Supporting Parents and Infants Through the Healthy Child Programme


This is a comprehensive review of the latest evidence of relevance to the Healthy Child Programme.

  • Authors: Kirsten Asmussen and Lucy Brims
  • The Early Intervention Foundation
  • June 2018

Established in 2009, the Healthy Child Programme provides public health services to all families with a child between conception and age five in England. It is based on the best available evidence summarised in the fourth edition of Health for All Children and supplemented with guidance from the National Institute for Health and Clinical Excellence.

As a universal prevention and early intervention programme, it forms an integral part of Public Health England's priority to ensure:

  • Every woman experiences a healthy pregnancy
  • Every child is ready to learn by the age of two
  • Every child is ready for school by the age of five
  • A reduction in child obesity and inequalities in oral health.

The programme ensures that all children are offered five mandated health reviews by the health visiting service before turning five.

The Early Intervention Foundation (EIF) report refreshes the 2009 evidence by consolidating key messages from two sources:

  • The Rapid Review to Update Evidence for the Healthy Child Programme 0-5, by Nick Axford and colleagues, which summarised key evidence conducted between 2008 and 2014 involving activities aimed at supporting young children's health and development in the early years.
  • Foundations For Life: What Works to Support Parent-Child Interaction in the Early Years, which assessed the strength of evidence underpinning 75 interventions developed to support children's attachment security, behavioural self-regulation and cognitive development between conception and the age of five.

These were further updated with a systematic review of evidence published since 2014.

Findings are prioritised in terms of activities identified as having good evidence of improving child and parent outcomes. In addition, EIF describes interventions which have been found through robust evaluation to not provide benefits for parents or children. Activities which have not been robustly evaluated are described as having weak evidence.

The report covers the following:

Conception to birth

  • Transition to parenthood
  • Smoking cessation
  • Maternal mental health and harmful drug and alcohol use
  • Intimate partner violence.

Birth to 12 months

  • Low-birthweight infants
  • Breastfeeding
  • Exposure to second-hand smoke
  • Sudden Infant Death Syndrome (SIDS)
  • Sleep training
  • Attachment security
  • Early language
  • Maternal mental health
  • Preventing unintentional injury
  • Child abuse and neglect.

Policy implications

Although the methodology used prioritises evidence from manualised interventions over other common health visiting practices, EIF believes this information is nevertheless useful for informing health visiting and midwifery more generally. Given the range of topics covered in this work it is not possible to cover all the findings here. But some key messages include:

Conception to birth

The primary aim of most antenatal interventions is to help mothers take care of themselves and prepare for the transition to parenthood.

  • Few programmes that aim to support parents with the transition to parenthood have been rigorously evaluated. However, there is good evidence showing that the Family Foundations programme reduces parental stress and child attachment related behaviours when offered to couples expecting their first child.
  • Incentive-based programmes have the strongest evidence of encouraging smoking abstinence during pregnancy.
  • Interventions aimed at preventing the onset of mental health problems during pregnancy and the postnatal period have been found to have no effect.

Birth to 12 months

  • Infant massage has good evidence of improving physical outcomes in low-birthweight babies, as well as decreasing parental stress and increasing sensitivity. It is important to note, however, that these benefits have not been replicated with normal-weight infants.
  • Individual breastfeeding advice, provided to mothers over the phone and in person in the weeks before and after childbirth, has the best evidence of increasing breastfeeding initiation and duration rates.
  • There is good evidence that intensive home-visiting interventions support children's language development.

Findings

  • There are few magic bullets or quick wins. The majority of effective interventions identified in this review are relatively intensive - that is, taking place for three months or longer through multiple family visits. This is because studies consistently suggest that time is often necessary for families to develop a positive relationship with professionals, to appreciate that aspects of their circumstances may need to change, and to develop skills to make that change happen.
  • There is a lack of evidence about when and how to intervene when parents misuse drugs and alcohol. EIF's research did not identify any interventions with robust evidence of improving outcomes for drug and alcohol-misusing parents and their infants. This represents a serious gap in the evidence base.
  • Overall, the Healthy Child Programme is a good delivery mechanism for many of the interventions described in the EIF report.
  • The vast majority of interventions and practices identified in our report were developed specifically to be delivered or coordinated by health professionals, including midwives, nurses and health visitors. With minimal additional training in the programme delivery models, it is highly likely that the majority of these interventions could be successfully delivered as part of the Healthy Child Programme.

FURTHER READING

What Works to Enhance the Effectiveness of the Healthy Child Programme: An Evidence Update, Asmussen and Brims, Early Intervention Foundation (2018)

Rapid Review to Update Evidence for the Healthy Child Programme 0-5, Axford et al, Public Health England, (2015)

Foundations For Life: What Works to Support Parent-Child Interaction in The Early Years, K Asmussen, L Feinstein, J Martin & H Chowdry, Early Intervention Foundation (2016)

 

  • The Early Intervention Foundation is a What Works Centre that champions and supports the use of effective early intervention to improve the lives of children and young people at risk of experiencing poor outcomes.

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