From child health surveillance to child health promotion, and onwards: a tale of babies and bathwater.

Child health surveillance (CHS) has evolved greatly over the past 30 years from a proactive screening process by health professionals to a more passive approach of child health promotion (CHP), which places the main responsibility for detection of developmental problems on carers. The impetus for this change came from the Hall Report (1989), which reported a lack of evidence for CHS. Although research on developmental screening is sparse, some data show that use of structured methods for identifying deviations from normal increases the pick-up rate of abnormalities, compared with informal or parent-initiated methods. The majority of countries recommend a universal 'CHS' type of programme, in contrast to the UK and some other European countries. Alternatives to universal CHS include 'targeting' which, however, has been criticised for including too many 'normal' children and missing those who are most in need. CHS and CHP are basically primary care activities but require essential support from secondary paediatric services. There are concerns about the competence and numbers of general practitioners and health visitors who deliver child healthcare. Both these professional groups are under great pressure because of continuing reorganisations of the National Health Service in the UK. Politically driven agendae complicate the fundamental aim of enhancing child health at the primary level and it is vital to keep the focus on providing high-quality services to the most needy children. CHS has evolved beyond CHP to a Healthy Child Programme (HCP). Hopefully this is not an 'emperor's new clothes' situation and will improve outcomes. A major problem is the 'inverse care law', and reliance on carers runs the risk of excluding those children who need most input. Inequality is currently a headline problem and the change from CHS to HCP may not have helped. More research is urgently needed to resolve uncertainty about the application of these fundamental procedures for secondary preventive of childhood disability.