Guidance

Part 3: school nursing (ages 5 to 19)

Published 6 February 2026

Applies to England

The importance of school nursing

School nursing teams are among the first health professionals that children and young people engage with independently. These services play a critical role in:

• promoting physical, mental and emotional wellbeing
• supporting early identification of health needs
• helping children navigate major transitions, whether they’re starting school, progressing to secondary school or advancing into adulthood

School nursing teams also support school attendance, recognising that poor attendance can be both a symptom and a driver of wider health and wellbeing concerns. By working with families, schools and other professionals, school nurses help address barriers to attendance and ensure children are supported to stay engaged in education.

As visible, accessible professionals within schools and communities, school nurses provide timely advice, safeguarding support and health promotion across a wide range of public health areas, such as:

• physical activity
• nutrition
• emotional wellbeing
• healthy relationships
• sexual health
• bullying
• mental health
• substance misuse
• lifestyle behaviours

They help children, young people and their families to understand and navigate the wider support system when facing school-related challenges, including attendance, emotional wellbeing and unmet health needs. This work is essential to:

• improving outcomes
• reducing inequalities
• delivering long-term value for public investment

School nursing teams liaise closely with education staff, social care, mental health services, youth services and voluntary sector organisations. This multi-agency collaboration ensures that children and families receive co-ordinated, holistic care that reflects their individual needs and circumstances.

School nursing services are evolving in line with NHS England’s work to standardise community health services for children and young people. While special school nursing (SSN) is a distinct clinical service, specialist community public health nurses (SCPHNs) work collaboratively with SSN teams and other professionals in schools to ensure children with complex health needs receive co-ordinated support across education settings.

Core components for effective delivery

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 children and families.

Leadership and workforce

Qualified SCPHNs lead delivery supported by a suitably qualified team.

Regular reflective supervision supports quality, consistency and safe delegation. Reviews and assessments should be delivered by Nursing and Midwifery Council-registered practitioners, or those working under appropriate supervision and delegation.

Integration of research and structured preceptorship supports:

• professional development
• evidence-based practice
• workforce sustainability

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 with education, general practice, mental health, social care, special educational needs and disabilities (SEND) services, neighbourhood teams, the voluntary and academic sectors, and other health agencies as required.

This includes:

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

Core offer and tailored support

A minimum of 4 core health needs assessments are expected as part of the healthy child programme, led by a school nurse. These assessments:

• evaluate child health and wellbeing
• ensure appropriate support is - or will be - offered

The service should enable access and engagement for all children and young people, especially those facing barriers. Named school nurses build therapeutic relationships using person-centred and trauma-informed approaches.

Public health and health promotion

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

• mental health engagement
• smoking cessation
• physical exercise

Family and community focus

Services should:

• build personal resilience
• link children, young people and families to local resources
• provide connection between education, health services and the home
• support long-term engagement in education

Safeguarding and early intervention

Practitioners should routinely assess for:

• domestic abuse
• neglect
• sexual abuse
• extra-familial harms, including exploitation, radicalisation and peer-on-peer abuse

Early identification, engagement with children and young people, and proportionate intervention supports safeguarding outcomes for children, young people and families.

Location and accessibility

School nursing services support children and young people across a range of settings, with schools acting as a pivotal access point. These services are primarily delivered in:

• maintained schools in a local authority’s area (including community, foundation and voluntary schools, but not community or foundation special schools)
• academies in a local authority’s area (as defined in section 1A of the Academies Act 2010)
• city technology colleges and city colleges for the technology of the arts in a local authority’s area

Independent schools and family homes where children are home schooled are not typically covered by school nursing services for those aged 5 to 19.

In accordance with schedule 1 to the National Health Service Act 2006, and by agreement with that school or educational establishment’s proprietor, local authorities may choose to extend certain aspects of school nursing services to:

• any educational establishment in the local authority’s area for the medical inspection of pupil
• any school in the local authority’s area for the weighing and measuring of children

Nursing provision in special schools is commissioned separately by NHS England.

For children who attend school in a different local authority area from where they live, schools should ensure there are clear arrangements in place to liaise with relevant health services, such as the child’s GP, to support continuity of care.

School nurses are not confined to school buildings. They also work from Best Start Family Hubs, neighbourhood clinics, family homes, youth hubs and other community venues. Offering services flexibly helps:

• minimise disruption to education
• increases accessibility
• supports engagement with children, young people and families

School nursing services are a vital part of the multidisciplinary support system that helps children and young people navigate the physical, emotional and social changes of their school years.

