Growth charts for breastfed infants have been published but have not been adopted for routine use. (N.B.: The WHO is developing growth charts for fully breast fed babies). Cole TJ, Paul AA, Whitehead RG. Weight reference charts for British long-term breastfed infants. Acta Paediatr 2002 91 1296-1300 The issue of tongue tie and frenulotomy has attracted considerable attention recently. The hypothesis is that a tight or short frenulum prevents the infant latching on to the breast effectively, thereby making breast feeding painful. There are some strongly held opinions but few hard data and the topic calls for further research. See discussion in the Systematic Reviews referenced above. The topic is to be reviewed in the Archives of Disease in Childhood. Evidence has been presented (but challenged by other authors) that breast feeding for the early weeks of life may offer some protection against later cardiovascular risk factors including obesity: Atul Singhal, Alan Lucas. Early origins of cardiovascular disease: is there a unifying hypothesis? Lancet 2004; 363: 1642–45 Nutrition. The Government is planning to reform the Welfare Foods scheme and draft regulations are currently out for consultation: “Healthy start - consultation on food regulations”. 2005. Dental: a good example of a region-wide study on dental health, with analysis and recommendations, is available: The Dental Health of Five-Year-Old Children in the Northern & Region 1999/2000. Northern and Public Health Observatory. Decline in obvious in children’s permanent teeth. ONS 2003. Chapter 5 Pre-school and school services. Children’s Centres Government policy is to bring together pre-school provision in Children’s Centres, applying the lessons learned from Sure Start, and to provide a comprehensive multi-agency service that includes child care, family support and some aspects of health care. Similarly, there are proposals for Extended Schools that will offer
Where a child starts their course of meningococcal C vaccine after 4 months old and less than 12 months old, 2 doses of the vaccine should be given The two doses of MMR should be at least three months apart, expect in an outbreak when this can be reduced to one month Key: DTaP, diphtheria/tetanus/acellular pertussis IPV, inactivated polio vaccine; Hib, Haemophilus influenzae type b; MMR. measles/mumps/rubella; Td, tetanus/low dose diphtheria. Unfortunately, immunisation schedules vary enormously between different countries, even in . They also vary from time to time and it is not easy to publish a paper guide to them as it would rapidly be out of date. Some information is available from websites of individual National Health Departments and also WHO (http://www.who.int/gpv-surv/sched.xls), but the latter is often very out of date A better education for children in care. ODPM, 2003. Chapter 17 Personal child health records have been widely supported though their use remains variable. See Hampshire AJ, Blair ME, , Avery AJ, Williams EI. Variation in how mothers, health visitors and general practitioners use the personal child health record. Child Care Health Dev 2004;30:307-16. Chapter 18 The relevant NSF standard is Standard 1 (Core Standards): “Promoting Health and Identifying Needs and Intervening Early”. See link under chapter 1 - “Decade of change”. The schema on page 351 should be replaced by the Child Health Promotion Programme from the NSF. This is available as a separate document - schema NSF.doc . Chapter 19 The relevant NSF document is “Key Issues for Primary Care” See link under chapter 1 - “Decade of change”. Home visiting programmes: do they work? Home visiting by midwives and health visitors, supported by staff, is generally thought to be part of the solution to engaging hard to reach families, but UK evidence of benefit is scanty. Randomised trials are very difficult to do in an area where the quality of the relationship between professional and