Guidance

Part 2: health visiting (ages 0 to 5)

Published 6 February 2026

Applies to England

The importance of health visiting

Health visiting provides a unique universal service, beginning in the antenatal period, that forms the foundation for safe, trusting and respectful relationships with families. Early contacts - specifically the antenatal, new birth and 6‑to-8‑week health and development reviews - are best delivered in the home by a health visitor. These visits:

• support continuity of care
• offer essential insight into family circumstances and the home environment
• enable early identification of risks to inform safeguarding practice

Home visits enable health visitors to gain a fuller understanding of the family’s living conditions and dynamics, which are central to a robust assessment of health needs. Certain indicators of risk may not be apparent in clinical or community settings, such as:

• environmental neglect
• domestic abuse
• unsafe sleeping arrangements

While the 12-month and 2-to-2-and-a-half-year health and development reviews may be delivered flexibly in other suitable venues, such as Best Start Family Hubs, neighbourhood clinics or community settings, this flexibility should be based on family needs and preferences - not service convenience.

This flexibility helps ensure services remain accessible, inclusive and tailored to individual needs. Early contact enables practitioners to build on family strengths, promote resilience and achieve optimal child development. This reinforces the preventative, relationship-based foundation of the healthy child programme.

Named health visitors should deliver all 5 statutory health and development reviews at specified stages to support continuity of care and relationship building. In certain circumstances, a health visitor may delegate a review to a suitably qualified health professional or nursery nurse, provided they are supervised and the health visitor maintains overall accountability. See ‘Delegation and accountability’ in the ‘Value of skill mix’ section under ‘Part 1: principles of delivery’ for more detail on this.

Component areas and core requirements 

The following components ensure a sustainable and evidence-informed approach to delivering the healthy child programme. The components have been shaped by extensive stakeholder engagement around meeting the needs of babies, children and families.

Leadership and workforce

Health visitors lead delivery for a defined population, supported by skill mix teams.

The statutory offer of 5 health and development reviews must be delivered by a health visitor or, in specified circumstances under regulation 5B of the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) and Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (as amended),  a health visitor can decide that a suitably qualified health professional or nursery nurse may carry out a universal health visitor review with guidance from, and supervision by, the health visitor. The suitably qualified health professional or nursery nurse must agree to carry out the review with delegated accountability to the health visitor.

Regular supervision supports safe delegation and consistency.

To support evidence-based practice and workforce sustainability, workforce development includes:

• structured preceptorship
• research integration
• training in core competencies

Commissioning and system alignment

Local authorities are responsible for delivering the full healthy child programme offer, which may be commissioned or provided in house. This includes community, universal, targeted and specialist services. Delivery should be:

• locally monitored
• quality assured
• evaluated

Integrated working

Services should work in timely partnership, as required, with:

• maternity
• general practice
• early years
• Best Start Family Hubs
• neighbourhood teams
• social care
• special educational needs and disabilities (SEND) services
• the voluntary and academic sectors
• other health agencies (including mental health)

This includes:

• sharing concerns appropriately
• referring families to wider support
• contributing to integrated pathways through data sharing, co-location and joint planning to reduce duplication and improve outcomes

Core offer and tailored support

A minimum of 5 health and development reviews must be offered at 5 specified stages. In line with best practice, the antenatal, new birth and 6-to-8-week health and development reviews should be delivered face to face in the home by a health visitor. Other reviews may be offered in alternative settings based on family preference and individual circumstances, rather than service convenience.

Named health visitors build therapeutic relationships using client-centred and trauma-informed approaches. Reviews should assess child health and development as well as family needs to ensure appropriate support is or will be offered. This is particularly important when families are first discharged from hospital and may be at their most vulnerable. The service should enable access and engagement for all families, especially those facing challenges.

Reviews should:

• consider strengths and risks
• include all adults in the family home, where appropriate

Emotional wellbeing and communication

Practitioners should:

• support the emotional wellbeing of infants and young children through attuned and responsive relationships
• listen to families, and observe babies’ and children’s behaviours and interactions, to understand their emotional needs
• consider babies’ and children’s expressions in play, behaviour and communication when planning care and support

This approach helps build trust, safety and emotional regulation.

Public health and health promotion

In line with the principle of Making Every Contact Count (MECC), every contact should promote crucial public health evidence-based messages such as:

• safe sleep practices
• immunisation
• breastfeeding
• oral health
• smoking cessation
• healthy lifestyles
• emotional wellbeing

Parenting support, responsive caregiving and behaviour change tools should be embedded.

Family and community focus

Family-led care recognises and supports parents. Services should:

• build family strength
• link families to local resources
• promote early learning to develop school readiness

Safeguarding and early intervention

Practitioners should routinely screen for domestic abuse (including coercive control) and other forms of harm, including neglect, and physical, sexual, financial and emotional abuse. Reviews should consider risks and support early identification.

Practitioners should:

• share information with relevant agencies, where this is legally permitted and necessary to protect a child’s safety or wellbeing
• work collaboratively to support families where needed

Proportionate intervention helps safeguard babies, children and families, and promotes positive outcomes.

Families transferring into area

When notified that a family with at least one child under the age of 5 is transferring into the area, the health visiting service should:

• respond to the notifying organisation within 5 working days
• make contact with the family within 10 working days to arrange a home visit at the earliest opportunity

When a family is known to have transferred into temporary accommodation, recognising the increased risks (particularly for babies under a year old), the health visitor should prioritise arranging a visit as soon as possible.

During all transfer-in visits, a comprehensive assessment of health needs is conducted, including:

• checking the child’s developmental progress
• reviewing immunisation status and advising on catch-up immunisations if needed
• confirming registration with a local GP or, if not registered, signposting to registration services
• providing information and links to relevant community resources, support groups and local services
• introducing the family to the health visiting service by explaining the statutory offer and how to access support between scheduled visits

This approach ensures continuity of care, supports early identification of needs, and enables families to access appropriate services and resources as they settle into the area.

Proportionate universalism and levels of support

Services within the healthy child programme should be offered across 4 levels of support:

• community
• universal
• targeted
• specialist

The level of service provided to each family should be determined through holistic assessment in collaboration with families. All 4 levels of support should be available within each local authority, with service delivery tailored to assessed individual needs.

Proportionate universalism, as outlined in Fair Society, Healthy Lives: the Marmot Review - a strategic review of health inequalities in England post-2010, means offering more intensive support for families facing greater challenges while maintaining universal provision for all. Importantly, families receiving targeted or specialist support should also continue to receive universal service provision.  

Practitioners should also be mindful of the impact of child poverty and use healthy child programme visits to help families access:

• financial support
• benefits advice
• other relevant services

This aligns with the wider role of health visiting in mitigating the effects of poverty and promoting equity in early childhood.

The examples provided below illustrate the types of practice that may be delivered at each level by health visiting services, but they are not exhaustive. Local teams should build on existing community assets, evidence-based frameworks and professional judgement to shape delivery in response to population needs.

A breakdown of the 4 levels of service for health visiting follows.

Community level

Purpose

At the community level, practitioners contribute to public health by promoting healthy environments and reducing health inequalities through population-wide approaches. This includes:

• raising awareness of crucial health and safety messages
• strengthening community assets through collaboration with local partners
• supporting relational wellbeing - that is, helping families build strong, emotionally attuned relationships that support children’s development and resilience. This involves:
  • promoting secure attachments
  • responsive caregiving
  • positive interactions within families and communities
• encouraging a ‘Think Family’ approach, valuing the relationships around the child and recognising the role of caregivers, families and networks in shaping early development

Practice examples

Examples of community-level practice include:

• health promotion campaigning (such as on oral health, balanced diet and nutrition, breastfeeding and Better Health: every mind matters)
• awareness raising of safe co-sleeping practices and other crucial safety messages (such as substance use while caring for babies and bath supervision)
• hosting open-access health promotion groups (such as on weaning, nutrition and physical activity) in community settings such as Best Start Family Hubs
• supporting and training community champions to share health messages across languages and cultures
• embedding relational approaches across the system by working with other practitioners in Best Start Family Hubs, neighbourhood clinics and community settings
• working with partner agencies (such as housing, employment and the voluntary sector) to influence social determinants of health
• collaborating with academic and research partners (such as National Institute of Health Research health innovation networks) to support innovation and evidence-based practice at community level

Universal level

Purpose

At the universal level, practitioners deliver the core healthy child programme offer through 5 health and development reviews, which must be offered at 5 specified stages. These reviews are offered to all families with children of the eligible age and aim to:

• ensure consistent access
• build trusting relationships
• support early identification of need
• promote equity

Universal reach aims to ensure all families - including those who may face barriers to access - are supported to engage with services at major developmental points.

A plain list of the 5 statutory health and development reviews is provided below:

• antenatal review
• new birth review
• 6-to-8-week review
• 12-month review
• 2-to-2-and-a-half-year review

For more detail, see the ‘Health and development review summaries’ section below.

Practice examples

Additionally, practice at the universal level may also include the following:

• working collaboratively with midwifery services, including joint visits, information sharing and co-ordinated care planning, to:
  • reduce duplication
  • share risk
  • ensure continuity of support during the perinatal period
• sharing relational health messages (such as the importance of emotional connection, responsive caregiving and secure attachment) and signposting families to community-based resources that reinforce these themes (such as Best Start Family Hub groups, peer support and parenting programmes)
• holding child health clinic drop-in sessions to provide accessible advice and support
• considering escalation to targeted or specialist level of support in line with assessed need
• liaising with health, early years settings, social care and other services to ensure joined-up support
• supporting families to access local groups and resources (such as Best Start Family Hubs and Healthy Babies services, libraries or early years settings)
• referring to other services (such as a GP or speech and language therapist) when needs are identified
• encouraging joined-up working across services that promotes emotionally attuned caregiving and supports relational wellbeing from pregnancy to age 5. For example, by:
  • modelling responsive interactions during reviews
  • promoting caregiver-infant attunement
  • using a ‘Think Family’ approach to understand the wider caregiving context and relational dynamics

Targeted level

Purpose

At the targeted level, practitioners deliver additional support based on an assessment identifying specific needs. These interventions are offered in addition to the 5 statutory universal health and development reviews that must be offered, and aim to:

• reduce escalation of concerns
• build resilience
• empower families through strengths-based and trauma-informed approaches

Targeted support can be structured in 2 ways:

Targeted selective support

Targeted selective support is offered proactively to families who are at higher risk of poor outcomes due to known vulnerabilities such as:

• young parental age
• social isolation
• housing instability
• a history of trauma

This support aims to prevent problems before they occur and may include enhanced home visiting, parenting support or group-based interventions.