Their work complements wider initiatives, such as the whole-school approach to mental health and the work of mental health support teams (MHSTs), which help to:

• embed health and wellbeing across the education system
• ensure children receive timely, co-ordinated support

Partnership with schools

School nurses are crucial partners in creating healthy, safe and supportive school environments. Their close collaboration with education staff is essential to achieving the best outcomes for children and young people. Through strong, visible partnerships with schools, school nurses help ensure that health needs are:

• identified early
• responded to effectively
• managed with dignity and care

Shared commitments should include:

• ensuring every school has an actively engaged, named school nursing team member who is integrated into pastoral and safeguarding structures
• promoting regular, open communication to express concerns, co-ordinate care and support families
• facilitating access to children and young people during the school day for essential health interventions, assessments and wellbeing support
• sharing relevant information appropriately and lawfully to build a full picture of a child’s needs and ensure joined-up support

Schools should also provide appropriate, private accommodation for confidential health assessments and sensitive conversations. Embedding school nursing services within the school community:

• builds trust
• encourages engagement
• ensures children and young people know where to turn for support

Children and young people’s physical and mental health 

School nurses have a vital role in promoting health and wellbeing across school communities. They support whole-school approaches to healthy nutrition, physical activity, and emotional wellbeing (to name a few examples), while also working with individual children and young people facing physical or mental health challenges.

Promoting healthy choices

Using their expertise in behaviour change and public health, school nurses provide advice and support to help children and young people make healthy choices as part of the universal offer, while delivering targeted interventions for those engaging in addictive behaviours or experiencing emerging health concerns.

This work is undertaken in collaboration with school staff, families and multidisciplinary teams. It recognises that children and young people may have limited agency to adopt changes affecting some aspects of health, for example:

• family diet
• access to physical activity
• home routines

School nurses help navigate these barriers through sensitive, practical support that is tailored to each child’s context.

Helping young people navigate adolescence

Adolescence is a major developmental stage marked by:

• rapid brain maturation
• emotional growth
• identity formation

During this period, young people may experience (and exhibit) heightened emotional sensitivity, increased risk taking, difficulty with impulse control and challenges in long-term decision making - all of which are linked to the evolving structure and function of the adolescent brain.

School nurses use this window of opportunity to provide age-appropriate, relational interventions that support:

• behaviour change
• emotional regulation
• healthy decision making

Their work helps young people build resilience, develop coping strategies and form positive, long-lasting healthy habits for adulthood.

School nursing and mental health

Children and young people need to be supported by a system that values and nurtures their mental health and relationships. School nurses play a vital role in this system, contributing to a shared vision across health, education and social care to meet the needs of our youngest citizens.

School nurses also support digital wellbeing by:

• promoting safe online behaviours
• addressing concerns such as cyberbullying, screen time and exposure to harmful content
• helping children and young people navigate the digital world safely

Mental health support should be inclusive of neurodivergent children and young people, recognising that emotional distress may be expressed differently and tailored approaches are often needed to ensure equitable access to care.

School nurses collaborate with MHST pastoral staff and external services to:

• identify concerns early
• provide brief interventions
• ensure children and young people are connected with appropriate care

Their role is relational, trauma informed and rooted in public health principles, making them essential contributors to a system that nurtures both physical and emotional wellbeing.

The work of school nurses is supported by the development of workforce skills across the health and social care system, enabling practitioners to respond effectively to emerging mental health needs.

Proportionate universalism and levels of support

School nursing services are delivered across 4 levels of support:

• community
• universal
• targeted
• specialist

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

Proportionate universalism means offering more intensive support for people facing greater challenges, while maintaining universal provision for all. Importantly, people receiving targeted or specialist support should also continue to receive universal service provision.  

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

Community level

Purpose

The community level’s main aim is the promotion of health and reduction of inequalities through population-wide initiatives. This level focuses on public population-wide approaches that are designed to create healthy environments and resilient communities.

