Child Health in New Zealand

Newsletter No 2, December 2006

This second newsletter updates the progress of the Well Child Framework review, and provides more information on the planning for the new pre-school Well Child check and latest developments on the Newborn Hearing Screening Programme, the Oral Health Strategy and the Healthy Eating Healthy Action Strategy for breastfeeding promotion.

Well Child Review Update

The Well Child Tamariki Ora Framework review started in July this year and runs through to the end of 2007. The review also includes planning and implementation for the new pre-school Well Child check.

To guide the review and to ensure an intersectoral approach a steering group has been established. A reference group with a wide range of key stakeholders and ‘frontline’ providers has also been set up and valuable feedback and comment was provided by this group. Further focus group meetings will be held on specific topics in the New Year.

A literature review has been completed that identifies current evidence on best practice and new and emerging issues in child health.

Planning for the pre-school Well Child Check

In November a workshop was held to discuss options for the new pre-school Well Child check. What should be included in the check, who should deliver the service and when and where the check should be done were covered. Attendees included Maori, Pacific, Education and health providers.

It is likely that the check will include:

• hearing and vision screening
• height, weight and BMI
• behavioural and developmental screening
• a health questionnaire
• a social questionnaire (ie, questions about the environment the child lives in)
• dental health assessment
• health promotion (actual content of this not decided at present).

Assessment will probably be between the ages of four and a half and five and a half. The check could be carried out at preschool, or through primary health care, Maori or Pacific providers, or as home visits for those unable to attend. A ‘mop up’ of children who have missed out would happen at school.

This new service will be piloted in one region in late 2007, before the main implementation in 2008.

Some key early findings from the literature review

• A universal service, with targeted intensity will deliver the best outcomes, but a stronger focus on need and measurable outcomes is required.
• Routine screening may significantly improve the detection of postnatal depression (PND) and treating PND results in measurable improvements in child health outcomes.
• Good parenting protects and promotes children’s mental health.
• Testing the hearing and vision of children younger than four years is difficult and there is little support in the literature for routine tympanometry screening at three years old.

Next steps

• Development of an Options paper for discussion and feedback from the sector in the first half of 2007.
• Further focus group meetings on specific topics.
• Scoping of workforce implications.
• Scoping of information system requirements.
• Ongoing consultation.

Newborn Hearing Screening

Since the Budget 2006 announcement of $16 million over the next four years to establish a universal newborn hearing screening programme, the Ministries of Health and Education have been working together on options for programme design and implementation.

Ministers agreed that a nationally consistent programme should be developed with the following characteristics:

• screening provision based around regional lead providers in diagnostic audiology to ensure the integration of screening and diagnostic services
• nationally consistent policy and quality standards for all providers, to be developed in collaboration with key stakeholders
• a national set of indicators and targets to ensure a high quality and consistent programme across the country
• a nationwide information system with monitoring data to be provided to the National Screening Unit
• facilitator roles to support onward referral and co-ordination of early intervention services.

It has been agreed that implementation will be phased over three years, starting in 2007/08.

Oral Health

In August this year the Ministry’s strategic vision Good Oral Health for All, for Life was launched by the Minister and the Prime Minister. It paints a picture of improved oral health services for 0–18 year olds.

One of the priority areas is to improve services for preschoolers. An advisory group is being set up to help identify strategies for reducing early childhood dental caries levels. The work will include how dental therapists can work with other health and education sector workers to create good linkages between providers who have contact with young children and their parents. Our aim is to make sure that all groups are passing on key messages about oral health care and that they can refer parents to a dental therapist where appropriate.

Breastfeeding

The Well Child framework review has identified breastfeeding as a key area. The Well Child programme will make improving breastfeeding a priority.

Breastfeeding rates at initiation (in the first 48 hours of life) have improved with the implementation of the Baby Friendly Hospital Initiative. However, the rates at six weeks drop off and are currently lower than the target, particularly among Maori and Pacific women. This presents a greater risk to Maori and Pacific children and their families compared to other population groups.

Developing policies and campaigns that promote and support breastfeeding is one of the seven key actions of the Healthy Eating – Healthy Action (HEHA) Strategy.

Scoping work on the national breastfeeding promotion campaign is currently under way as part of the implementation of HEHA.