Targeted indicated support

Targeted indicated support is provided when a specific concern has been identified - for example:

• a sensory impairment
• delayed speech and language
• mild to moderate mental health difficulties in a young person (and/or parent)
• atypical attachment and bonding
• the social impact of neurodiversity

All targeted interventions should be tailored to the family’s circumstances and may be delivered (sometimes jointly with partner agencies) in home visits, clinics or community settings.

Practitioners should be mindful that not all families are able or willing to attend group-based services, and home-based support may be essential to ensure equitable access.

Practice examples

Examples of practice at targeted level include the following:

• conducting joint visits with partner agencies (such as midwifery, early help or social care) to provide co-ordinated support and share relevant information (with appropriate agreements in place) and risk assessments
• promoting relational approaches within targeted contacts by:
  • modelling attuned caregiving
  • validating parental emotions
  • supporting reflective conversations that build confidence and emotional safety
• delivering targeted contacts antenatally and postnatally in response to identified concerns (such as mild or moderate mental health issues and developmental or social vulnerabilities). These may be particularly valuable at critical time points, such as around 3 months, 6 months and 2 and a half years old, to:
  • support responsive feeding
  • promote accident prevention and home safety
  • prepare children for school readiness
• addressing parental isolation and conflict, which may be supported through Best Start Family Hubs or other local services, while recognising the importance of flexible delivery models including home visits
• running small group or one-to-one support sessions focused on health promotion (such as weaning, feeding and nutrition), which may also include topics such as managing stress, sleep and coping strategies, especially in postnatal groups
• facilitating short-term interventions that support early development and strengthen the relationship between infants and caregivers. For example, using play-based activities to:
  • help parents understand their baby’s cues
  • respond sensitively
  • build secure, trusting connections
• providing carbon monoxide monitoring and smoking cessation support to families where smoking or exposure to tobacco smoke is a concern. Health visitors may:
  • use carbon monoxide monitors to raise awareness of second-hand smoke risks
  • offer tailored advice and referrals to stop smoking services

Practitioners may draw on a range of relational and trauma-informed frameworks to support caregiver-infant relationships and reflective practice. In addition to the Solihull Approach, models such as Five to Thrive, PACE (which stands for playfulness, acceptance, curiosity and empathy) and the Circle of Security offer practical tools for promoting attuned caregiving and secure attachment.

These frameworks help practitioners support families to understand and respond to their child’s emotional needs, build trust and strengthen relational wellbeing, particularly during periods of stress or transition.

Specialist level

Purpose

At the specialist level, practitioners deliver substantial interventions for families requiring intensive or more complex care, based on ongoing assessment. Support at this level is often more comprehensive and longer term, and may involve:

• safeguarding concerns
• significant health vulnerabilities
• complex developmental needs

Support at this level also aims to strengthen relational safety and caregiving capacity, particularly where families are experiencing trauma, adversity or complex vulnerabilities.

Practitioners should work in a trauma-informed way, promoting:

• trust
• emotional containment
• reflective engagement

Health visitors work closely with partner agencies (including social care, education, acute healthcare and mental health services) to plan and deliver integrated care that is responsive, co-ordinated and relationship focused.

Practice examples

Examples of practice by practitioners at specialist level include the following: 

• actively participating and contributing in multi-agency safeguarding and child protection processes, such as:
  • strategy discussions
  • case conferences
  • child in need, team around the family and core groups
• contributing to assessments and care planning, ensuring health needs and relational factors are considered
• delivering targeted home visiting programmes, such as the Family Nurse Partnership programme, which delivers sustained improvements in child development, school readiness and maternal self-efficacy, breaking cycles of disadvantage for young parents and children
• providing ongoing carbon monoxide monitoring and intensive smoking cessation support, integrated into care plans for families where tobacco use may exacerbate health or safeguarding risks. This may include:
  • liaison with specialist stop smoking services
  • tailored advice
• identifying and responding to concerns around other substances (such as alcohol or drug use) that may impact caregiving capacity, referring to appropriate services and contributing to risk management plans
• arranging referrals and liaising with specialist services for children who are neurodivergent or have complex medical or developmental needs, and for parents requiring adult mental health support
• where appropriate, supporting access to evidence-based, relationship-focused interventions delivered by parent-infant mental health-trained staff. These interventions:
  • address the baby’s developmental and relational needs, such as secure attachment, emotional regulation and caregiver attunement
  • may include referral into specialist parent-infant mental health services or pathways within children and young people’s mental health services, where available

Structure and composition of the service

The healthy child programme includes a structured schedule of health and development reviews. The 5 universal health and development reviews are supported by additional contacts delivered at targeted or specialist levels, based on professional assessment of emerging needs or clinically relevant concerns, including those raised by families.

Health and development reviews are major opportunities to deliver important public health messages and build strong therapeutic relationships. Woodman and others (see reference 2 in Annex B) found that trusted relationships between families and practitioners are often the mechanism through which positive change occurs, reinforcing the importance of continuity of care and a named practitioner.

Every family should be allocated a named health visitor who provides continuity throughout their healthy child programme journey. 

Types of reviews

Statutory health and development reviews

Best practice is that the antenatal, new birth and 6-to-8-week health and development reviews should be delivered face to face in the family home by a health visitor. Later reviews may be offered in alternative settings, such as clinics, neighbourhood health centres or Best Start Family Hubs, where clinically appropriate and agreed with the family.

Reviews completed solely by video, telephone or through posted questionnaires would not meet the required standard for statutory health and development reviews at the 5 specified stages and should not be reported as a fulfilled statutory review.

Statutory health and development reviews should be conducted by a health visitor, given the breadth of issues assessed and the professional expertise required. Each review should draw on:

• professional knowledge and observation
• parental insight
• the use of developmental tools (where appropriate), such as the:
  • Ages and Stages Questionnaire (ASQ) and the Ages and Stages Questionnaire: Emotional-Social (ASQ:SE)
  • Early Language Identification Measure (ELIM) (see also the Early language identification measure and intervention: guidance handbook)

All reviews should support national priorities including the following:

• family health education and promotion tailored to individual family needs
• promotion of sensitive and responsive caregiving, which helps parents recognise and respond to their baby’s cues, to support secure attachment and emotional development
• promoting immunisation uptake
• supporting family planning and sexual health (including discussing contraception needs, giving advice and signposting)
• supporting oral health and healthy lifestyles
• reinforcing safe sleeping practices
• guidance on supervision and safety in and out of the home
• addressing substance misuse risks during caregiving

Each contact should include a review of immunisation status and the provision of accessible, evidence-based information for parents. In some cases, particularly where families have missed scheduled immunisations or are at risk of under-vaccination, public health nursing teams may administer immunisations as part of a targeted intervention that is aligned with local pathways and national direction.

Additional reviews

Additional health and development reviews can be completed at any point between ages 0 to 5 in response to assessed need. While not part of the statutory offer, completing additional targeted reviews at certain time points - such as around 3 months, 6 months or 3 and a half years old - may be particularly valuable. These time points align with the following known developmental milestones and public health opportunities:

• around 3 months old: supporting responsive feeding practices and helping parents understand the importance of delaying weaning until developmentally appropriate
• around 6 months old: promoting home safety and providing guidance on safe and appropriate weaning behaviours as babies begin to show signs of readiness
• around 3 and a half years old: supporting school readiness, including communication, social development and self-care skills

These additional reviews are not prescriptive or exhaustive. They should be:

• led by assessed need
• proportionate
• rooted in a personalised care approach that meets the needs of babies, children and families

Depending on the nature of the identified need and the required intervention, these reviews may be delivered by the most appropriate member of the health visiting skill mix team, such as:

• nursery nurses
• nursing associates
• early years practitioners

Their specialist skills and trusted relationships with families enhance the public health offer.

Focus of universal and targeted health and development reviews

The following table summarises how the focus of health and development reviews shifts during the delivery of the healthy child programme. It is intended as a high-level reference to support practitioners and readers.

Table 1: universal and targeted health and development reviews

Review	Time point	Service level	Primary focus	Priorities at this stage
Antenatal health and development review	From 28 weeks of pregnancy onwards	Universal	Preparing for parenthood and early identification of need	Building the initial relationship with the family; holistic assessment of family circumstances, strengths and vulnerabilities; screening for maternal mental health needs; safeguarding and domestic abuse enquiry; introduction to the health visiting service; planning the appropriate level of support; promoting infant brain development; responsive caregiving; and readiness for birth
New birth health and development review	1 day to 2 weeks old	Universal	Early postnatal health, bonding and safety	Assessing the baby’s early health and wellbeing; supporting parental physical and emotional recovery; reinforcing infant feeding and safety messages (including safer sleep); observing parent-infant interaction; safeguarding vigilance; ensuring continuity from maternity services; and access to screening and primary care
6-to-8-week health and development review	6 to 8 weeks old	Universal	Adjustment, early development and family wellbeing	Monitoring maternal mental health and adjustment; assessing early development and growth; supporting infant regulation, feeding and sleep; reinforcing responsive caregiving; identifying emerging needs early; safeguarding vigilance; and promoting immunisation uptake and engagement with universal services
3-month targeted review	Around 3 months old	Targeted	Regulation, coping and early intervention	Providing additional support where needs are identified; addressing crying, regulation and parental coping; reviewing feeding, sleep and emotional demands; early developmental surveillance; strengthening resilience and engagement with support networks; and reassessing level of service required
6-month targeted review	Around 6 months old	Targeted	Developmental progression and routines	Supporting transitions such as weaning, sleep routines and oral health; monitoring growth and development; addressing parental wellbeing and coping; promoting safe environments and healthy behaviours; and co-ordinating targeted or specialist support where required
12-month review	9 to 15 months old	Universal	Mobility, independence and emerging behaviour	Assessing development as mobility increases; supporting routines, boundaries and behaviour; addressing separation anxiety; promoting healthy diet, oral health and safety; identifying developmental delay or emerging concerns; and planning onward support and referrals if needed
2-to-2-and-a-half-year review	24 to 30 months old	Universal	Readiness for early learning and independence	Focusing on communication, social development and self-care; supporting behaviour, routines and emotional regulation; promoting early learning, healthy lifestyles and safety; working with early years settings where appropriate; identifying additional needs; and supporting school readiness
3-and-a-half-year targeted review	Around 3 and a half years old	Targeted	School readiness and transition	Reviewing progress where concerns were previously identified; reinforcing health, development and wellbeing messages; supporting readiness for school; co-ordinating with early years and other services; planning transition to the school nursing service; and ongoing support if required

A detailed description of every review and what it should cover is provided in the ‘Ages 0 to 5: health and development review summaries’ section below.

