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Red Book

Chapter 3

Preventive activities in children and young people

Guidelines for preventive activities in general practice
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Prevention and health promotion in the early years, from conception to 5 years of age, is important for an individual’s lifelong health and wellbeing.1 It may also be an opportunity to redress health inequalities.2, 3 In adolescence, neurodevelopmental studies support the value of early intervention to prevent ongoing harm.

Many infants and children visit their general practitioner (GP) frequently, and adolescents visit at least once a year.5 This frequent contact provides opportunities for disease prevention and health promotion.

Evidence provides moderate support for the hypothesis that ‘accessible, family-centred, continuous, comprehensive, coordinated, compassionate and culturally effective care improves health outcomes for children with special healthcare needs’.6 There is also evidence that supports the beneficial impact of similar care for children without special healthcare needs.7-8

What are the key equity issues and who is at risk?

  • Low socioeconomic status (SES) is associated with increased childhood morbidity and mortality.9 This includes higher rates of death from neonatal hypoxia, sudden unexpected death in infancy (SUDI), prematurity-related disorders, and accidental and non-accidental injury;10,11 hospitalisations related to asthma;12 and risk of child abuse.13 Low SES is also associated with overweight and obesity in children.14
  • While there has been a decline in infant mortality since the 1990s, infant mortality in Aboriginal and Torres Strait Islander peoples is more than twice that of non-Indigenous children,10 in part due to pregnancy, labour and delivery complications, and trauma and congenital malformations.15 Aboriginal and Torres Strait Islander infants have higher rates of death from SUDI.16 They are also more likely to be born premature or with low birth weight17,18 and are more likely to be hospitalised before 1 year of age.19
  • Aboriginal and Torres Strait Islander peoples and people from socioeconomically disadvantaged backgrounds are more likely to experience low immunisation rates.20

What can GPs do?

  • Refer to the general strategies for supporting patient education and health literacy in disadvantaged groups.
  • Consider advocating for and supporting community-based strategies or policies for health promoting changes within the environments in which families live (eg school-based programs targeting nutrition and physical activity).21–27
  • Use resources supporting the provision of culturally competent care to adolescents from culturally diverse backgrounds.28
Age-related health checks in children and young people

Table 3.1

Age-related health checks in children and young people
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Explanatory notes for Practice Points