Practice examples

Examples of practice at community level include:

• designing and delivering health promotion campaigns, such as:
  • oral health
  • healthy lifestyles
  • nutrition
  • positive mental health
  • screen time
  • vaping, smoking and drugs prevention
• establishing links with, and strengthening access to, youth venues, sports clubs, voluntary sector providers and youth workers, supporting children and young people to create a wider network of community support
• representing health in multi-agency forums (such as within neighbourhood multidisciplinary teams) and influencing strategic decisions around education, transport, housing and community safety that affect child health. This includes efforts to improve school attendance, which is an important indicator of wellbeing and access to support

Universal level

Purpose

At this level, there is universal provision of access to health advice and support for school-aged children. The aim is to build trusted relationships and promote early identification of need in a way that aligns with both health equity and whole-school approaches.

Universal provision includes a range of health and development activities delivered through both population-level and individual approaches such as:

• school health needs assessments: population-level assessments (such as surveys or questionnaires) used to:
  • understand the health profile of the school community
  • identify emerging trends
  • inform targeted interventions
• individual health and development contacts: one-to-one interactions with children and young people at major developmental stages that promote early identification, personalised care and appropriate signposting or referral, such as:
  • the 4 recommended health needs assessments
  • drop-in sessions
  • digital interactions

Practice examples

Examples of practice at universal level include:

• conducting health needs assessments at major transition points (such as school entry and transition to secondary education)
• delivering school health needs assessments at population level (such as year 6) to identify emerging health trends and inform service planning
• use of online screening tools, such as the Lancaster model, to support early identification and triage
• provision of the National Child Measurement Programme (NCMP) delivery, follow-up and support for families
• supporting vision and hearing screening (where commissioned as part of the local service specification)
• promoting immunisation uptake, identifying children not fully immunised and linking families with relevant services
• offering drop-in sessions for children and young people to access confidential advice and support
• using digital communication tools (such as ChatHealth and mobile apps) to provide accessible, confidential text-based support
• promoting consistent school attendance through whole-school health messaging, including guidance for staff and parents on managing minor illness
• supporting regular school attendance through universal messaging and early support, particularly during major transitions (such as years 6 to 7), with attention to vulnerable pupils. This reflects the ambition of the Healthy child programme: high-impact area framework’s ages 5 to 19 high-impact area ‘4. Making transitions’
• providing health education and promotion activities aligned with curriculum priorities, such as:
  • personal, social, health and economic education (PSHE)
  • relationships and sex education (RSE)
  • mental wellbeing.
• participating in whole-school initiatives such as the whole-school approach to mental health and wellbeing (in line with government guidance on Promoting children and young people’s mental health and wellbeing)

Targeted level

Purpose

The targeted level provides additional support based on assessed need. These interventions are typically short to medium term and aim to:

• build resilience
• prompt behaviour change
• prevent escalation of need

They are tailored to the individual and delivered in collaboration with the child or young person and their family, with a focus on equity and inclusion for all. Targeted interventions should recognise and build upon the strengths and resources of young people and their families.

Targeted support can be structured in 2 ways as follows.

Targeted selective support

This is offered proactively to children, young people or families at higher risk of poor outcomes due to known vulnerabilities, such as:

• persistent absence from school
• young carer responsibilities
• SEND
• being at risk of entering care
• family breakdown
• housing instability
• a history of trauma

This support aims to prevent problems before they occur and may include:

• enhanced school nurse contact
• small group interventions (such as on emotional wellbeing or healthy lifestyles)
• signposting to specialist services

Targeted indicated support

This is provided when a specific concern has been identified, for example:

• emerging mental health difficulties
• bullying
• risk-taking behaviour
• difficulties with peer relationships
• the social impact of additional needs such as neurodiversity or disability

Support may include:

• one-to-one sessions
• referrals to counselling or mental health services
• tailored health education

Practice examples

Targeted support may be offered in school, community or home settings, and often involves multi-agency co-ordination. It recognises the impact of developmental stage, life transitions and social context on health and wellbeing.