Ongoing visits and contacts

A health visitor may plan and delegate additional visits beyond the statutory reviews and those outlined in table 1 above. These visits should be purposeful and outcome orientated. Examples include:

• monitoring developmental progress or developmental delay
• supporting parent-child interaction (such as understanding play)
• addressing wider determinants of health
• co-ordinating multiagency input

Additional visits or contacts should be delivered by the most appropriate and competent member of the skill mix team, and delegated under specialist community public health nurse (SCPHN) leadership, in line with local governance and supervision frameworks. Alongside targeted interventions, these additional contacts offer opportunities for partnership working and co-ordination, enabling a responsive and efficient service to families while ensuring they receive safe, high-quality care.

Where a child attends an early years setting, the universal 2-to-2-and-a-half-year and targeted 3-and-a-half-year health and development reviews should, where practical and necessary, include liaison between early years practitioners and health visitors, alongside parents, to provide a holistic view of the child’s development. Early years practitioners also complete a progress check at 2 years old, which offers valuable insight into the child’s learning and development in the setting.

Where developmental concerns are identified, early years practitioners and health professionals should:

• seek parental consent to share relevant personal or health information
• work together to develop a co-ordinated support plan. This includes health visitors initiating contact with early years settings where appropriate, and vice versa, to ensure timely follow-up and joined-up support

While National Institute for Health and Care Excellence (NICE) guidance, local pathways and standard operating procedures (SOPs) inform practice, it is assessed clinical need that should determine the timing and content of additional visits, reviews and contacts.

The expected quality standard of health and development reviews

Completion of the 5 statutory health and development reviews at the specified stages is essential but, alone, it does not ensure a safe, effective, and equitable health visiting service. These reviews should represent high-quality, relational and clinically informed engagement with families that is tailored to their unique circumstances.

Each review should ensure meaningful and therapeutic engagement with the family. This includes:

• a holistic assessment of the infant’s health, development and wellbeing
• a comprehensive assessment and evaluation of family circumstances, including parental physical and mental health, caregiving, family relationships and environmental factors
• recognition and sensitive discussion of any additional needs or disabilities that parents may have, including learning, physical, sensory or neurodivergent needs, and how these may influence parenting
• active identification and exploration of family needs, concerns and aspirations
• support to strengthen parental capacity, resilience and confidence in caregiving through tailored guidance and evidence-informed strategies
• consideration of historical safeguarding or child protection concerns, where relevant
• supportive exploration of caregiving practices, including sleep routines, supervision and substance use, with a focus on building parental awareness, confidence and capacity to create safe and nurturing environments for their child

Where clinically indicated or when the infant is being undressed for weighing or care tasks, practitioners should take the opportunity to observe the baby more fully. Visible observation of the infant’s skin (its tone, colour and general presentation) is expected at every review, as part of safeguarding vigilance and holistic care. This includes noting any:

• marks
• bruising
• birthmarks (such as Mongolian blue spots)
• unexplained injuries

Observations should be conducted in a strengths based and respectful manner, recognising parental efforts to provide safe and nurturing environments.

While health visitors should facilitate access to wider services - such as financial advice, housing support or mental healthcare - the primary focus of each review is to assess:

• the child’s health and development
• their family’s overall health and wellbeing

Reviews should be delivered in settings that support therapeutic engagement and accessibility, in line with the delivery expectations outlined earlier in this guidance.

Use of development tools within health reviews

Developmental tools such as the following support clinical consistency and offer structured insights into a child’s developmental progress and social emotional wellbeing:

• ASQ and ASQ:SE
• ELIM
• WellComm

While these tools offer valuable insights into a child’s development, the completion of a questionnaire (whether by parent or practitioner) represents only one component of the broader health and development review. On its own, it does not meet the expected standard for a comprehensive, clinically informed and relational assessment.

Development tools should be used to:

• support professional judgement
• guide meaningful discussion with parents or carers
• contribute to a holistic understanding of the child’s development within the context of their family and environment

When a developmental tool has been completed prior to the review, it should be all of the following:

• analysed and discussed in detail with the parent or carer during the review
• used to explore parental understanding of their child’s health, development and milestones
• considered in the context of the child’s broader health, behaviour and environment

This approach aims to:

• ensure the assessment is accurate, meaningful and reflective of the child’s lived experience.
• support early identification of developmental needs
• prevent missed opportunities for timely intervention

Practitioners should treat developmental tools as part of a wider, relational assessment - not as standalone data - and use them to deepen engagement, build parental confidence and inform clinical decision making.

The 2-to-2-and-a-half-year review, as the last mandated review before a child goes to school, provides a major opportunity to identify additional or emerging needs and ensure appropriate support is provided to promote school readiness. Ensuring parents receive the ASQ or ASQ:SE questionnaire and supporting information on its use ahead of this review will facilitate timely completion and effective, holistic assessment.

Face-to-face contact should be considered the norm for health and development reviews, particularly when interpreting developmental tools and building therapeutic relationships. Where a parent has completed the questionnaire, health visitors should ensure there is space for open, reflective discussion of the scores, enabling professional curiosity and challenge where appropriate.

In exceptional circumstances where in-person contact is not possible, health visitors should still ensure that any developmental tool is meaningfully explored as part of a comprehensive, relational assessment.

The maternity and health visiting transition

A robust and proactive partnership between maternity and health visiting services is critical to ensure continuity of care. Midwives remain responsible for postnatal care up to 28 days after birth, although many families are discharged to health visiting services before this point. The timing and quality of this handover are critical to:

• avoid duplication
• prevent gaps in support
• reduce unnecessary burden on families

Effective information sharing is essential to ensure seamless care. A clear, timely and clinically informed handover from maternity to health visiting services is critical to maintain continuity of care and safeguard maternal health.

The handover between the midwife and health visitor should include a full account of maternal health needs and conditions, including:

• physical and mental health
• labour and delivery outcomes
• known risk factors
• any safeguarding concerns

According to Jenner and others (see reference 3 in Annex B), the MBRRACE-UK Saving lives, improving mothers’ care 2024 report found that fragmented care and poor communication between services were contributing factors in preventable maternal deaths, and cardiac disease was noted as the leading indirect cause of maternal death in the UK. Health visitors should be alert to subtle signs that may indicate underlying cardiac concerns, such as breathlessness, fatigue, chest discomfort or reduced functional capacity, particularly when these symptoms are disproportionate or unexplained.

It is equally important to recognise that mental health issues, including suicide, are now the leading cause of late maternal death in the UK. This underscores the need for integrated, holistic care that addresses both physical and mental health throughout the perinatal period.

Health visitors need access to previous and current health information, as well as relevant contextual information (for example, that the family is living in temporary accommodation), to carry out holistic assessments and provide appropriate support.

Where electronic records are not interoperable, handheld maternity notes should be made available in line with agreed information-sharing protocols. System-level solutions should be pursued to facilitate secure and efficient information sharing across services, recognising that current infrastructure may not yet support seamless access.

Local systems should ensure that maternity and health visiting teams have agreed protocols and secure mechanisms for sharing information, with a focus on clinical relevance and timeliness.

Local areas should have the following in place:

• clear service pathways
• SOPs
• joint-working protocols to support timely information sharing and co-ordinated care
• use of digital and electronic patient records to facilitate secure and efficient information sharing during this transition period

Maternity and health visiting teams should routinely liaise prior to the antenatal visit to:

• share relevant and timely information
• co-ordinate care planning to ensure a seamless approach
• identify families who may benefit from joint antenatal visits, especially where vulnerabilities, safeguarding concerns or complex needs exist

Joint visits should be considered not only for high-risk families but also as a proactive measure to support early engagement, build trust and ensure continuity of care.

Scheduling of visits should be sensitive to family needs and avoid midwifery and health visiting appointments occurring on the same day, unless clinically necessary. Flexibility is crucial to supporting engagement and reducing burden.

Joined-up working is especially important for families with:

• babies in neonatal intensive care units (NICU) or special care baby units (SCBU)
• with complex medical needs requiring technology dependency (such as cardiac conditions or long-term hospitalisation)

These families may experience heightened emotional stress, delayed bonding and complex health needs. Health visitors should be alerted to these cases early, and maternity, neonatal and paediatric teams should work collaboratively to ensure:

• parents’ emotional wellbeing is prioritised
• timely information is shared with the health visiting team
• a co-ordinated plan is in place for post-discharge support

Health and development review summaries

The summaries provided in this section outline the core components of each health and development review, which must be offered to all children at 5 specified stages.

They are not exhaustive and should be used in conjunction with SOPs for each review, in line with organisational governance and local protocols. SOPs should:

• address any elements not detailed here
• reflect local population needs, service models and demographic variation

Given that mental health issues, including suicide, are now the leading cause of late maternal death in the UK as of 2025 (according to the MBRRACE-UK report Saving lives, improving mothers’ care 2025), health visitors should routinely enquire about both physical and mental health during postnatal reviews and contacts. Early identification and timely referral to appropriate support are essential to safeguarding maternal wellbeing and preventing avoidable harm.

