:

• First time mothers

• Parents expecting multiple pregnancies

• Parents with learning difficulties

• Parents with pre existing or current safeguarding concerns, including domestic abuse

• Parents at higher risk of having emotional/mental health needs

• Unborn baby is known to have a medical condition

If referred this may trigger an invite for an antenatal review commencing from 28 weeks gestation. Parental expectations and preparation for parenthood will be discussed and assessed to identify risk and an assessment of family resilience conducted. The assessment and evaluation of available information will determine the level of intervention necessary to support the family; which will be discussed and agreed with the familyHealth Visitors work in partnership with midwives and aim to visit you after the 28th week of pregnancy. This will give you an opportunity to discuss your pregnancy, your health and wellbeing and your ideas about your baby and plans for after your baby is born.

A routine birth contact will be offered by the Health Visitor to all parents/carers between 10 to 14 days following the birth of their baby. Further contacts will be offered before the baby is 6 weeks old if needed.

A family resilience assessment and evaluation of parenting capacity will be conducted to support identification of individual need.

Through these contacts the Health Visitor will take the opportunity to influence family health and health behaviours that will impact upon long term health outcomes. This will include delivering on priorities such as; smoking cessation, increasing immunisation rates and supporting children and families to achieve a healthy weight.

The Health Visitor will seek opportunities to promote secure attachment and bonding between the parent/carer and their baby, which is vital to ensure the baby`s optimal brain development. This will help parents understand the baby’s behaviour and enable them to build on their skills and knowledge. It is hoped that this will ensure that parents will be caring, confident and competent in their parenting.

The Health Visitor will emphasise the importance of parental emotional and physical wellbeing for family health. Support and advice will be offered to parents/carers about key 11 health promotion messages, which will improve the family’s well being and also support parents/carers to become resilient to the challenges of parenting.

The Health Visitor will discuss expected developmental milestones and the ongoing management of baby‘s well being, for example, the management of minor illnesses and the prevention of accidents, including Choose Well (NHS 2011).

Following the birth of a baby some women can experience feeling low and emotional. This can occur between 4-12 days after childbirth and is often mild and perfectly normal.

Postnatal depression symptoms can occur within the first year of having had your baby and affects between one and four in every 10 women. Symptoms include low mood, feeling emotional and tearful, anxious, and loss of enjoyment in activities that you previously enjoyed.

If you feel you have symptoms of postnatal depression then you may need help from your Health Visitor or GP.

Your health visitor will sensitively discuss your emotional health and wellbeing with you between 6-8 weeks. They will be able to organise extra support for you if you need it. Best Beginnings has several videos relating to maternal mental health.

The Health Visitor will encourage attendance and uptake of immunisations at Child Health Clinics when the baby is 8, 12 and 16 weeks. The Health Visitor will review the baby`s growth and developmental progress.

Key public health messages may be reinforced as appropriate at these contacts i.e. breastfeeding, dental health, healthy start vitamins, healthy nutrition and promoting baby development.

The Health Visitor will discuss the baby’s developmental progress and age appropriate milestones. Advice will be offered regarding the management of baby and childhood minor ailments as stated in the previous review.

A home visit will be offered by the Health Visitor to all parents/carers at 6 months.

A family resilience assessment and evaluation of parenting capacity will be conducted to support identification of individual need.

The Health Visitor will use this contact as an opportunity to promote secure attachment between a parent/carer and their growing baby which is vital for the baby’s optimal brain development and the baby`s social and emotional wellbeing. This will assist parents to build on their own skills and knowledge of their baby’s ever expanding capabilities to encourage caring, confident and competent parenting.

The Health Visitor will emphasise the importance of parental emotional and physical wellbeing and include an assessment of maternal emotional health and well being using the NICE questions.

The Health Visitor will support and advise parents/carers about key public health messages which improve family well being and also support parents/carers to become resilient to the challenges of parenting.

Public health priorities will be met by the provision of support and advice on various key areas including baby and home safety, breastfeeding, weaning, healthy food choices, reading and play, pet safety, dental care and dental registration, immunisation programmes, smoking cessation and promoting smoke free environments.

A home visit will be offered by the Health Visitor to all parents/carers when their child is 15 months of age.

A family resilience assessment and evaluation of parenting capacity will be conducted to support identification of individual need.

This is another opportunity for the Health Visitor to support the family and assess the child’s health and development and to discuss any concerns or support needed in order to assist families to help their child reach their full potential.

Children not walking should be observed and followed up at 18 months of age.

This contact will have specific focus on the development of speech and language skills.

Public health priorities will be met by the provision of support and advice on various key areas including: promotion of safety in the home and the community, dietary advice, stimulation of development through play and reading, dental health, smoking cessation and the childhood immunisation programme.

A home visit will be offered by the Health Visitor to all parents/carers at 27 months.

A family resilience assessment and evaluation of parenting capacity will be conducted to support identification of individual need.

The purpose of this contact is for the Health Visitor to assess growth and developmental progress of the child and provides an opportunity to review family resilience.

Public health priorities will be met by the provision of support and advice on various key areas including: dietary advice, smoking cessation, dental health, play, vision, childhood immunisation programme, preparation of school readiness and promotion of safety in the home and the community.

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A home visit will be offered by the Health Visitor to all parents/carers when their child is 3 ½ years old.

A family resilience assessment and evaluation of parenting capacity will be conducted to support identification of individual need. Those children who will require a full handover to the School Health Nurse will be identified.

Public health priorities will be met by the provision of support and advice on various key areas including: dietary advice, smoking cessation, dental health, play, vision, childhood immunisation programme, preparation of school readiness and promotion of safety in the home and the community

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Improving the physical and emotional health and wellbeing of expectant mothers, infants, children and young people throughout Aneurin Bevan University Health Board Area.

(N.B: The Family and Therapies team at ABUHB is NOT responsible for the content on the webpage links that we refer to in our resource sections and linked information to external sites. All information was accurate and appropriate at the time the webpage was created.)

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