Examples of practice at the targeted level include: 

• engaging in behaviour change work (such as on healthy lifestyles, mental health, substance misuse and sexual health)
• supporting attendance, school avoidance or transition challenges
• delivering additional health needs assessments for children and young people with vulnerabilities or emerging health concerns
• offering carbon monoxide monitoring and smoking cessation support, including brief interventions and referrals to stop smoking services
• facilitating vaping-related education, recognising its growing prevalence among young people
• providing psychoeducation and support around adolescent brain development, helping young people understand:
  • emotional regulation
  • decision making
  • risk-taking behaviours
• attending consultations requested by young people who are exploring their gender identity or sexuality and need access to inclusive, non-judgmental health advice (which could be additionally available to them from a signposted gender and sexuality support service)
• ensuring early support for neurodivergent children and young people, including in respect of:
  • sensory needs
  • emotional regulation
  • liaison with families and education staff to promote understanding and inclusion

Targeted-level support also involves hosting online workshops or small group sessions on topics such as:

• enuresis (bedwetting) and continence support
• balanced diet and nutrition
• sleep hygiene
• managing anxiety or low mood
• healthy relationships, including boundaries, respect and communication
• sexuality and sexual health, including puberty, consent, contraception and LGBT+ inclusion
• liaising with families and other professionals to co-ordinate care and ensure continuity of support

Specialist level

Purpose

At the specialist level, school nurses provide intensive, multi-agency support for children and young people with complex or high-risk needs. These interventions are co-ordinated (often long term) and shaped by ongoing assessment and analysis of greater need. School nurses contribute their public health expertise to:

• care planning
• case management
• safeguarding

Practice examples

Examples of practice at specialist level include: 

• identifying children and young people at risk of harm at the earliest opportunity, including at (but not limited to) health needs assessments
• supporting the management of SEND, including contributing to education, health and care plans (EHCPs) where appropriate. School nurses may contribute where they have a well established understanding of the child or young person and their family, and their clinical insight adds value to the assessment. Contributions should be made collaboratively with other professionals and only where the school nurse is the most appropriate practitioner. In many cases, specialist nurses or other clinicians may lead or provide the primary health input with school nurses supporting co-ordination and continuity of care
• providing guidance to young people and their families on accessing diagnostic pathways, including for neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder (ADHD)
• supporting children and young people who may be neurodivergent through care co-ordination, reasonable adjustments and liaison with specialist services
• offering ongoing carbon monoxide monitoring and smoking cessation support, which is embedded within multi-agency care plans for young people with complex health or safeguarding needs
• collaborating with MHSTs to support children and young people with emotional wellbeing and behavioural health needs, particularly where mental health intersects with:
  • safeguarding
  • attendance
  • chronic health conditions
• contributing to multi-agency risk assessments and safeguarding plans, including attendance at case conferences, core groups and strategy meetings
• providing continuity of care for children and young people with:
  • long-term conditions
  • complex medication needs
  • frequent hospital admissions

Structure and composition of the service

The healthy child programme contains an ages 5 to 19 offer for children and young people based on a proportionate universal model: a core universal offer for all, with targeted or specialist support based on assessed need. Best practice is that this offer is delivered consistently across all school settings, in line with local commissioning arrangements.

Local authorities are responsible for ensuring the programme is implemented:

• safely
• equitably
• in alignment with the needs and priorities of the local population

The purpose of school nursing health needs assessments

In line with the School and Public Health Nursing Association’s vision for school nursing, children and young people should be offered at least 4 individual health needs assessments.

These assessments are distinct from population-level screening programmes (such as the NCMP) and are designed to be:

• holistic
• relational
• responsive to individual needs

Local areas may adapt the timing and delivery of assessments to meet local needs. However, variation from the recommended schedule should be underpinned by a clear rationale and be subject to ongoing evaluation to ensure effectiveness, equity and safety.

Typically, these school-age health needs assessments should occur at the following times:

• school entry: to support the transition from early years to school and identify any early health or developmental concerns
• year 6: to address any physical or emotional challenges before secondary education commences
• year 8: to support the beginning of adolescence, strengthen health literacy and raise awareness of lifestyle impacts
• year 10: to prepare for adulthood, promote self-care and facilitate any necessary transition to adult services

These assessments are typically delivered through structured health needs analysis, using questionnaires or digital platforms tailored to age and developmental stage. They may be conducted face to face or virtually, depending on local arrangements and individual needs.

School nurses are responsible for the following:

• triaging responses
• identifying emerging concerns early, including physical, emotional or social issues that may benefit from additional support
• co-ordinating follow-up with other services such as GPs, child and adolescent mental health services or social care where appropriate

By enabling early identification, these assessments help ensure that children and young people receive timely, proportionate and personalised support, reducing the risk of escalation and promoting positive outcomes.

Additional visits and contacts

Children and young people assessed as requiring a targeted or specialist level of support should receive additional school nursing contacts outside of the 4 core health needs assessments and on top of the universal service.

