Guidelines for preventive activities in general practice

Development and behaviour

Preventive activities in childhood

      1. Preventive activities in childhood

Development and behaviour | Preventive activities in childhood

Screening age bar

0–9* 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75v79 ≥80

*Newborn screening

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 GP frequently, and adolescents visit at least once a year.4 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’.5 There is also evidence that supports the beneficial impact of similar care for children without special healthcare needs.6–7

Screening

Recommendation Grade How often References
All newborns should have: Practice point Neonatally 8,9,10

Case finding

Recommendation Grade How often References
For the psychosocial assessment of adolescents, use the HEEADSSS assessment, in which the patient is asked about:
  • Home life
  • Education/employment
  • Eating habits
  • Activities
  • Drug and alcohol use
  • Sexuality
  • Personal safety
  • Suicidal ideation/depression.
Practice point Opportunistically 11

Preventive activities and advice

Recommendation Grade How often References
Immunisation    
Ensure immunisation in accordance with the Australian Immunisation Schedule. For information, see the immunisation chapter Practice point As per the immunisation schedule 12
 
Preventive counselling and advice    
Neonatally, provide education and advice about:
  • the harms of passive smoking
  • the prevention of sudden infant deaths (SIDS; see Further information)
  • the need to use appropriate restraints in motor vehicles
  • the benefits of breastfeeding.
Practice point Neonatally 11, 13,14
Throughout childhood, provide education and advice to parents regarding injury prevention, sun protection, promotion of good oral health, nutrition, physical activity and providing a strong antismoking message. See Skin cancer, Oral health, Nutrition, Physical activity and Smoking and nicotine vaping chapters. Practice point Opportunistically 15,16,17
Monitor weight and height in children aged 2–6 years using age-specific body mass index charts (either CDC or WHO). Practice point At well child visits or immunisation 18,19
Monitor weight and length in children aged <2 years using WHO growth charts. Practice point At well child visits or immunisation 19
Breastfeeding and introduction of solid food   
When the infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods (texture appropriate, in any order, as long as iron-rich foods are included), preferably while continuing to breastfeed. Refer to the Australian dietary guidelines. Practice point start at 6 months 14
Unless there is already an established allergy to certain foods, all infants should be given the common food allergens (peanut, tree nuts, cow’s milk, egg, wheat, soy, sesame, fish and shellfish), including smooth peanut butter/paste, cooked egg, dairy and wheat products before 12 months of age.
 
More information is available in First Do No Harm: a guide to choosing wisely in general practice.
Practice point Before 12 months of age 14, 20
  Recommended (Strong) for peanuts    
Table 1. Prevention of sudden infant deaths (SIDS)
Place on back to sleep for every sleep
Use a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or wedging/entrapment
Feeding of human milk is recommended because it is associated with a reduced risk of SIDS
It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for at least the first 6 months
Keep soft objects (eg pillows, pillow-like toys, quilts, comforters, mattress toppers and fur-like materials) and loose bedding (eg blankets and non-fitted sheets) away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment/wedging and strangulation
Avoid smoke and nicotine exposure during pregnancy and after birth
Avoid alcohol, marijuana, opioids and illicit drug use during pregnancy and after birth
Avoid overheating and head covering in infants
It is recommended that infants be immunised in accordance with Australian guidelines
Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
Supervised awake tummy time is recommended to facilitate development and to minimise the risk of positional plagiocephaly. Parents are encouraged to place the infant on their tummy while awake and supervised for short periods of time beginning soon after hospital discharge, increasing tummy time incrementally to at least 15–30 minutes total daily by the age of 7 weeks
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Table modified from Moon et al.21
 
 

The rates of stillbirth and neonatal deaths of Aboriginal and Torres Strait Islander infants were 1.5- and 2-fold higher than for non-Indigenous infants, respectively, in 2015–19.22 Aboriginal and Torres Strait Islander infants are also more likely to be born premature or with low birthweight,23,24 and are more likely to be hospitalised before one year of age.25

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to the Child health chapter in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.


 
  1. Centre for Community Child Health. Early childhood and the lifecourse. The Royal Children’s Hospital Melbourne, 2006 [Accessed 22 February 2024].
  2. Marmot M. Fair society, healthy lives (the Marmot review). University College London, 2010 [Accessed 22 February 2024].
  3. Hayes A. The ‘two worlds’ of Australian childhoods: Current research insights into early opportunities, challenges and life chances. National Investment for the Early Years/Centre for Community Child Health Conference and The Royal Children’s Hospital Melbourne, 2011.
  4. 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. doi: 10.1016/s0140-6736(07)60371-7.
  5. 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. doi: 10.1016/j.acap.2010.12.014.
  6. 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. doi: 10.1007/s10995-013-1315-9.
  7. 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. doi: 10.1542/peds.2011-1739.
  8. National Health and Medical Research Council (NHMRC). Child health screening and surveillance: A critical review of the evidence. Report no. CH42. NHMRC, 2002.
  9. Department of Health and Aged Care. National framework for neonatal hearing screening. Australian Government, 2013 [Accessed 22 February 2024].
  10. NSW Health. My personal health record (Blue Book). NSW Ministry of Health, 2023 [Accessed 28 February 2024].
  11. The Royal Australian College of General Practitioners (RACGP), National Aboriginal Community Controlled Health Organisation (NACCHO). National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. RACGP and NACCHO, 2018 [Accessed 22 February 2024].
  12. Department of Health and Aged Care. Australian immunisation handbook. Department of Health and Aged Care, 2023 [Accessed 22 February 2024].
  13. SIDS and Kids. Safe sleeping: A guide to assist sleeping your baby safely. Malvern, Vic: SIDS and kids, 2014.
  14. Australasian Society of Clinical Immunology and Allergy (ASCIA). Infant feeding and allergy prevention clinical update. ASCIA, 2018 [Accessed 22 February 2024].
  15. Kendrick D. Preventing injuries in children: Cluster randomized controlled trial in primary care. BMJ 1999;318(7189):980–83. doi: 10.1136/bmj.318.7189.980.
  16. 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. doi: 10.1136/bmj.316.7144.1576.
  17. Stanton A, Grimshaw G. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2013;8:CD003289. doi: 10.1002/14651858.cd003289.pub5.
  18. Centres for Disease Control and Prevention (CDC). Clinical growth charts. CDC, 2022 [Accessed 22 February 2024].
  19. World Health Organization (WHO). Body mass inder-for-age (BMI-for-age). WHO, 2006 [Accessed 22 February 2024].
  20. de Silva D, Halken S, Singh C, et al. Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials. Pediatr Allergy Immunol. 2020 Oct;31(7):813-826. doi: 10.1111/pai.13273.
  21. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics 2022;150(1):e2022057990. doi: 10.1542/peds.2022-057990.
  22. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework: Perinatal mortality. Australian Government, 2023 [Accessed 22 February 2024].
  23. Australian Health Ministers’ Advisory Council. Clinical practice guidelines: Antenatal care – Module 1. Department of Health and Ageing, 2012 [Accessed 27 February 2024].
  24. 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. doi: 10.1016/j.whi.2010.08.005.
  25. 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. doi: 10.1186/1471-2431-12-19.
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