Section 2 - Child health checks

Health check recommendations

• All parents of children aged < 8 years
• All children aged 8 to < 15 years

1. Procedure

• Ask the questions in your own words and words the child understands
• The questions are:
  • general exploratory questions of a parent/child’s wellbeing. They are not diagnostic
  • based on general anxiety disorder and depression based screening tools
• Be prepared for the child or parent to debrief with you. See Engaging our patients
• Provide brief intervention if required
• Determine if the parent or child requires a referral and place on a follow-up and recall register

1. Parents of children aged < 8 years questions
   • Ask parent the questions as per Table 1.
   • Observe how the child reacts or responds to the parent’s cues:
     • do they seek the comfort of the parent if they are hurt or scared?
     • responds positively or negatively to their parent?
     • the child’s facial expressions, eye contact, vocalisations, activity and
       recognition of others around them
     • quiet and withdrawn
   • Observe the interactions, reactions and verbal statements of the parent with the child including:
     • impatience
     • unrealistic expectations e.g. a child should sleep all night and never cry
     • anger towards, yelling at or rough handling of the child
     • limited or no eye contact or communication between the parent and child
     • the parent speaking negatively, e.g. “she does this just to annoy me”, “he hates me” or “I don’t like her”
     • parent is silent, flat or fails to respond to the child’s cues
     • the parent is anxious about the child’s behaviour

2. Children aged 8 to < 15 years questions
   • With consent ask the questions with or without a parent present as per Table 2.
   • If a clinician is uncomfortable asking any questions refer to a senior clinician
   • If children find the questions difficult to understand, reword or rephrase the questions e.g. “is your spirit weak or strong at the moment?”
   • Observe for visual cues (facial expressions, body language) being mindful of cultural aspects of communication (eye contact, bowed head)

2. Results

• If the parent or child talks about harming themselves or some other person refer immediately to the Primary Clinical Care Manual, the MO/NP or mental health services. Do not leave them alone or send away
  1. Parent responses
     • If a parent responds ‘yes’ to any of the questions, offer brief intervention and make an appropriate referral. See Table 3.
     • To determine the urgency for when the parent needs to be seen, perform a 25 item Strengths and Difficulties Questionnaire (SDQ). See Resource 1.
     • If the parent responds ‘no’ to any of the questions and the clinician has no concerns, offer information and praise successes
  2. Child questions
     • If the child scores ≥ 3 for questions i and ii (combined) or iii and iv (combined):
     • perform a HEADDS assessment to determine the urgency for when the child or young person needs to be seen. See Resource 2.
     • refer for further investigation. See Table 3.
     • provide brief intervention

3. Brief intervention

• Infancy is a foundational physical, psychological and social development period
• The quality of the parent attachment relationship and experiences affects a child’s ability to form meaningful relationships, play, communicate, learn, face challenges and temperament (how a child reacts to situations)
• To develop into socially and emotionally healthy adults, children need to feel wanted, loved and secure
• Adverse relationships and experiences increases risks for adverse mental health
• Identify if the child, young person or parent has someone to talk with when they feel worried or scared. If not, provide 24 hour health service details to seek help if thoughts become regular, intrusive or impact on their ability to function
• Discuss how certain feelings or thoughts are normal, but ongoing negative thoughts and feelings require management and monitoring to help feel better
• Discuss how a body reacts to stress, fear, confusion or sadness including:
  • fast heart beat
  • sweating
  • crying
  • shaking
  • sadness
  • anger

4. Referral

• Refer to the Primary Clinical Care Manual if parent or child talks of self-harm or harm to others
• Refer to the MO/NP/mental health services if:
  • concerns are raised by the parent or child
  • you are concerned about the parent’s ability to cope
  • you are concerned about the child’s social-emotional wellbeing
  • you observe relationship or attachment issues between the child and parent
  • a child scores ≥ 3 for questions i and ii (combined) or iii and iv (combined)
• Refer all parents to:
  • child health nurse, MO/NP or Early Intervention Specialist (psychologist or social worker) or
  • perinatal mental health services and
  • a home visiting child health program and
  • parenting program or group e.g. Circle Of Security©, Together in Mind© and
  • local family support services
• Make a Child safety reporting for any child safety concerns
• See Table 3. for further referral options

5. Follow-up

• Place the child or parent on a recall register if required
• Ensure all referrals are actioned
• Provide the child or parent with the next scheduled follow-up appointment

6. References

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

7. Resources

1. The Strengths and Difficulties Questionnaire and how to score
2. The HEADDS assessment
3. Talking with young people
4. Menzies social-emotion wellbeing resources for Aboriginal or Torres Strait Islander people
5. Children of Parents with a Mental Illness (Australian COPMI Initiative)
6. Queensland Centre for Perinatal and Infant Mental Health
7. Child Safety Practice Manual: Mental health and mental illness