Table 3.2

Explanatory notes for Practice Points
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  1. Centre for Community Child Health. Early childhood and the lifecourse. Parkville, Vic: The Royal Children’s Hospital, Melbourne, 2006 au/emplibrary/ccch/PB1_Earlychood_lifecourse.pdf [Accessed 25 May 2016].
  2. Marmot M. Fair society, healthy lives – The Marmot review. London: University College London, 2010 [Accessed 25 May 2016].
  3. Hayes A. The ‘two worlds’ of Australian childhoods: Current research insights into early opportunities, challenges and life chances. Melbourne: National Investment for the Early Years/Centre for Community Child Health Conference and The Royal Children’s Hospital, Melbourne, 2011. [Accessed 25 May 2016].
  4. Patton GC, Viner R. Pubertal transitions in health. Lancet 2007;369(9567):1130–39. [Accessed 25 May 2016].
  5. Tylee A, Haller DM, Graham T, Churchill R, Sanci LA. Youth-friendly primary-care services: How are we doing and what more needs to be done? Lancet 2007;369(9572):1565–73. [Accessed 25 May 2016].
  6. Kuhlthau KA, Bloom S, Van Cleave J, et al. Evidence for family-centered care for children with special health care needs: A systematic review. Acad Pediatr 2011;11(2):136–43. [Accessed 25 May 2016].
  7. Hadland SE, Long WE. A systematic review of the medical home for children without special health care needs. Matern Child Health J 2014;18(4):891–98. [Accessed 25 May 2016].
  8. Long WE, Bauchner H, Sege RD, Cabral HJ, Garg A. The value of the medical home for children without special health care needs. Pediatrics 2012;129(1):87–98. [Accessed 25 May 2016].
  9. Barros FC, Victora CG, Scherpbier RW, Gwatkin D. Health and nutrition of children: Equity and social determinants. In: Blas E, Kurup AS, editors. Equity, social determinants and public health programmes. Geneva: World Health Organization, 2010; p. 49–75. [Accessed 25 May 2016].
  10. Australian Institute of Health and Welfare.. Australia’s health 2014. Canberra: AIHW, 2014. [Accessed 25 May 2016].
  11. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: AIHW, 2015. [Accessed 25 May 2016].
  12. McGrath RJ, Stransky ML, Seavey JW. The impact of socioeconomic factors on asthma hospitalization rates by rural classification. J Community Health 2011;36(3):495– 503. [Accessed 25 May 2016].
  13. Friedman E, Billick SB. Unintentional child neglect: Literature review and observational study. Psychiatric Q 2015;86(2):253–59. [Accessed 25 May 2016].
  14. O’Dea JA, Chiang HW, Peralta LR. Socioeconomic patterns of overweight, obesity but not thinness persist from childhood to adolescence in a 6-year longitudinal cohort of Australian schoolchildren from 2007 to 2012. BMC Public Health 2014;14:222. [Accessed 25 May 2016].
  15. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework 2012: Detailed analyses. Canberra: AIHW, 2013. [Accessed 25 May 2016].
  16. Steering Committee for the Review of Government Service Provision. Overcoming Indigenous disadvantage: Key indicators 2014. Canberra: Productivity Commission, 2014. [Accessed 25 May 2016].
  17. Australian Health Ministers’ Advisory Council. Clinical practice guidelines: Antenatal care – Module 1. Canberra: Department of Health and Ageing, 2012. [Accessed 25 May 2016].
  18. Shah PS, Zao J, Al-Wassia H, Shah V. Pregnancy and neonatal outcomes of aboriginal women: A systematic review and meta-analysis. Womens Health Issues 2011;21(1):28–39. [Accessed 25 May 2016].
  19. Bar-Zeev SJ, Kruske SG, Barclay LM, Bar-Zeev NH, Carapetis JR, Kildea SV. Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: A retrospective cohort study. BMC Pediatr 2012;12:19. [Accessed 25 May 2016].
  20. Ward K, Chow MYK, King C, Leask J. Strategies to improve vaccination uptake in Australia, a systematic review of types and effectiveness. Aust N Z J Public Health 2012;36(4):369–77. [Accessed 25 May 2016].
  21. Beauchamp A, Backholer K, Magliano D, Peeters A. The effect of obesity prevention interventions according to socioeconomic position: A systematic review. Obes Rev 2014;15(7):541–54. [Accessed 25 May 2016].
  22. Kimbro RT, Denney JT. Neighborhood context and racial/ ethnic differences in young children’s obesity: Structural barriers to interventions. Soc Sci Med 2013;95:97–105. [Accessed 25 May 2016].
  23. Barr-Anderson DJ, Singleton C, Cotwright CJ, Floyd MF, Affuso O. Outside-of-school time obesity prevention and treatment interventions in African American youth. Obes Rev 2014;15(Suppl 4):26–45. [Accessed 25 May 2016].
  24. Hoelscher DM, Springer AE, Ranjit N, et al. Reductions in child obesity among disadvantaged school children with community involvement: The Travis County CATCH Trial. Obesity 2010;18(Suppl 1):S36–44. [Accessed 25 May 2016].
  25. King KM, Ling JY. Results of a 3-year, nutrition and physical activity intervention for children in rural, lowsocioeconomic status elementary schools. Health Edu Res 2015;30(4):647–59. [Accessed 25 May 2016].
  26. Lubans DR, Morgan PJ, Okely AD, et al. Preventing obesity among adolescent girls. Arch Pediatr Adolesc Med 2012;166(9):821–27. [Accessed 25 May 2016].
  27. Magnusson MB, Sjoberg A, Kjellgren KI, Lissner L. Childhood obesity and prevention in different socioeconomic contexts. Prev Med 2011;53(6):402–07. [Accessed 25 May 2016].
  28. Chown P, Kang M, Sanci L, Newnham V, Bennett DL. Adolescent health: Enhancing the skills of general practitioners in caring for young people from culturally diverse backgrounds, GP resource kit. 2nd edn. Sydney: NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, 2008. [Accessed 25 May 2016].
  29. National Health and Medical Research Council. Child health screening and surveillance: A critical review of the evidence. Report no. CH42. Canberra: NHMRC, 2002. [Accessed 25 May 2016].
  30. Department of Health. National framework for neonatal hearing screening. Canberra: DoH, 2013 neonatal-hearing-screening [Accessed 15 December 2015].
  31. NSW Health. Child personal health record (Blue Book). Sydney: NSW Health, 2015. Available at www. [Accessed 15 December 2015].
