Section 2 - Child health checks

Environment

Information

Undertaken to identify preventable environmental hazards that influence child health, behaviours and lifelong illnesses

Child Safety

For a suspicion of harm or neglect see Child safety reporting
For child exposed to domestic violence see Social-emotional wellbeing (child)

Health check recommendations

All children < 15 years of age opportunistically
All Aboriginal and Torres Strait Islander children at each scheduled health check

1. Procedure

Ask and explore the age appropriate questions as per Table 1.
Provide brief intervention as required
Determine if the child requires a referral and place them on a follow-up and recall register

Table 1. Age related environment questions
Age	Question	Explore
< 18 months	Where does the infant sleep?	If permitted view cot or sleeping area Assess for safety
< 18 months	Is the infant placed on their back to sleep?	If not, are they placed on side or front?
All children	Is the child exposed to cigarette/vape smoke?	Are smokers living with the child? How many? Where do smokers smoke?
	How many people live in the house?	The number of bedrooms? Bedding arrangements Observe for safety and hygiene concerns
	Any observed safety concerns?	Car seats Open bodies of water e.g. dams, blow up pools Unrestrained animals Ungated stairs, balconies etc Unsecured poisons, chemicals, medicines

2. Results

Exposure to cigarette/vape smoke ^1–3
- Babies and children should not be exposed to second-hand cigarette/vape smoke in the house or a confined space such as a car
- Babies and children should not be exposed to third-hand cigarette/vape smoke i.e. cigarette/vape smoke that is adsorbed by walls, furniture, clothes, toys etc. and lasting for hours
Overcrowding ^2,4
- Observed assessment of sleeping arrangements and safe hygienic conditions
- Aboriginal and Torres Strait Islander children are 5 times more likely to live in overcrowded housing
Sudden unexpected deaths in infancy (SUDI) and sudden infant death syndrome (SIDS) ^2,5,6
- Children should have their own cot or bed according to safe sleeping practices. See 3.3 SUDI, SIDS and a safe sleeping environment
Injury prevention ²
- Observed assessment of the home, car and yard for safety concerns

3. Brief intervention

Exposure to cigarette/vape smoke ^1–3
- Children exposed to environmental hazards especially second-hand smoke experience higher rates of:
  - respiratory infections
  - middle ear infections
  - meningococcal infections
  - Asthma (children 1–12 years)
  - sudden infant death syndrome
- Tobacco/vape toxins are absorbed by clothes and toys and continue to be released into the air months after a cigarette/vape is smoked
- Smokers should smoke outside and away from children. Consider wearing a smoking shirt, or change clothes after smoking, if likely to be around children
- Dispose of cigarette butts in bins to avoid children being burnt, choking on or eating discarded butts
Overcrowding ^2,4
- Puts stress on kitchens, bathrooms, laundries and sewerage systems increasing risks of:
  - poor personal hygiene
  - family relationship breakdown
  - domestic violence
  - sexual abuse
- The effects of unhygienic living conditions on Skin (child) conditions can lead to debilitating lifelong chronic conditions
- Discuss principles of hygiene with the parent and child including:
  - washing hands after toileting, changing nappies and blowing or wiping nose
  - washing hands before and after preparing and eating food
  - coughing and sneezing into arm rather than hands
  - brushing teeth at least twice daily
  - not sharing toothbrushes and razors
  - regularly washing bed linen and clothes
  - regularly removing rubbish from kitchen and living area
  - keeping pets away from living areas, especially where food is prepared
SUDI, SIDS and a safe sleeping environment ^1,2,5,6
- Provide safe sleeping information and strategies. See Resource 1.
- To reduce the risk of SIDS in babies:
  - sleep baby on the back from birth
  - sleep baby with head and face uncovered
  - provide baby with their own cot (or bassinet), mattress, bedding in the same room as the parents for the first 6–12 months rather than bed sharing
  - encourage breastfeeding
- To provide a safe sleeping environment for an infant:
  - put baby’s feet at the bottom end of the cot
  - cot should meet Australian standards. Check for standards label
  - use a firm, clean mattress that fits snug in the cot
  - tuck bedding in securely
  - keep quilts, doonas, pillows, bumpers, sheepskins, toys etc. out of the cot
- The risk of SIDS significantly increases when:
  - infant sleeps on stomach or side
  - soft surfaces with loose bedding
  - room is hot with excess clothing and bedding
  - sharing a bed, especially with smokers
  - infant is exposed to tobacco/vape smoke
  - infant is not immunised
  - bouncinette, prams and strollers are used as sleeping areas
Injury prevention ²
- Falls, drowning, poisoning, road safety incidents, burns and scalds are amongst the leading causes of preventable hospital admissions, deaths and disability for children. Provide Resources 2–3.
- Encourage the parent to keep an updated list of emergency numbers near the telephone or in their mobile phones including:
  - Poisons Information Centre (131126)
  - local health centre
  - child health nurse
  - all-night pharmacist (if available)
  - trusted neighbours
  - relatives
- Provide injury prevention and safety awareness strategies. See Table 2.

Table 2. Injury prevention and safety awareness strategies (continued)^4,7
Risk	Prevention strategy
Supervision	Small children require constant surveillance
Fire	Turn pot handles inwards. Teach stove top and oven safety Remove lighters and matches Supervise around camp fires Extinguish cigarette butts when disposing
Water	Fence swimming pools or dams Drain blow-up pools, nappy buckets, baths and all containers after use monitor access to toilets
Suffocation and strangulation	Stow plastic bags and blind cords out of reach
Falls from height	Close windows Safety gate stairs and balconies
Kitchen	Child lock cutlery and utensil drawers, plates and glassware cupboards Consider safety gates to any unsafe areas
Toys	Monitor toys for small parts choking hazards or where fingers can be jammed
Choking hazards	Button batteries, grapes, nuts, hotdogs or any small firm foods
Car	Australian standards car seats, restraints and seatbelts
Sun protection	Do not expose child < 12 months to direct sun. Protect skin with clothing, shade and hats Sunscreen on infants < 6 months age is not recommended From 6 months, apply sunscreen to face, ears and hands if these areas cannot be protected with clothing or wraps
Lounge room	Monitor large televisions for stability on furniture Stow electrical cords and cables Child lock furniture drawers Furniture with sharp edges at head height
Poisoning	Child lock poisons, cleaning and gardening products and medicines

4. Referral

For any identified overcrowding or housing issues, advocate and refer the patient or family to:
- social worker
- the Department of Housing and Public Works. See Resource 4.
- private real estate institutes
- housing co-ops
- regional community housing providers
- councils
Consider Child safety reporting for any child safety concerns

5. Follow-up

Place the child on a recall register to monitor development if required
Ensure all referrals are actioned
Provide the parent with details for the next scheduled follow-up appointment

6. References

All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

Last updated: September 2024