A New Look at Hall 4 – the Early Years – Good Health for Every Child

Guidance setting out the way forward for the successful delivery of Health for All Children (Hall 4) in the early years.


The 24-30 month review for all children is the appropriate time to review the child's parameters of development identifying and addressing areas where additional support is required. Needs identified should be addressed using evidence-based interventions with subsequent monitoring to ensure that agreed outcomes are achieved.

It is important that contact is made with all families with children at this stage and no child misses out on the opportunity for a review. NHS Boards must ensure there are protocols in place to deal with non-responders.

The review should be carried out in partnership with parents/carers, ensuring that they understand the expected developmental progress of their child at this stage. The Personal Child Health Record (The Red Book 3) contains a number of developmental firsts and this should be used as a proactive tool to work with parents to help them understand, and take the lead on, discussions regarding any concerns they may have.

Where there are concerns about a child's development or growth patterns, health visitors should ensure that the necessary follow-up action is taken. For example, where a parent expresses concern about a child's weight or if the health visitor, during the review, is concerned regarding the child's weight, the child's height and weight should be measured and recorded on the WHO growth chart 4. If there are further concerns following this measurement, the Public Health Nurse - Health Visitor should ensure appropriate advice is provided. In cases where a more detailed clinical assessment is necessary, the Public Health Nurse - Health Visitor should refer the child to the appropriate local resource, informing the GP of their action.

In order to protect children, core principles, values and shared standards of practice and communication form the foundation for effective, collaborative child protection activity. While different agencies will have differing codes of practice and responsibilities, a shared approach to values and standards will bring clarity and purpose to single-agency, multi-agency and inter-agency working.

The 24-30 month review should cover the following as a minimum and may require to be expanded, depending on child and family circumstances and professional concerns:

  • Speech, language and communication
  • Personal, social and emotional development (including behavioural issues)
  • Nutrition, growth and weight
  • Immunisations
  • Parental concerns and issues
  • Vision, hearing and oral health
  • Physical activity and play.

Key Recommendations

  • 24-30 month review to be carried out for allchildren.
  • NHS Boards should ensure that needs identified are addressed using evidence-based interventions to achieve agreed outcomes.
  • NHS Boards should agree the format and approach to the review.
  • The review should be carried out in partnership with parents/carers and the Red Book should be used as a tool to assist this.
  • NHS Boards should ensure protocols are in place for non-responders.
  • Where there are specific concerns, appropriate referrals should be made to other services.
  • NHS Boards should develop clear pathways of care to ensure that referrals for support are appropriately managed.
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