All records of health and development reviews should be completed contemporaneously, in line with the Nursing and Midwifery Council’s The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates.

This ensures accuracy, accountability and continuity of care. Documentation should be clear, factual, and completed as soon as possible after the interaction to maintain professional and legal standards.

Each review should include the completion of the personal child health record (PCHR) to support:

• shared information
• parental engagement
• continuity of care across services

This record should be updated accurately and promptly to reflect all assessments, interventions and advice provided.

Structure of this section

Each health and development review from ages 0 to 5 has a number of aims, some of which apply to all reviews and others that are specific to the age of the baby or child. The purpose for all reviews is set out first, followed by a summary for each review.

Each summary will provide an outline of the following:

• best practice in delivering the review
• the purposes of the review
• the core components and outcomes that are expected

Lists of ‘Resources to draw upon during each health and development review’ are provided at the end of this section.

The common purposes of all reviews

All reviews have the following purposes - to:

• engage with the family to build trust and establish a therapeutic relationship
• undertake a holistic assessment to identify family strengths, needs and vulnerabilities, ensuring families are offered the appropriate level of service (such as universal, targeted or specialist)
• undertake routine enquiry and consideration of domestic abuse
• assess for safeguarding risks, including any concerns about child sexual abuse
• provide evidence-based public health information
• ensure that parents are aware of the immunisation and health and development review schedules
• signpost and support families to access community resources and support
• agree the future plan of care with the family
• explore any financial concerns that the family may have, raise awareness of advice available and offer referral to relevant services

What happens following each review

At the end of each review, families should be:

• informed of the timing and purpose of their next scheduled contact with the health visiting team
• provided with clear information on how to contact the service between visits - whether:
  • for additional support or advice
  • to access drop-in clinics for routine checks, weighing or developmental concerns

Antenatal statutory universal health and development review (from 28 weeks of pregnancy)

As the first of 5 statutory health and development reviews that must be offered, the antenatal health and development review is pivotal for:

• setting the foundation for an ongoing relationship between the family and the health visiting service
• ensuring services are prepared to provide any support needed

This review also enables early identification of risk factors and informs planning across the wider system. 

The antenatal review introduces parents to their named health visitor, who will provide continuity of clinical care and support throughout ages 0 to 5. This relationship is fundamental to the healthy child programme’s preventative, relational approach and reflects the ambition of the Healthy child programme: high-impact area framework’s ages 0 to 5 high-impact area ‘1. The transition to parenthood’.

During this visit, families are typically introduced to:

• the wider health visiting service
• the composition of the team
• the types of support available
• what to expect from the healthy child programme

Wherever possible, the antenatal review should take place in the home, unless:

• a risk assessment identifies that this is unsuitable
• the family declines a home visit

In cases of the latter, the health visitor should remain professionally curious and explore the reasons for declining, particularly where other risk factors and/or vulnerabilities may be present. The home environment provides valuable context, enabling the health visitor to observe the following:

• family dynamics and interactions
• living conditions and broader environmental factors that may impact health and development
• potential risk and protective factors

This antenatal review helps determine the appropriate level of service offer (universal, targeted or specialist), which should be reviewed regularly as the family’s needs and circumstances evolve.

Best practice for the antenatal review

This review should be delivered as an individual face-to-face contact by the named health visitor, in the family home, from 28 weeks of pregnancy onwards. Before the review, health visitors should liaise with midwifery colleagues to:

• discuss the family’s individual needs and any identified or suspected risks
• ensure a co-ordinated and informed approach to care

Where a home visit is not possible, practitioners should offer an alternative suitable location, such as a neighbourhood clinic or a Best Start Family Hub, and explore the reasons for declining a home visit with professional curiosity. This may help identify:

• hidden vulnerabilities
• safeguarding concerns
• barriers to engagement

Services should have contingency plans in place for these exceptions to ensure the review is still delivered in a meaningful and relational way, even if not conducted in the home.

All families, including those experiencing a second or subsequent pregnancy, must be offered an antenatal review after 28 weeks’ gestation.

During this review, families are expected to receive a health needs assessment to identify health needs or safeguarding concerns and plan appropriate support. Assumptions of low risk based on parity alone are inappropriate - family circumstances can change significantly between pregnancies and each situation should be assessed individually.

In some cases, a joint visit with midwifery may be clinically indicated before 28 weeks to address specific concerns or vulnerabilities. These early contacts are not counted as part of the statutory antenatal health and development review, but may be necessary to support safe, timely and effective care planning.

Decisions about joint visits and the need for multiple antenatal contacts should be made collaboratively, based on professional judgement and the family’s circumstances.

Objectives of the antenatal health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include the following:

• introduction to the healthy child programme and health visiting service, and the initial development of a therapeutic relationship with the family
• completion of a family health needs assessment, including the impact of any illness or disability affecting the family or unborn child, to ensure early identification of additional needs
• provision of health visiting service contact details, signposting to and raising awareness of community resources, and highlighting details in the PCHR
• consideration of a joint antenatal needs assessment between a family’s midwife and health visitor in the case of families with identified vulnerability or need
• provision of crucial public health evidence-based information, such as on responsive caregiving, secure attachment and health and wellbeing
• initiation of early assessment of maternal and/or wider family health and emotional wellbeing, as well as early identification (where possible) of any vulnerabilities, additional needs and/or complex social factors - particularly:
  • alcohol or drug misuse
  • recent migrant or asylum seeker status
  • difficulty reading or speaking English
  • teenage parenthood
  • domestic abuse
• assessment and support on infant wellbeing, and sensitive and responsive parenting. This includes understanding of:
  • baby states and cues
  • brain development
  • infant feeding and the benefits of breastfeeding
  • infant safety (for example, ICON: Babies cry, you can cope (linked below)), including safe sleeping and home safety
  • readiness for birth

Core components and outcomes of the antenatal review

This review has several core components and outcomes that health visitors should aim to deliver. These include:

• introduction of the family to the health visiting service as a source of credible, evidence-based advice and a means of accessing other services
• introduction to the support available following their transition from midwifery care, including how services will work together
• familiarisation with local community resources, such as parenting groups and Best Start Family Hubs
• assessment and identification of individual and family strengths, needs and vulnerabilities, including the family’s support network
• completion of a family genogram (family tree) to support understanding of family structure, relationships and history
• screening for anxiety and depression during pregnancy, in line with NICE quality standard [QS115] Antenatal and postnatal mental health
• determination of initial level of service required by a family (universal, targeted or specialist), informed by holistic assessment
• discussion of who lives in the family home and who will have regular access to the infant
• routine enquiry and consideration of safeguarding concerns, including domestic abuse, coercive control, unsafe relationships and environmental risks, with escalation to a multi-agency risk assessment conference (MARAC) or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working - for example, with midwifery, housing or mental health services
• referrals to more specialised services, where required, including domestic abuse and safeguarding services
• promotion of positive parental mental health and early parental-infant bonding
• provision of support around the transition to parenthood
• provision of advice around registering the baby’s birth and booking postnatal GP and primary care appointments
• promotion of responsive caregiving and secure attachment from birth
• promotion of smoking cessation with the clear advice that smoking should not occur around the baby, and referral to smoking cessation services where appropriate
• promotion of immunisation schedule and what to expect after birth
• recommendation of Healthy Start vitamins during pregnancy, where eligible
• discussion of safe sleep practices, including observation of where the baby will sleep, and discussion of managing stress and sleep deprivation
• discussion of managing minor ailments and knowing when and how to seek help
• discussion of contextual risks or local issues (for example, exploitation, gangs or housing insecurity) where relevant
• sharing knowledge around neurological development in the unborn and the impact of stress on development
• discussion of the need for child supervision and creating a safe home environment
• discussion of substance use in the home and its potential impact on the baby
• discussion of family planning, sexual health and contraceptive choices, supporting informed decisions before and after birth
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next visit or contact
• confirmation of parental understanding of how to contact the health visiting team between scheduled reviews

New birth statutory universal health and development review (1 day to 2 weeks old)

This review must be offered to a child aged between 1 and 14 days old. It should be delivered as an individual face-to-face contact by the named health visitor, ideally in the family home, within this period. This review provides a vital opportunity to:

• assess the baby’s early health and development
• support parental wellbeing
• build on the therapeutic relationship established during the antenatal review

Best practice for the new birth review

Health visitors should liaise with midwifery colleagues to ensure co-ordinated care and avoid scheduling visits on the same day, unless clinically necessary. This helps to:

• reduce duplication
• support continuity
• ensure families are not overwhelmed during the early postnatal period

While midwives can retain responsibility for postnatal care for up to 28 days, they usually discharge women between 10 and 14 days after birth. The health visitor’s role begins within this window and should complement - not duplicate - maternity input.

Clear communication pathways between midwives and health visitors should be established to ensure no health concerns are missed, and that women receive appropriate, timely referrals and support. Early intervention can be lifesaving, and every contact should count.

Face-to-face contact in the home is the expected standard for the new birth health and developmental review.

Where a home visit is not possible - for example, if the family is temporarily away or in cases where a baby remains in NICU or SCBU beyond the statutory review window - the review should be completed as soon as possible after they have been discharged home. Interim contact should continue during the hospital stay to:

• provide emotional support
• maintain engagement
• prepare for post-discharge care

Health visitors should work closely with neonatal teams to ensure the baby’s needs are met and the family is connected to the health visiting service. The timing and reason for any delay should be clearly documented in line with local protocols.

