Section 2 - Child health checks

Health check recommendations

• All children from birth to < 15 years at each scheduled health check

1. Procedure

• Ask the parent the nutrition questions according to the child’s age. See Table 1.
• Identify if the child meets adequate dietary intake and provide brief intervention
• Determine if the child requires a referral and place on a follow-up and recall register

2. Results

• A child’s nutritional intake should be balanced and healthy according to Diet and nutrition

3. Brief Intervention ^1–5

• Poor Diet and nutrition increases risk of chronic conditions, including:
  • iron deficiency and anaemia
  • some forms of cancer
  • Diabetes
  • Coronary heart disease
  • Chronic kidney disease
  • Overweight and obesity (child)
  • Dental caries and periodontal disease
• Encourage parents to be role models for healthy lifelong family eating habits. Use visual charts to assist. See Resource 1.

• Children exposed to frequent unhealthy diets are more vulnerable to visual food-cues (advertising) and increased food-cue salience (difficulty restraining eating poor foods)
  1. Babies aged 0 to < 6 months ¹
     • Support exclusive breastfeeding until 6 months of age for optimal growth, health and development. No additional fluid or food is needed
     • Formula-fed babies should have infant formula exclusively until 1 year of age
     • Breast milk and formula provides all the iron needed for the first 6 months
  2. Infants 6–12 months of age ^1,5
     • Infants can continue to be breastfed until 2 years and beyond if mutually desirable
     • Cooled boiled tap water can be offered to infants > 6 months via sipper cup if needed
     • Introduce infants to a range of appropriately textured foods. Tips include:
       • add breastmilk, formula or water to thin consistency and assist swallowing
       • provide thicker foods as the child ages and becomes better at swallowing
         • puréed iron rich meat, cereal, vegetables, fruits, fish and eggs
         • yoghurt and cheese
       • infants should be offered 3 regular meals each day by 9 months
     • Reduce food allergy risk for infants with severe eczema or egg allergy by introducing common allergy causing foods by 12 months in an age appropriate form:
       • well cooked egg, peanut butter/paste, cow’s milk, tree nuts, soy, sesame, wheat, fish and other seafood
       • continue to provide these foods twice weekly to maintain tolerance
       • refraining from offering can result in infant developing food allergies
     • Avoid honey which can contain bacteria that causes botulism in infant < 12 months
     • Avoid takeaway foods, cakes, biscuits, lollies, ice cream and deep fried foods
     • Avoid high salt foods which harm babies underdeveloped kidneys
  3. Infant 1–2 years of age ¹
     • Formula-fed infants can switch to full fat cow’s milk from 1 year of age: low-fat and reduced-fat milks are not recommended in the first 2 years of life
     • Encourage only water or milk from a sipper cup or cup
     • Offer infants up to 6 small meals a day including:
       • nutritious fruit, vegetables, meats and dairy
       • eating similar healthy foods as the family
     • Avoid tea, coffee, cordials, sports and energy drinks, juice and fizzy drinks
     • Avoid foods high in sugar and fat
  4. Children 2 to < 15 years of age ²
     • Offer a variety nutritious foods to grow and develop normally including:
       • vegetables, legumes and fruits
       • cereals, breads, rice, pasta and noodles, preferably wholegrain
       • lean meat, fish, poultry and eggs
       • reduced fat milks, yoghurts, cheeses and alternatives
       • water only
       • foods low in salt
     • Avoid nutritionally poor foods high in saturated fats, salt and sugar
     • Avoid soft, sports and energy drinks, cordial, fruit juices, tea and coffee

4. Referral

• Consider barriers to healthy eating such as finances, location and availability of
  nutritious foods and refer accordingly. Consider referrals to:
  • dietitian and community nutrition team
  • child health nurse or health worker
  • MO/NP or paediatrician
  • social worker
• For any concerns about a child’s nutritional intake refer to the dietitian

5. Follow-up

• Place the child on a recall register 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

1. Australian dietary guidelines