School nurses should also offer drop-in sessions as part of their universal service, enabling children and young people to access health advice confidentially.

The expected quality standard of health needs assessments

Health needs assessments within the school nursing service fall into 2 distinct categories, each with its own purpose, structure and professional requirements. These assessments are central to the healthy child programme and play a vital role in:

• identifying needs
• promoting wellbeing
• determining the appropriate level of support, whether universal, targeted or specialist

Assessments should be delivered using relational and strengths-based practice, enabling school nurses to:

• pinpoint emerging needs
• encourage healthy behaviours
• contribute to safeguarding through trusted engagement

Types of assessments

School health needs assessments (population level)

These assessments are designed to understand the overall health profile of the school population. They:

• are typically delivered through surveys or questionnaires
• may be completed by children and young people themselves and/or parents or carers, depending on age and capacity

School health needs assessments:

• identify emerging health trends
• inform service planning
• guide targeted interventions

The analysis of these assessments should be led by qualified SCPHNs or suitably qualified practitioners with sufficient competence to ensure accurate interpretation and appropriate follow-up.

Findings should be used to shape responsive, equitable health provision across the school community. These assessments are not designed to identify individual safeguarding concerns, but may highlight population-level vulnerabilities that warrant further exploration or targeted support. All data should be handled in accordance with relevant public health and data protection legislation, such as the UK General Data Protection Regulation and the Data Protection Act 2018.

The quality expectation is that school health needs assessments should:

• be designed and delivered to a high standard, ensuring validity, reliability and inclusivity
• use tools and methods that are evidence-based, accessible and culturally appropriate to capture an accurate health profile of the school population

Individual health assessments (one to one)

These assessments provide a holistic assessment of a child or young person’s health and wellbeing. They should be led by SCPHNs or suitably qualified practitioners with the competence to undertake comprehensive assessments and respond to emerging health and safeguarding concerns, including domestic abuse, sexual abuse and exploitation.

Topics explored may include the following:

• nutrition
• physical activity
• emotional wellbeing
• relationships
• family life
• learning
• school attendance, recognising regular absence may be a sign of emotional distress or wider unmet need

Where concerns arise - such as around alcohol use, antisocial behaviour, poor attendance or emotional distress - timely and proportionate support should be offered, including:

• signposting
• brief interventions
• referral to targeted or specialist services

Practitioners should remain alert to signs of distress, neglect, sexual abuse or exploitation, and use professional curiosity to explore concerns sensitively and proportionately. Confidentiality, accessibility and trust are central to effective professional engagement. School nurses should always seek to create safe, non-stigmatising spaces where young people feel heard and supported.

Health needs assessment summaries

The summaries provided in this section outline the core components of each health needs assessment.

They are not exhaustive and should be used in conjunction with standard operating procedures (SOPs) for each contact, 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

Early identification and timely intervention can:

• improve health outcomes
• reduce inequalities
• prevent escalation of need

These assessments are strategically placed at major developmental stages to support children and young people’s health, wellbeing and development.

Components such as the NCMP, vision screening and hearing screening are part of the healthy child programme universal offer.

In some areas, these may be commissioned separately from the core school nursing service. Best practice is that local systems ensure clear pathways, shared protocols and effective communication between providers to maintain continuity of care and uphold the quality and equity of the universal offer.

School entry health needs assessment

The school entry health needs assessment (which takes place when a child enters reception at ages 4 to 5) marks a major transition from early years services to formal education.

This needs assessment:

• supports school readiness
• helps identify emerging developmental, emotional or physical health needs
• strengthens early collaboration between health and education systems
• identifies any safeguarding concerns, including domestic abuse, sexual abuse and neglect

It should reflect locally identified population health priorities.

Year 6 health needs assessment

The year 6 health needs assessment (which takes place at ages 10 to 11) is a major developmental check point within the healthy child programme, supporting children as they prepare for the transition to secondary school.

This stage is characterised by significant physical, emotional and social changes, including the onset of puberty, increasing independence, and new academic and peer environments.