Objectives of the new birth health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• explanation of why the first 1,001 days are critical for babies’ brain development
• support for infant feeding, including the benefits of breastfeeding
• maximisation of infant safety, including safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’ (linked below)
• monitoring of bonding and attachment between parents and the infant
• assessment of the baby’s growth, health and development, including feeding, jaundice, weight and skin

Core components and outcomes of the new birth review

This review has several core components and outcomes that health visitors should aim to deliver. These include the following:    

• structured continuity of care, including ongoing assessment and re-assessment of individual family needs
• continuation and strengthening of therapeutic relationships with families that encourage meaningful engagement
• construction of family genogram (family tree) if not completed antenatally
• introduction to genomics and family health history, supporting parents to understand how genetic factors may influence health and development, and when to seek further advice
• provision of assurance to the family that the system is alert to their needs, supporting empowerment
• completion of effective liaison and handover between maternity and health visiting
• holistic assessment of health needs in the postnatal period, including maternal, physical, emotional and psychological wellbeing alongside the infant health and family contexts
• re-assessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• exploration of family relationships and dynamics, including pressures and transitions associated with a new baby
• provision of support to build coping strategies and resilience, including connection with community networks
• provision of evidence-based information to support informed decision making about parental and infant health and care, including:
  • the first 1,001 days
  • infant feeding and breastfeeding
  • vitamin D supplementation
  • infant safety (including home safety)
  • coping with crying
  • safer sleep (prevention of sudden unexpected death in infancy (SUDI))
  • co-sleeping risks
• confirmation of registration of the baby with a local GP and signposting to registration services where needed
• promotion of sensitive, responsive and attuned parenting and secure attachment
• assessment and support for maternal postnatal recovery, emotional wellbeing and physical activity
• promotion of smoking cessation with the clear message that smoking should not occur around the baby, and referral to smoking cessation services where appropriate
• provision of support to manage minor ailments (involving use of tools such as the Baby Check app (linked below) to support recognition of signs of illness)
• early identification of parental mental health needs, with timely support and referral to appropriate services, including specialist mental health services, and NHS talking therapies
• assessment of the baby’s growth, health and development, including feeding, jaundice, weight and skin. A hands-on, top-to-toe physical examination may be undertaken, in line with clinical judgement and local protocols. This includes observing the infant’s skin - tone, colour, and general presentation - and checking for any:
  • marks
  • bruising
  • birthmarks (such as Mongolian blue spots)
  • unexplained injuries as part of safeguarding vigilance
• early identification of risks to child or parent wellbeing, including feeding difficulties, safeguarding concerns and parental anxieties
• provision of appropriate support to parents following physical examination so they can make evidence-based, informed decisions
• completion of the PCHR, also known as the ‘red book’
• promotion and discussion of the routine immunisation schedule
• explanation of purpose of any weighing and measurements undertaken
• promotion of age-appropriate play, stimulation, early communication and early reading to support development
• encouragement and support for families to access local groups, play opportunities and wider community resources
• provision of advice on booking postnatal GP appointment and accessing primary care services
• confirmation that the following newborn screening tests have been completed:
  • newborn hearing screening
  • newborn and infant physical examination
  • newborn blood spot test
• collaboration with health and social care professionals as required
• routine enquiry and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with referral to MARAC or other safeguarding processes where required
• completion of risk assessments as per local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of support around transition to parenthood
• discussion of family planning, sexual health and contraceptive choices, supporting informed decisions
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next contact
• confirmation of parental knowledge around how to contact the health visiting team between scheduled reviews

6-to-8-week statutory universal health and development review (6 to 8 weeks old)

This review must be offered to a child aged between 6 and 8 weeks. This review should be delivered as an individual face-to-face contact carried out by the named health visitor, ideally in the family home. It typically forms part of a 2-stage assessment:

• the GP conducts a full physical examination of the infant
• the health visitor provides health promotion, developmental surveillance and tailored support to the family

Best practice for the 6-to-8-week review

This review should be a home visit as these offer the safest and most effective environment for assessment during this critical window. The postnatal period is associated with heightened risks, including:

• maternal mental health deterioration
• domestic abuse
• SUDI

MBRRACE-UK ‘Saving lives, improving mothers’ care 2025’ report findings highlight that maternal deaths often occur in the first weeks and months postnatally, and that early signs of distress or illness may be missed without proactive, holistic assessment. Home-based contact:

• enables fuller observation of the home environment
• supports therapeutic engagement
• ensures the review is accessible to families who may struggle to attend clinic settings

Scheduling of the GP and health visitor reviews should be sensitive to family needs, and ideally not occur on the same day unless clinically indicated. This helps avoid overwhelming families and ensures each professional has sufficient time to engage meaningfully.

In cases where the baby has been discharged from NICU or SCBU or where there are ongoing health concerns, the review should be adapted to reflect the family’s context. Additional time, follow-up visits or multi-agency input may be required to ensure the family feels supported and the review covers all the child’s needs in sufficient detail.  

Health visitors should use this review to actively explore maternal wellbeing, including:

• physical recovery
• emotional health
• social support

Where developmental concerns or wider vulnerabilities are identified, the health visitor should consider additional targeted reviews or contacts to assess and respond to emerging needs, rather than waiting until the 12-month universal health and development review.

Objectives of the the 6-to-8-week health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• explanation of why the first 1,001 days are critical for babies’ brain development
• support for infant feeding and explanation on the benefits of breastfeeding
• facilitation of reflection on transition to parenthood
• maximisation of infant safety, including in relation to safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’
• monitoring of bonding and attachment between parents and the infant
• assessment of growth, health and development of the baby, including feeding, weight and skin

Core components and outcomes of the 6-to-8-week review

This review has several core components and outcomes that health visitors should aim to deliver. These include the following:    

• structured continuity of care, including ongoing assessment and re-assessment of individual family needs
• consideration of use of postnatal promotional guides and motivational interviewing techniques (employing strengths-based approaches)
• discussion of transition to parenthood and early postnatal adjustment
• continuation and strengthening of therapeutic relationships with families to support meaningful engagement
• provision of assurance to the family that services are alert to their needs, supporting empowerment
• holistic assessment of health needs in the postnatal period, including maternal physical, emotional and psychological wellbeing alongside infant health and family contexts
• reassessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• exploration of family relationships and dynamics, including the pressures and transitions associated with caring for a new baby
• verification of parental awareness of expected developmental milestones for their baby
• provision of support to parents in understanding the importance of floor time, and age-appropriate play and stimulation
• early identification of any growth or developmental delay and onward referral, where required
• confirmation of any SEND notifications to the local authority
• promotion of early communication and reading to support listening and language development
• encouragement and support for families to access local groups, play opportunities and community resources
• observation of infant’s skin for marks, bruising, birthmarks (such as Mongolian blue spots) or unexplained injuries as part of safeguarding vigilance
• explanation of the purpose of weighing and measurements undertaken, and discussion of results with parents
• early identification of risks to child or parent wellbeing
• provision of appropriate support to parents following physical examination, enabling informed evidence-based decision making
• review of newborn blood spot test results, where available
• support on implementing coping strategies and resilience, including connection with community networks
• provision of evidence-based information to support informed decision making about parental and infant health and care, including:
  • infant feeding and breastfeeding
  • vitamin D supplementation
  • infant safety (including home safety)
  • coping with crying
  • responsive parenting attuned to the baby’s cues
  • smoking cessation and smoke‑free homes
  • managing minor ailments (for example, through the Baby Check app)
  • family planning and contraception
  • safer sleep (prevention of SUDI)
  • postnatal physical activity
• early identification of parental mental health needs, with timely support and referral to appropriate services, including specialist mental health services, and NHS talking therapies
• completion of PCHR, also known as the ‘red book’
• promotion and discussion of the routine immunisation schedule
• collaboration with health, social care and other professionals as required
• routine enquiry and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with escalation to MARAC or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next contact
• confirmation of parental understanding of how to contact the health visiting team between scheduled reviews

3-month targeted health and development review (around 3 months old)

This is a recommended face-to-face review for families receiving a targeted or specialist level of support, which is usually delivered in the home. It is not part of the statutory universal offer but can be a valuable opportunity to:

• provide early intervention
• reinforce crucial public health messages
• monitor emerging concerns

Best practice for the 3-month targeted review

The named health visitor should assess whether they or another appropriate member of the ages 0 to 19 skill mix team is best placed to deliver this review, based on the:

• family’s needs
• complexity of the case
• local governance arrangements

Delegation should be clinically appropriate and supported by supervision and oversight. The qualified SCPHN:

• remains accountable for all delegated practice
• must ensure that delegates’ competence is sufficiently high to deliver a standard of service that meets the family’s needs

Objectives of the 3-month health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• assessment of infant’s growth, health and developmental progress
• communication of evidence-based information on feeding, weaning and oral health
• maximisation of infant safety, including in relation to safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’
• monitoring of bonding and attachment between parents and the infant
• assessment of growth, health and development of the baby, including feeding, weight and skin
• internal service protocols

Core components and outcomes of the 3-month targeted review

This review has several core components and outcomes that health visitors and their teams should aim to deliver. These include the following:

• structured continuity of care, including ongoing assessment and re-assessment of individual family needs
• provision of early intervention and targeted support for families that is tailored to their identified needs
• support on parental adjustment to changing routines and developmental transitions at 3 months old
• continuation and strengthening of therapeutic relationships with families to support meaningful engagement
• provision of assurance to the family that services are alert to their needs, supporting empowerment
• holistic assessment of health needs in the postnatal period, including maternal physical, emotional and psychological wellbeing alongside infant health and family contexts
• review of how parents are coping with changes in infant sleep, feeding patterns and emotional demands
• support on managing expectations and building resilience during early parenting
• discussion around infant behaviour, regulation and emotional development
• provision of support for parents in understanding normal crying patterns, and using coping strategies and soothing techniques
• sharing of resources relevant to crying, managing stress and sleep
• early identification of any growth or developmental delay, with considered use of validated screening tools (such as ASQ) to support developmental surveillance, and onward referral where required
• re-assessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• exploration of family relationships and dynamics, including pressures and transitions associated with caring for a new baby
• verification of parental awareness of expected developmental milestones for their baby
• provision of support to parents in understanding the importance of floor time, age-appropriate play, stimulation and early communication
• confirmation of any SEND notifications to the local authority
• promotion of early communication and reading to support listening and language development
• encouragement and support for families to access local groups, play opportunities and early learning activities
• observation of infant interaction and motor development milestones
• observation of infant’s skin for marks, bruising, birthmarks (such as Mongolian blue spots) or unexplained injuries as part of safeguarding vigilance
• explanation of the purpose of weighing and measurements undertaken, and discussion of results with parents
• early identification of risks to child or parent wellbeing
• provision of appropriate support to parents following physical examination, enabling informed, evidence-based decision making
• support on building coping strategies and resilience, including connection with community networks
• provision of evidence-based information to support informed decision making about parental and infant health and care, including:
  • infant feeding and weaning
  • vitamin D supplementation
  • infant safety (including home safety)
  • oral health and teething
  • responsive parenting attuned to the baby’s cues
  • smoking cessation and smoke‑free homes
  • managing minor ailments
  • family planning and contraception
  • safer sleep (prevention of SUDI)
  • physical activity and postnatal exercise
  • use of tools such as the Baby Check app
• exploration of parental access to peer support, parenting groups and community resources
• early identification of parental mental health needs, with timely support and referral to appropriate services, including specialist mental health services and NHS talking therapies
• completion of PCHR, also known as the ‘red book’
• promotion and discussion of the routine immunisation schedule
• collaboration with health, social care and other professionals as required
• routine enquiries and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with escalation to MARAC or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next contact
• confirmation with parents of when the next universal 12-month health and development review will occur
• confirmation of parental understanding of how to contact the health visiting team between scheduled reviews