  32. The Royal Australian and New Zealand College of Psychiatrists. Report from the Faculty of child and adolescent psychiatry. Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand. Melbourne: RANZCP, 2010. [Accessed 15 December 2015].
  33. SIDS and Kids. Safe sleeping: A guide to assist sleeping your baby safely. Malvern, Vic: SIDS and kids, 2014 SIDS053-Safe-Sleeping-Long-Brochure-Updates-web.pdf [Accessed 15 December 2015].
  34. Douglas PS, Hiscock H. The unsettled baby: Crying out for an integrated, multidisciplinary primary care approach. Med J Aust 2010 Nov 1;193(9):533–36. [Accessed 15 December 2015].
  35. National Health and Medical Research Council. Infant feeding guidelines: Information for health workers. Canberra: NHMRC, 2012. [Accessed 15 December 2015].
  36. National Health and Medical Research Council. Australian dietary guidelines. Canberra: NHMRC, 2013. [Accessed 15 December 2015].
  37. Duursma E, Augustyn M, Zuckerman B. Reading aloud to children: The evidence. Arch Dis Child 2008;93(7):544–47. [Accessed 15 December 2015].
  38. Sim S, Berthelsen D. Shared book reading by parents with young children: Evidence-based practice. Australasian J Early Childhood 2014;39(1):50–55. [Accessed 15 December 2015].
  39. Cheng TL, Emmanuel MA, Levy DJ, Jenkins RR. Child health disparities: What can a clinician do? Pediatrics 2015;136(5):961–68. [Accessed 15 December 2015].
  40. NSW Health. Early childhood oral health guidelines for child health professionals. Sydney: Centre for Oral Health Strategy, 2014 policies/gl/2014/pdf/GL2014_020.pdf [Accessed 21 March 2016].
  41. Rogers JG. Evidence-based oral health promotion resource. Melbourne: Prevention and Population Health Branch, Department of Health (Vic), 2011. [Accessed 21 March 2016].
  42. Sleep Health Foundation. Sleep shack. Blacktown, NSW: Sleep Foundation, 2015 more/sleepshack.html [Accessed 25 May 2016].
  43. Department of Health. Australia’s physical activity and sedentary behaviour guidelines, 2014. Canberra: DOH, 2014 [Accessed 21 March 2016].
  44. National Institute for Health and Care Excellence. CG43 Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE, 2006. [Accessed 21 March 2016].
  45. Barton M. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics 2010;125(2):361–67. [Accessed 21 March 2016].
  46. Kendrick D. Preventing injuries in children: Cluster randomized controlled trial in primary care. BMJ 1999;318(7189):980–83. [Accessed 21 March 2016].
  47. Clamp M, Kendrick D. A randomized controlled trial of general practitioner safety advice for families with children under 5 years. BMJ 1998;316(7144):1576–79. [Accessed 21 March 2016].
  48. beyondblue. Clinical practice guidelines for depression and related disorders – Anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Hawthorn, Vic: beyondblue, 2011 au/health-professionals/clinical-practice-guidelines [Accessed 21 March 2016].
  49. Bakermans-Kranenburg MJ, van IJzendoorn MH, Juffer F. Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin 2003;129(2):195–215. [Accessed 21 March 2016].
  50. Milgrom J, Ericksen J, McCarthy RM, Gemmill AW. Stressful impact of depression on early mother–infant relations. Stress Health 2006;22:229–38. [Accessed 21 March 2016].
  51. Australasian Society of Clinical Immunology and Allergy. Guidelines for allergy prevention in infants. Balgowlah, NSW: ASCIA 2016 images/pcc/ASCIA_PCC_Guidelines_Allergy_Prevention_ Infants_2016.pdf [Accessed 21 March 2016].
  52. Glascoe FP. If you don’t ask: Parents may not tell: Noticing problems vs expressing concerns. Arch Pediatr Adolesc Med 2006;160:220. [Accessed 21 March 2016].
  53. McLean K, Goldfeld S, Molloy C, Wake M, Oberklaid F. Screening and surveillance in early childhood health: Rapid review of evidence for effectiveness and efficiency of models. Ultimo, NSW: The Sax Institute, 2014. [Accessed 21 March 2016].
  54. The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice. 2nd edn. East Melbourne, Vic: RACGP, 2015. [Accessed 21 March 2016].
  55. Sanders MR, Ralph A, Thompson R, et al. Every family: A public health approach to promoting children’s wellbeing. Brisbane: University of Queensland, 2007. [Accessed 21 March 2016].
  56. Brookes-Gunn J, Berlin LJ, Fuligni AS. Early childhood intervention programs: What about the family? In: Shonkoff JP, Meisels SJ, editors. Handbook of early childhood intervention. 2nd edn. New York: Cambridge University Press, 2000; p. 549–88. [Accessed 21 March 2016].
  57. US Preventive Services Task Force. Screening for visual impairment in children ages 1 to 5 years: Topic page. Rockville, MD: USPSTF, 2011. Available at www. [Accessed 25 May 2016]
  58. Australian Infant Child Adolescent and Family Mental Health Association. Improving the mental health of infants, children and adolescents in Australia. Position paper of the Australian Infant, Child, Adolescent and Family Mental Health Association Ltd. Adelaide: AICAFMHA, 2011. Available at www.emergingminds. pdf [Accessed 25 May 2016].
  59. US Preventive Services Task Force. Depression in children and adolescents: Screening. Rockville, MD: USPSTF, 2016. Available at www. [Accessed 25 May 2016 June].
  60. Goldenring J, Rosen D. Getting into adolescent heads: An essential update. Contemp Pediatr 2004;21:64. [Accessed 25 May 2016 June].
  61. McDermott B, Baigent M, Chanen A, et al. beyondblue Expert Working Committee, Clinical practice guidelines: Depression in adolescents and young adults. Hawthorn, Vic: beyondblue, 2010. [Accessed 25 May 2016 June].
  62. Sanci L, Chondros P, Sawyer S, et al. Responding to young people’s health risks in primary care: A cluster randomised trial of training clinicians in screening and motivational interviewing . PLOS ONE 2015;10(9):e0137581. [Accessed 25 May 2016 June].
  63. McNeill YL, Gillies ML, Wood SF. Fifteen year olds at risk of parasuicide or suicide: How can we identify them in general practice? Fam Pract 2002;19(5):461–65. [Accessed 25 May 2016 June].
  64. Stanton A, Grimshaw G. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2013;8:CD003289. [Accessed 25 May 2016 June].
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