The review provides an opportunity to:

• assess health and wellbeing
• identify emerging needs
• assess risk and identify any safeguarding concerns
• offer tailored support
• promote positive health behaviours that enable a confident and healthy transition

Year 8 health needs assessment

This health needs assessment supports young people during early adolescence - a period of rapid physical, emotional and cognitive development. It provides an opportunity to:

• assess health and wellbeing
• promote autonomy
• assess risk and identify any safeguarding concerns
• encourage healthy decision making as young people navigate increasing independence and more complex social environments

Year 10 health needs assessment

This health needs assessment supports young people in mid-adolescence as they prepare for adulthood. It provides a timely opportunity to:

• assess health and wellbeing
• reinforce independence
• assess risk and identify any safeguarding concerns
• promote self-management of health

As young people face increasing academic pressures, social complexity and identity development, the review helps guide healthy choices and supports a confident transition into adult life.

The NCMP and health needs assessments

The NCMP was established in 2006 and involves measuring the height and weight of reception (ages 4 to 5) and year 6 (ages 10 to 11) children at state-funded schools, including academies, in England.

It is delivered by local authorities in line with the statutory requirements in respect of weighing and measuring of children, as set out in the:

• Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013 (as amended)
• Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013

At a local level, school nursing teams are often (though not always) responsible for NCMP delivery.

Purpose of the NCMP

The NCMP supports practitioners in monitoring healthy growth by assessing a child’s body mass index (BMI) against age-appropriate standards.

It also generates population-level data that informs:

• local and national public health planning and service development
• the identification of trends in childhood growth and obesity over time

Delivery and consent

The NCMP operates on an opt-out basis. Each local authority must take steps to give each parent of a child who is due to be weighed and measured under the NCMP a reasonable opportunity to withdraw their child from participation in the exercise. Parents or guardians can choose to withdraw their child from the programme prior to or on the day of measurement.

Children who have been withdrawn or who are not comfortable with being measured on the day should not be measured. Local authorities must take steps to ensure this.

Practitioners should ensure that:

• families are given a reasonable opportunity to opt out
• children’s autonomy is respected

The NCMP must be delivered in accordance with regulations 9 to 17 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013.

The arrangements for the weighing and measuring exercise are managed on behalf of the local authority by a registered medical practitioner, registered nurse or registered dietitian.

Integration with health needs assessments

The NCMP can be included as part of the child’s health needs assessments at school entry and in year 6. This allows practitioners to:

• monitor healthy growth in the context of the child’s overall wellbeing and development
• offer proportionate support where needed

Measurement considerations for children and young people with SEND

Practitioners should be aware of the specific sensitivities and challenges that families of children and young people with SEND may experience in relation to the NCMP. Height and weight measurements may not reflect a child’s typical growth pattern or health status, and comparisons to standard BMI thresholds may not be appropriate.

Reasonable adjustments should be made to accommodate the child’s needs, including:

• understanding and respecting what is ‘normal’ for that individual child
• ensuring the child is comfortable and supported throughout the process
• communicating with families in a sensitive and informed manner
• avoiding assumptions or generalised feedback based on population norms

Where appropriate, practitioners should consult with the child’s wider care team and consider whether participation in the NCMP is suitable. The child’s wellbeing and dignity should remain central to all decision making.

Immunisations

School-aged immunisations are delivered by commissioned school-aged immunisation service (SAIS) teams, who work in partnership with schools, community settings and families to ensure children and young people receive vaccines in line with the national immunisation schedule.

These services typically include delivery of crucial vaccines such as:

• human papillomavirus (HPV)
• meningococcal A,C W and Y (MenACWY)
• tetanus, diphtheria and polio (Td/IPV) boosters
• measles, mumps and rubella (MMR) catch-up
• the annual children’s influenza vaccine

Immunisations are usually administered in schools, with additional provision through community clinics to support catch-up and access for children not in mainstream education.

School nurses are ideally placed to assess immunisation status during health needs assessments. As part of holistic health needs assessments, particularly for 12 to 15 year olds, school nurses can identify outstanding immunisations and developmental needs, ensuring timely referral and support.

A full list of immunisations by age is available at NHS vaccinations and when to have them.

Immunisations applicable to school-aged children appear in the table below.

Schedule for school-aged children

Table 1: school-age immunisation schedule, England

School year	Age	Immunisation	Delivered by
Year 8	12 to 13 years old	HPV vaccine	SAIS or GP
Year 9	13 to 14 years old	Td/IPV vaccine (otherwise known as the 3-in-1 teenage booster) and MenACWY) vaccine	SAIS
Yearly from reception to year 11	5 to 16 years old	Influenza vaccine	SAIS