6-month targeted health and development review (around 6 months old)

This is a recommended face-to-face review for families receiving a targeted or specialist level of support. It is not part of the statutory universal offer, but represents a valuable opportunity to:

• monitor health and development
• reinforce public health messaging
• respond to emerging needs in a timely and proactive way

Best practice for the 6-month targeted review

The named health visitor should determine whether they or another appropriate member of the skill mix public health nursing service team for those aged 0 to 5 is best placed to deliver this review, based on the:

• family’s circumstances
• complexity of need
• local governance arrangements

Any delegation should be clinically appropriate, supported by supervision and oversight, and compliant with local policy. The qualified SCPHN:

• remains accountable for all delegated practice
• is responsible for ensuring that any delegated activity is aligned with the practitioner’s level of competence, training and role

Objectives of the 6-month targeted health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• assessment of infant’s growth, health and developmental progress
• communication of, evidence-based public health information (particularly around feeding, weaning and oral health)
• maximisation of infant safety, including in relation to safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’
• monitoring of bonding and attachment between parents and the infant
• assessment of growth, health and development of the baby, including feeding, weight and skin

Core components and outcomes of the 6-month targeted review

This review has several core components and outcomes that health visitors and their teams should aim to deliver. These include the following:

• structured continuity of care, including ongoing assessment and reassessment of individual family needs
• provision of early intervention and targeted support for families that is tailored to their identified needs
• support on parental adjustment to changing routines and developmental transitions at around 6 months old
• continuation and strengthening of therapeutic relationships with families to support meaningful engagement
• provision of assurance to families that services are alert to their needs, supporting empowerment
• holistic assessment of health needs in the postnatal period, including maternal physical, emotional and psychological wellbeing alongside infant health and family contexts
• review of how parents are coping with changes in infant sleep, feeding patterns and emotional demands
• support on managing expectations and building resilience during early parenting
• discussion around infant behaviour, regulation and emotional development
• provision of support for parents on understanding crying, and using coping strategies and soothing techniques
• sharing of resources relevant to crying, managing stress and sleep
• early identification of any growth or developmental delay, with considered use of validated screening tools (such as ASQ) to support developmental surveillance, and onward referral where required
• re-assessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• exploration of family relationships and dynamics, including pressures and transitions associated with caring for a new baby
• verification of parental awareness around expected developmental milestones
• provision of support to parents in understanding the importance of floor time, age-appropriate play, stimulation and early communication
• confirmation of any SEND notifications to the local authority
• promotion of early communication and reading to support listening and language development
• encouragement of and support for families to access local groups, play opportunities and early learning activities
• observation of infant interaction and motor development milestones
• observation of infant’s skin for marks, bruising, birthmarks or unexplained injuries as part of safeguarding vigilance
• explanation of the purpose of weighing and measurements undertaken, and discussion of results with parents
• early identification of risks to child or parent wellbeing
• provision of appropriate support to parents following physical examination, enabling informed evidence-based decision making
• support on building coping strategies and resilience, including connection with community networks
• support on informed decision making about parental and infant health and care, including:
  • infant feeding and introduction of solid foods
  • vitamin D supplementation
  • infant safety (including home safety)
  • oral health and teething
  • responsive parenting attuned to the baby’s cues
  • smoking cessation and smoke‑free homes
  • managing minor ailments (for example, through the Baby Check app)
  • family planning and contraception
  • safer sleep (prevention of SUDI)
  • postnatal physical activity
• discussion of emerging sleeping routines
• discussion of balanced diets, introduction of solid foods and toothbrushing twice daily, with support until the age of 7
• encouragement of visits to dentist
• exploration of parental access to peer support, parenting groups and community resources
• early identification of parental mental health needs, with timely support and referral to appropriate services, including specialist mental health services and NHS talking therapies
• completion of PCHR, also known as the ‘red book’
• check of infant’s vaccination history with a non-judgemental, explorative and evidence-based discussion where vaccination has been delayed or declined. Consideration of behaviour change technique application as endorsed by the ‘MECC: consensus statement’
• collaboration with health, social care and other professionals as required
• routine enquiry and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with escalation to MARAC or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of basic financial advice and signposting to financial support services where families are facing hardship
• where targeted or specialist levels of support is required, agreement of the timing of the next contact
• confirmation with parents of when the next universal 12-month health and development review will occur
• confirmation of parental understanding of how to contact the health visiting team between scheduled reviews

12-month statutory universal health and development review (9 to 15 months old)

This review, known as the ‘12-month review’ throughout this guidance, is one of the 5 statutory universal reviews, and must be offered to all children aged between 9 and 15 months.

It is expected to be delivered as an individual face-to-face contact by the named health visitor, usually between 9 and 15 months of age. The review provides a critical opportunity to:

• assess the child’s health and development
• review family wellbeing
• determine the appropriate level of ongoing support

Best practice for the 12-month review

The location of the 12-month review should be discussed and agreed collaboratively with the family, taking into account their individual circumstances, preferences and practical considerations. While home visits can offer additional benefits, such as supporting accessibility and enabling contextual assessment, reviews may also be delivered in alternative settings where this is considered appropriate and helpful for the child and family, including:

• clinics
• neighbourhood health centres
• Best Start Family Hubs

The service should be designed to fit around families’ needs, ensuring that delivery is flexible, inclusive and responsive.

Developmental tools may be used at this stage to support developmental surveillance, particularly where there are concerns about the child’s progress. These tools should be embedded within a broader professional assessment and not used in isolation to determine outcomes.

Where developmental concerns are identified, the health visitor should ensure that a clear, personalised plan is in place for targeted intervention. This may include:

• follow-up contacts
• delegated support from the wider ages 0 to 19 public health nursing team
• co-ordination with other services to address emerging needs and promote positive developmental outcomes

Objectives of the 12-month health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• assessment of child’s growth, health and developmental progress
• maximisation of child safety, including in relation to safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’
• monitoring of bonding and attachment between parents and the child
• assessment of growth, health and development of the child, including feeding, weight and skin

Core components and outcomes of the 12-month review

This review has several core components and outcomes that health visitors should aim to deliver. These include the following:

• structured continuity of care, including ongoing assessment and re-assessment of individual family needs
• continuation and strengthening of therapeutic relationships with families to support meaningful engagement
• provision of assurance to families that services are alert to their needs, supporting empowerment
• exploration of family relationships and dynamics, including pressures and transitions associated with caring for a mobile child
• holistic assessment of health needs in the postnatal period, including maternal physical, emotional and psychological wellbeing alongside child health and family contexts
• review of how parents are coping with changes in sleeping patterns, emotional demands and increased mobility
• discussion of infant behaviour, regulation and emerging independence
• sharing of resources relevant to managing stress, sleep and boundary setting
• early identification of any growth or developmental delay, with considered use of validated screening tools (such as ASQ) to support developmental surveillance, and onward referral where required
• re-assessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• verification of parental awareness of expected developmental milestones
• support for parents on understanding the importance of floor time, age-appropriate play, stimulation, and early communication and learning
• confirmation of any SEND notifications to the local authority
• promotion of early communication and reading to support listening and language development
• encouragement and support for families to access local groups, play opportunities and early learning activities
• observation of infant interactions, mobility and motor development milestones
• observation of infant’s skin for marks, bruising, birthmarks or unexplained injuries as part of safeguarding vigilance
• explanation of the purpose of weighing and measurements undertaken, and discussion of results with parents
• early identification of risks to child or parental wellbeing
• support around child’s increased mobility and separation anxiety, including parental guidance on reassurance
• provision of appropriate support to parents following physical examination, enabling informed, evidence-based decision making
• support on implementing coping strategies and resilience, including connection with community networks
• provision of evidence-based information to support informed decision making about parental and child health and care, including:
  • nutrition and feeding
  • vitamin D supplementation
  • child safety (including home safety)
  • oral health and teething
  • responsive parenting attuned to the child’s developing needs
  • smoking cessation and smoke‑free homes
  • managing minor ailments
  • family planning and contraception
  • safer sleep
  • physical activity and postnatal exercise
• discussion of balanced diets, portion sizes, limiting sugar intake and toothbrushing twice daily with support until the age of 7
• discussion of limiting screen time and establishing healthy routines
• discussion of emerging sleep routines, boundary setting and implementing consistent strategies
• encouragement of visits to dentist
• exploration of parental access to peer support, parenting groups and community resources
• early identification of parental mental health needs with timely support and referrals to appropriate services, including specialist mental health services and NHS talking therapies
• completion of PCHR, also known as the ‘red book’
• check of child’s vaccination history with a non-judgemental, explorative and evidence-based discussion where vaccination has been delayed or declined. Consideration of behaviour change technique application as endorsed by the ‘MECC: consensus statement’
• collaboration with health, social care and other professionals as required
• routine enquiry and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with escalation to MARAC or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next contact
• confirmation with parents of when the next universal 2-to-2-and-a-half-year health and development review will occur
• confirmation of parental understanding of how to contact the health visiting service between scheduled reviews

2-to-2-and-a-half-year statutory universal health and development review (24 to 30 months old)

This review is one of the 5 statutory universal reviews that should be offered to all families. It is typically expected to be delivered as an individual face-to-face contact by the named health visitor, usually between 24 and 30 months of age.

