Programmes of preventative child healthcare and child development surveillance vary between countries – the national policy for all UK nations set out a minimum programme offered on a universal basis (for details of current UK policy, please see UK Health Visiting Policy).
Child development assessments form part of a health visitor’s holistic assessment of the baby/ child, taking account of the family context. These universal reviews should be completed in partnership with parents and carers, incorporating their expert knowledge of their child, to identify strengths and any difficulties. Validating parental insight builds trust and aligns with family-centred public health practice.
The holistic assessment includes physical and mental health, development, growth, family factors, and safeguarding, based on professional observation, clinical judgment and parental report, and supported by a range of validated tools.
Child development does not unfold in a straight, predictable line – with some children following a less typical, but nevertheless normal variation of development (for example, bottom shuffling, rather than crawling). Understanding the difference between delayed development (for example, when considering the development of a baby/ child born preterm, using their corrected age) and atypical development which requires more urgent action, is important. Practitioners need to be observant for signs of atypical development and ‘red’/ ‘amber’ flags, and work within local pathways for child development, specialist assessment and ongoing support.
A proactive approach does not mean diagnosing, it means recognising concerns, supporting families, and ensuring timely referral to the right professionals. Diagnosis is made by medical professionals, typically paediatricians, using clinical assessment.
Most developmental assessment tools assume children follow a predictable sequence, with key developmental milestones. Developmental assessment tools should not replace practitioners’ clinical assessment skills and observations. There are known limitations of the Ages and Stages Questionnaire (ASQ-3). It is important to note that the ASQ was introduced into the UK as a population measure of child development and does not meet the UK Screening Committee criteria to be used as a standalone screening tool. See UK research, Wilson et.al. 2022, which found that the ASQ performs poorly as a language screening tool, missing one-third of cases of low language ability; similar errors have been found in other domains of child development including motor development, and social and emotional development (Lysons J., et.al., 2026).
The knowledge, skills and competencies of the practitioner completing the assessment also affects the validity and reliability of the assessment. Research on the Early Language Identification Measure reported significantly improved sensitivity and specificity when completed by health visitors using clinical observation and judgement alongside the assessment tool, compared to an early years practitioner. Both provide good examples of the importance of avoiding a ‘tick box’ approach.
The NMC sets the standards for education and practice for Specialist Community Public Health Nurses (SCPHN) - health visitors. In particular, domain D – at the point of registration, the SCPHN health visitor will be able to:
- D.HV1 demonstrate specialist knowledge and understanding of infant and child anatomy, physiology, genetics, genomics and development when undertaking programmed health assessment and development reviews
- D.HV2 apply specialist knowledge and use validated tools to deliver holistic health assessments and programmed health and development reviews, working in partnership with parents and families to promote health and identify emergent and existing concerns including vulnerability and inequality, and facilitate and prioritise support and/ or early intervention for the child and family as appropriate
- D.HV3 assess for early signs of atypical patterns of development, or significant anomalies, that may result in disability or emotional, physical or developmental health needs or risks, and deliver evidence-based anticipatory guidance or targeted intervention tailored to individual and family circumstances and needs
- D.HV4 apply advanced level communication and interpersonal skills to establish trusting relationships which are respectful of families’ capabilities, priorities and values
- D.HV5 work in partnership with families to continually assess and appraise the impact of known strengths, changing circumstances and relationships on child and family health and wellbeing and adapt support accordingly, acknowledging the needs of the family as a whole and prioritising support on the basis of immediate and continuing risk and need
- D.HV6 work in partnership with families to promote, educate and support sensitive, responsive relationships between parents and their children through the application of specialist knowledge of early emotional development, theories and models of attachment, and the impacts of positive and enduring parental-child relationships
- D.HV7 evaluate the effects of trauma on child development and how they adjust to those effects, and work in partnership with children and families who are affected by trauma to strengthen their resilience.
Ensuring that the workforce has the right knowledge, skills and training in competencies is the responsibility of both the provider organisation and the individual health visitor. This relies on access to:
- Robust SCPHN-HV training
- Structured preceptorship
- Research integration (including keeping abreast of new evidence and updates
- Access to continuous professional development and training to maintain core competencies.
