Synopsis
Deliver age-appropriate surveillance of growth, development, physical health, immunisation, family wellbeing and safeguarding while responding promptly to parental concern or developmental regression.
- In England, the Healthy Child Programme is the national public-health nursing model from birth to 19, extending to 25 for care leavers and people with SEND.
- The mandated early-years offer includes antenatal, new-birth, 6-to-8-week, 12-month and 2-to-2-and-a-half-year health and development reviews.
- Surveillance is continuous and opportunistic; parental concern, regression, faltering growth or safeguarding signs require assessment without waiting for the next scheduled review.
Key red flags
Loss of acquired skills requires prompt assessment. Refer language or social regression before age 3 to the autism team; motor regression at any age needs paediatric or paediatric-neurology assessment. New seizures, weakness or altered consciousness require urgent clinical escalation.
Reasoning priorities
Assess growth position and trajectory.
Use correct equipment, exact age, sex-specific chart and gestational correction; repeat implausible measurements before inference.
Worked reasoning
A parent reports that a 20-month-old who used several words now uses none and no longer responds consistently to their name.
- Clarify exact skills gained and lost, time course, hearing, social interaction, play, motor function, illness and seizures; observe the child and assess current physical illness and safeguarding context.
- Reason that loss of language plus altered response is regression rather than an isolated late milestone; consider hearing loss, neurodevelopmental and neurological causes without assigning a diagnosis from one visit.
- Arrange prompt referral to the autism team for language regression before age 3, alongside formal hearing evaluation and coordinated developmental assessment. This referral does not establish an autism diagnosis. Escalate urgently for seizures, acute weakness, altered consciousness or rapid further loss.
- Verify referral receipt, document baseline skills and parental videos or examples when appropriate, arrange a named review and actively follow non-attendance because delay could affect investigation and support.
The record shows an interrupted routine vaccine course.