The review provides a major opportunity to:

• assess the child’s health and development
• identify emerging needs
• support school readiness through timely intervention and partnership with families

Best practice for the 2-to-2-and-a-half-year review

The location of the 2-to-2-and-a-half-year review should be discussed and agreed collaboratively with the family, taking into account their individual circumstances, preferences and practical considerations. While home visits can offer additional benefits, such as enabling fuller observation and supporting accessibility, reviews may also be delivered in alternative settings where this is considered appropriate and helpful for the child and family, including:

• clinics
• early years settings
• Best Start Family Hubs

The service should be designed to fit around families’ needs, ensuring delivery is flexible, inclusive and responsive.

Developmental tools, such as the ASQ and ASQ:SE, may be used at this stage to support both individual developmental surveillance and population-level screening. Health visitors should explain to parents:

• the purpose of using these tools
• how the information will be used to support their child’s development

These tools should be embedded within a broader professional assessment and not used in isolation to determine outcomes.

Where a child has an identified disability or special educational need, practitioners should work collaboratively with parents and, where appropriate, other professionals to ensure the process and discussion of outcomes are sensitive and tailored to the child’s individual needs.

Completion of a screening tool alone - whether by post, online or without direct observation - does not constitute an acceptable review.

Where the child attends an early years setting, collaborative working between health visitors, early years practitioners and parents should be considered to support a holistic understanding of the child’s development.

While joint reviews may be appropriate in some cases, they are not always practical or necessary. However, where developmental concerns are identified, early years practitioners and health professionals should seek informed parental consent to share relevant information and work together to develop a co-ordinated support plan.

Where developmental concerns are identified, the health visitor should ensure that a clear, personalised plan is in place for targeted intervention. This may include:

• follow-up reviews or contacts
• delegated support from the wider public health nursing team
• co-ordination with early years and specialist services to address emerging needs and promote positive developmental outcomes

If the child is attending an early years setting, this should include a conversation with the setting to ensure a joined-up approach to supporting the child’s development and readiness for school.

Objectives of the 2-to-2-and-a-half-year health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• assessment of the child’s growth, health and developmental progress, including nutrition, weight and skin
• maximisation of child safety, including in relation to safe sleeping and home safety
• monitoring of parental physical and emotional health and wellbeing using NICE’s recommended identification questions from the ‘Interactive antenatal and postnatal mental health checklist’
• monitoring of bonding and attachment between parents and the child

Core components and outcomes of the 2-to-2-and-a-half-year review

This review has several core components and outcomes that health visitors should aim to deliver. These include the following:

• structured continuity of care, including ongoing assessment and re-assessment of individual family needs
• continuation and strengthening of therapeutic relationships with families to support meaningful engagement
• provision of assurance to families that services are alert to their needs, supporting empowerment
• exploration of family relationships and dynamics, including pressures and transitions associated with caring for a more independent child
• holistic assessment of health needs, including maternal physical, emotional and psychological wellbeing alongside child health and family contexts
• review of how parents are coping with changes in sleeping patterns, emotional demands and increased mobility
• sharing of resources relevant to managing stress, sleep and boundary setting
• early identification of any growth or developmental delay, with considered use of validated screening tools (such as ASQ) to support developmental surveillance, and onward referral where required
• re-assessment and early identification of need, including determining universal, targeted or specialist levels of support and making appropriate referrals
• where the child attends an early years setting, liaison with practitioners in line with local information‑sharing protocols and data protection legislation to support a joined‑up approach to development and school readiness
• verification of parental awareness of expected developmental milestones
• support for parents on understanding the importance of age‑appropriate play, stimulation and early communication
• confirmation of any SEND notifications to the local authority
• promotion of early communication and reading to support listening and language development
• encouragement and support for families to access local groups, play opportunities and early learning activities
• observation of the child’s interaction, mobility and motor development milestones
• observation of the child’s skin for marks, bruising, birthmarks or unexplained injuries as part of safeguarding vigilance
• explanation of the purpose of weighing and measurements undertaken, and discussion of results with parents
• early identification of risks to child or parental wellbeing
• provision of support around the child’s increased mobility, separation anxiety and growing independence
• provision of appropriate support to parents following physical examination, enabling informed, evidence‑based decision making
• support on building coping strategies and resilience, including connection with community networks
• provision of evidence‑based information to parents so they can make informed decisions about their health and baby care. Topics include:
  • nutrition
  • vitamin D supplementation
  • child safety (including home safety)
  • oral health and teething
  • responsive parenting attuned to the child’s developing needs
  • smoking cessation and smoke‑free homes
  • managing minor ailments (for example, through the Baby Check app)
  • family planning and contraception
  • safer sleep
  • physical activity and postnatal exercise
• discussion of balanced diets, portion sizes, limiting sugar intake and toothbrushing twice daily, with support until the age of 7
• discussion of limiting screen time and establishing healthy routines
• discussion of emerging sleep routines, boundaries and positive behaviour strategies
• encouragement of visits to a dentist
• discussion of nursery access and eligibility for funded early education places
• promotion of growing child independence in areas such as dressing, feeding and toileting, including provision of support around potty training
• exploration of parental access to peer support, parenting groups and community resources
• early identification of parental mental health needs with timely support and referral to appropriate services, including specialist mental health services and NHS talking therapies
• completion of PCHR, also known as the ‘red book’
• check of child’s vaccination history with a non-judgemental, explorative and evidence-based discussion where vaccination has been delayed or declined. Consideration of behaviour change technique application as endorsed by the ‘MECC: consensus statement’
• collaboration with health, social care and other professionals as required
• routine enquiry and consideration of safeguarding concerns (including domestic abuse, coercive control, unsafe relationships and environmental risks), with escalation to MARAC or other safeguarding mechanisms where required
• completion of risk assessments in line with local procedures
• identification of any additional needs requiring early intervention or joint working
• promotion of positive parental mental health and the role of parental bonding in its maintenance
• provision of basic financial advice and signposting to financial support services where families are experiencing hardship
• where targeted or specialist support is required, agreement of the timing of the next contact
• confirmation to families receiving a universal level of service that they continue to access care from the health visiting service until school entry
• confirmation of parental understanding of how to contact the health visiting service between scheduled appointments

3-and-a-half-year targeted health and development review (around 3 and a half years old)

This review should be delivered as an individual face-to-face review by the most appropriate member of the ages 0 to 19 skill mix team, as determined by the named health visitor. It is not part of the statutory universal offer.

It is an additional review that may be offered to:

• families receiving targeted or specialist support
• children identified with developmental delay or emerging concerns during the 2-to-2-and-a-half-year statutory health and development review

The review provides an opportunity to:

• monitor progress
• re-assess family needs
• ensure appropriate support is in place ahead of school entry

Best practice for the 3-and-a-half-year targeted review

The location of the 3-and-a-half-year review should be discussed and agreed collaboratively with the family, taking into account their individual circumstances, preferences and practical considerations.

While home visits can offer additional benefits, such as enabling fuller observation and therapeutic engagement, reviews may also be delivered in alternative settings where this is considered appropriate and helpful for the child and family, including:

• clinics
• early years settings
• Best Start Family Hubs

The service should be designed to fit around families’ needs, ensuring delivery is flexible, inclusive and responsive.

Where the child attends an early years setting, collaborative working between health visitors, early years practitioners and parents should be considered to support a holistic understanding of the child’s development.

While joint reviews may be appropriate in some cases, they are not always practical or necessary. However, where developmental concerns are identified, early years practitioners and health professionals should seek informed parental consent to share relevant information and work together to develop a co-ordinated support plan.

Targeted work should be planned, where needed, to support school readiness and ensure a smooth transition to school nursing services.

Objectives of the 3-and-a-half-year health and development review

In addition to the common purposes listed above for all reviews, the objectives of this health and development review include:

• consideration of the same topics as in the 2-to-2-and-a-half-year review
• re-assessment of growth and development in children with identified delays or concerns at the 2-to-2-and-a-half-year review
• identification of any emerging needs that may have developed since the last review
• assessment of child’s growth, health and developmental progress

Core components and outcomes of the 3-and-a-half-year targeted review

This review has several core components and outcomes that health visitors and their teams should aim to deliver. These include the following:

• reinforcement of major areas of development, health and wellbeing previously explored.
• continuity of care and therapeutic engagement with the child and family
• exploration of school readiness, including toileting, dressing, following instructions, social interaction and attention span
• encouragement and support for access to local groups, play opportunities and wider support networks
• confirmation of SEND notifications to the local authority
• review of previous interventions and prompting of referral for further assessment and support where needed
• empowerment of parents with evidence-based information to support informed decision making about their child’s health and care
• reinforcement of messages around diet, oral health, physical activity, sleep, behaviour, safety and immunisations, building on discussions held during the 2-to-2-and-a-half-year review
• discussion of the school nursing service and the child’s transition to it upon school entry, and provision of information and guidance to support families in preparing for this transition
• routine enquiry and consideration of safeguarding concerns, including domestic abuse and environmental risks, with escalation where required
• early identification of parental mental health needs, with timely support and referral where appropriate
• completion and updating of the PCHR, also known as the ‘red book’
• collaboration with early years, education, health and social care professionals as required
• agreement of ongoing support or further review where targeted or specialist input is needed

To note: families with targeted or specialist needs may continue to receive input from the health visiting team beyond this review, depending on individual circumstances.

