A Comparison of Child Health Programmes Recommended for Preschool Children in Selected High-income Countries

Background: The UK Child Health Programme (CHP) aims to ensure that children attain their development and health potential. It comprises a series of proactive child health reviews incorporating growth and development surveillance and health promotion; routine immunizations; and certain screening tests, and is offered to all children. The evidence underpinning different elements of the CHP varies from robust to sparse, and consequently there is uncertainty about optimal programme design. This study aimed to compare the CHP currently recommended in the UK with that recommended in selected other high-income countries in order to inform ongoing CHP policy development.

Methods: The CHP recommended for preschool children in the UK was compared with that in Australia; Canada; the USA; and Sweden using a combination of literature review, focused website searches, and consultation with experts in the countries studied. Delivery, content, and uptake of child health reviews, immunizations, and screening were considered.

Results: All the countries studied recommend CHP services including child health reviews, immunizations, and screening to their preschool populations. Despite this superficial uniformity, considerable variation exists between countries in the detail of CHP delivery and content. The UK programme is relatively narrow in scope, offering the fewest child health reviews, a relatively restricted immunization programme (although some expansion is planned), and limited newborn bloodspot screening. Internationally comparable data on the uptake/coverage of CHP services are patchy: the available information suggests substantial variation between and within countries in the uptake of child health reviews.

Conclusions: In the absence of uncontested evidence on the 'ideal' CHP for preschool children, demonstrating variation between countries in recommended programmes provides valuable contextual information for policy makers. Further work looking at relationships between CHP services and children's outcomes would add further value.