Resources to draw upon during health and development reviews

Table 2: core guidance and frameworks

Resource	Relevant to the following reviews
MECC: consensus statement	All reviews
NICE clinical guideline [CG192] Antenatal and postnatal mental health: clinical management and service guidance	All reviews
NICE’s Interactive antenatal and postnatal mental health checklist on recognising depression and anxiety disorders (see the interactive PDF linked on page)	All reviews
The CSA Centre’s Signs and indicators of child sexual abuse	All reviews
NICE guideline [NG201] Antenatal care	Antenatal review
Antenatal promotional guides from the Centre for Parent and Child Support	Antenatal review
NICE clinical guideline [CG110] Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors	Antenatal, new birth and 6-to-8-week reviews
NICE guideline [NG194] Postnatal care	New birth and 6-to-8-week reviews

Table 3: developmental, assessment and screening tools 

Tool	Relevant to the following reviews
ASQ and ASQ:SE	12-month and 2-to-2-and-a-half-year reviews. Targeted reviews when indicated
WellComm	12-month and 2-to-2-and-a-half-year reviews. Targeted reviews when indicated
ELIM	2-to-2-and-a-half-year review

Table 4: standard child health surveillance assessment or recording proformas 

Assessment	Relevant to the following reviews
SEND notification processes (local protocols)	All reviews
Royal College of Paediatrics and Child Health (RCPCH) UK-WHO growth charts	All reviews except antenatal
Newborn Behavioural Observations (NBO) system (where available)	New birth and 6-to-8-week reviews

Table 5: parent-infant relationship, emotional wellbeing and mental health 

Resource	Relevant to the following reviews
NHS Better Health: every mind matters	All reviews
Department of Health and Social Care Parent-infant relationships: starting conversations (practitioner guide)	All reviews
Anxiety and depression screening tools in pregnancy (see NICE clinical guideline [CG192] referenced in table 2 above)	All reviews

Table 6: infant health, safety and development 

Resource	Relevant to the following reviews
ICON: babies cry, you can cope advice for parents on coping with crying	Antenatal, new birth and 6-to-8-week reviews. 3-month and 6-month targeted reviews
Lullaby Trust’s Baby Check app	New birth and 6-to-8-week reviews. 3-month and 6-month targeted reviews

Table 7: immunisations

Resource	Relevant to the following reviews
UK Health Security Agency Routine childhood immunisation schedule	All reviews
NHS vaccinations and when to have them	All reviews

Table 8: local information on safety, home environment and health promotion (as per local SOPs) 

Resource	Relevant to the following reviews
Local services and community support - such as Best Start Family Hubs, libraries, parenting groups and community groups	All reviews
Local risk assessment protocols	All reviews
Internal service protocols	All reviews
Best Start in Life government guidance	All reviews

Immunisations and screening

Schedule during pregnancy

Table 9: core screening and immunisation schedule, England (during pregnancy)

Stage of pregnancy	Screening	Immunisation	Professional
From 10 weeks	Antenatal screening programmes	Pertussis and influenza vaccination	Midwife or GP surgery
More than 28 weeks	Antenatal health and development review	None	Health visitor

Schedule for babies from birth to 2 years old

Table 10: core screening and immunisation schedule, England (from birth to age 2)

Age	Screening	Immunisation	Professional
72 hours old	Newborn infant physical examination	None	Paediatrician
5 (up to 8) days old	Newborn blood spot test	None	Midwife
1 day to 2 weeks old	New birth health and development review	None	Health visitor
10 to 14 (up to 28) days old	Discharge from midwife care	None	Midwife
By 4 weeks old	Newborn hearing screening	None	Audiologist
6 to 8 weeks old	6-to-8-week health and development review	None	Health visitor
By 8 weeks old	Infant physical examination	First primary immunisation: first dose of diphtheria, tetanus and acellular pertussis/inactivated poliovirus vaccine/haemophilus influenzae type B/hepatitis B (DTaP/IPV/Hib/HepB), meningococcal B (MenB) and rotavirus	GP or GP surgery practice nurse
12 weeks old	None	Second primary immunisation: second dose of DTaP/IPV/Hib/HepB, MenB and rotavirus	GP surgery practice nurse
16 weeks old	None	Third primary immunisation: third dose of DTaP/IPV/Hib/HepB and first dose of pneumococcal conjugate vaccine (PCV)	GP surgery practice nurse
9 to 15 months old	12-month health and development review	None	Health visitor
12 months old	12-month immunisations	Second dose of PCV, first dose of measles, mumps and rubella (MMR) vaccine, and third dose of MenB	GP surgery practice nurse
18 months old (new from January 2026)	None	Fourth dose of DTaP/IPV/Hib/HepB, second dose of MMR and first dose varicella vaccine (combined with MMR)	GP surgery practice nurse

Schedule for children from 2 to 5 years old

Table 11: core screening and immunisation schedule, England (ages 2 to 5)

Age	Screening	Immunisation	Professional
2 to 2-and-a-half years old	2-to-2-and-a-half-year review	None	Health visitor
2 to 3 years old	None	Influenza vaccine	GP surgery practice nurse
By 3 years and 4 months old	None	Preschool immunisation: DTaP/IPV	GP surgery practice nurse

For the most up-to-date information on current vaccination schedules, see ‘NHS vaccinations and when to have them’ (linked in Table 7 above) and the NHS webpage on the Children’s flu vaccine.

Growth monitoring and physical measurements

Monitoring a child’s growth is a core component of health visiting practice. It:

• supports early identification of concerns
• helps families understand their child’s health and development

Growth monitoring includes weight, length or height and head circumference, and should be carried out in line with NICE guideline [NG75] Faltering growth: recognition and management of faltering growth in children, RCPCH’s UK-WHO growth charts and local protocols.

Practitioners should be trained and competent in:

• taking accurate measurements using properly calibrated and maintained equipment
• plotting results on the correct UK-WHO growth charts
• engaging families in a respectful, trauma-informed way

The purpose of monitoring should be clearly explained, and any questions or concerns addressed sensitively.

Measurement standards include the following:

• babies should be weighed naked (with no nappy) up to the age of 2
• children over 2 years old may be weighed in a vest and underwear
• head circumference should be measured at:
  • birth
  • the 6-to-8-week health and development review
  • any point where concerns arise
• length (under 2 years old) or height (over 2 years old) should be measured:
  • at birth
  • when clinically indicated or whenever there are concerns about growth, weight gain or general health

Routine weight monitoring typically occurs at:

• birth
• the first week
• 8, 12 and 16 weeks in line with immunisation schedules
• the 12-month and 2-to-2-and-a-half-year health and development reviews, which must be offered

If a baby loses more than 10% of their birth weight in the early days, weight should be monitored more frequently using a clinically informed approach. Families should be reassured that they can seek advice without needing their baby weighed unnecessarily.

Recommended weighing frequency:

• no more than once a month from 2 weeks to 6 months old
• once every 2 months from 6 to 12 months old
• once every 3 months over the age of 1

Most children do not need to be weighed this often. Over-monitoring can be misleading and may cause unnecessary anxiety. Clinical judgment should guide any deviation from routine schedules.

Additional measuring considerations

All infants should be monitored by health professionals, such as health visitors or other members of the public health nursing team, using the UK-WHO growth charts, which are based on the growth patterns of healthy, breastfed babies.

Ethnic background considerations

While UK-WHO growth charts provide a standard reference for monitoring child growth, practitioners should be aware that these charts do not adjust for ethnic background. Children from some ethnic groups may have different growth patterns that are healthy and normal for their background (see reference 4 in Annex B). Growth concerns should always be interpreted in the context of the child’s:

• ethnicity
• family history
• feeding
• development
• clinical history

Where there is uncertainty, practitioners should seek specialist advice and avoid making decisions based solely on centile positions. This approach helps prevent misinterpretation and ensures culturally competent care.

Responding to growth concerns

Any concerns about growth should prompt further assessment. Practitioners should follow local SOPs and NICE guideline ‘[NG75] Faltering growth’ to ensure:

• timely identification
• appropriate intervention
• referral, where needed

Growth concerns should never be interpreted in isolation. They should be considered alongside feeding, development, family context and clinical history.

For babies born before 37 weeks gestation, growth should be plotted using corrected age until at least 12 months old (or longer if clinically indicated). Low birth weight charts are available for infants aged under 32 weeks or those requiring detailed neonatal assessment.

Working sensitively with families

Unexplained weight loss, rapid weight gain or inconsistent measurements may indicate wider concerns. Practitioners should be alert to safeguarding risks and escalate appropriately.

Cultural norms and parental expectations around infant feeding, body size and growth should be respected. Conversations should be non-judgmental and tailored to individual families.

Families should:

• be informed of the purpose of growth monitoring
• feel empowered to ask questions

Consent is assumed as part of routine care, but practitioners should ensure families are informed and respected throughout.

Digital tools and training

Accurate and timely data entry into clinical systems is essential for continuity of care and population-level analysis. Practitioners should be supported with reliable digital tools and training.

Relevant legislative requirements

Note: the only legislative requirement for the weighing and measuring of children applies to school-aged pupils, as set out in paragraph 7A (1) and (2) of schedule 1 to the National Health Service Act 2006 and regulation 3 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.

Transfer to the school nursing service

As part of the transition process from health visiting to the school nursing service, children should be transferred the term before their fifth birthday. This timing supports preparation for school entry, but professional judgement should guide exceptions, particularly for children who have already started school or have specific needs. Continued health visitor involvement may be appropriate:

• in cases of ongoing child protection processes
• where there are complex safeguarding concerns
• where additional support is required

Health visitors are responsible for reviewing and updating each child’s records to ensure all relevant information is accurate, current and complete. For families receiving universal services, records should be transferred electronically in accordance with the local SOP, using recognised digital systems to support continuity and reduce duplication.

Where children are receiving targeted or specialist support, the handover should include both electronic transfer and a verbal discussion between professionals. This conversation should cover the child’s:

• current needs
• ongoing interventions
• identified risks or concerns

Health visitors should use professional judgement to determine whether additional support or reviews are needed prior to transfer, particularly where vulnerabilities are present. The transition point should not delay necessary intervention or re-assessment.

Where a child starts school before transfer has occurred, or transfer takes place after school entry, practitioners should ensure that communication between services remains timely and responsive to the child’s needs.