2yr developmental check

[Polly D]

I hadn't even realised this existed until a diligent friend told me she had taken her 2 year old. So I duly made an appointment at Dulwich hospital about 2 months ago and took my son. The Health Visitor was 45 minutes late and then we were told by a colleague that she had to cancel. She did leave me a message the next day to rearrange but I decided not to bother. I know that my son would not play ball for the appointment: he's a bit wary of docs etc and I think he wouldn't display his, errrrr, best side. I don't have any concerns about his development. I'm pretty confident he's doing what he should be (including the most amazing displays of tantrum meltdowns).

However, now I've received a letter telling me he is overdue his 2 year check. I want to ignore it but what are the consequences?

I know the checks exist for a good reason and I'm not adverse to taking him, I just feel we already tried, and I'm quite sure it will not be a positive/useful experience.

Am I going to get a big black mark next to my name for not going?!

[crystal7]

We've not had ours yet- didn't even know it existed either until a friend told me. I've been ignoring it due to my low opinion of hv and not great experience at 8 month check. Not sure what consequences are though!

[Belle]

I've had no letter - and we had our 8 mth check at 16 mths as I happened to go in for a v rare weigh-in and mentioned the lack of it - was totally pointless. My view is if I don't get summonsed I won't go, and even if I do...not convinced they are necessary unless you have any concerns. Know of people nearby who were told they wojuldn't be able to h ave one due to short staffing so surely not that essential?

[Saffron]

Unless you are due for some immunisations for you LO, or have another health concern, the checks are totally voluntary. However, you might keep getting reminder notices unless you phone to say you don't have any concerns so you're skipping it.

We had an 8 month check last autumn. It was pretty pointless, as I didn't have any concerns. The clinic was a 10 min walk from us, and we got some free baby stuff from the HVs. So that was nice at least. If it had been a hassle to go, I probably would have skipped it.

You might find this page useful:

http://www.healthvisitors.com/parents/development_two_yrs.htm

xx

[snowboarder]

Anyone know what they actually check? Never made the 8m check either!! If they have it at townley rd centre I really won't bother - rubbish and over nap time. Lucky newbie sb is a chubby one like his brother and I'm not bothered about getting him weighed!

[snowboarder]

OOps just realised that's what your like was Saffron!! God not on the ball today at all.

[snowboarder]

OOps just realised that's what your link was Saffron!! God not on the ball today at all.

[snowboarder]

Ok yep yep he's fine. Only he's not terribly possessive of his own toys and can't drink from a cup....! We'll leave it.

[Polly D]

That's a really helpful link Saffron, thanks. R seems to tick most boxes I'd say. I'm tempted to go just for the free baby stuff but think the drama really won't be worth it. However, I am taking him to the dentist for the first time this week - wish me luck!

[edanna]

I don't think they can do anything to you - it's not a legal requirement. But you get the Bookstart stuff - while the funding lasts - and my little boy enjoyed the opportunity to show off. They are checking fairly basic stuff, which I'm sure you could check yourself - it's well intentioned, to pick up any issues with sight/speech/movement etc that might benefit from early attention. I'm sure you could ask someone to come to your house if you wanted.

[crystal7]

Thanks for the link Saffron. E seems to tick all boxes athough like little SB she is not possessive over own toys, I just thought that was good natured!

Off topic: when do they get an awareness of danger?! Playground visits have just got quite stressful!

[Belle]

Hmm, J can do most of this I suppose, just chooses not to (e.g. drink from cup/kick ball) - guess these things are always a bit arbitrary. I'm not averse to going along but they haven't contacted me so can't really be bothered to chase up.

[crystal7]

I feel the same Belle, if it was that important why don't they contact you requesting you make an appointment?!

[buggie]

... wonder if number of developmental checks done has an effect on budget/bidding for services from the Primary Care Trust??

Know HV's are generally rubbish, but for the sake of the few good ones/the amount of child protection issues that are picked up/monitored by the HV team, for the sake of a few hours it could be worth attending to try and break the vicious cycle.

Also, always worth complaining after poor service in baby clinics. I wrote a huge complaint about the baby clinic I use (to Southwark PCT PALS - googled them and wrote the email on my phone while stuck in a v long wait to get the bugglet weighed!), asked for it to be formally investigated and as well as getting a long letter addressing my complaints within 4wks (the PCT has to both acknowledge and respond in a set time frame), there have been changes to the running of the baby clinic - while not perfect it's a huge improvement. Health service managers wear big blinkers and often don't take on board what their being told by front line staff, but if a member of the public complains then it prompts them to respond.

Know if everyone on here who has had HV issues/problems wrote to PALS in one go they'd be snowed under, but think it could be the sort of kick up the a**e they need ;-)

[Pickle]

My daughter will be 3 in June and I had completely forgotten about the 2 year check!

I do remember my son's one though. As he chatted away I was asked whether he could talk. She measured him and asked whether I was worried about his height (had never given it a thought). Complete waste of my time so I'm not in a hurry to go through it a 2nd time.

[crystal7]

oops somehow managed to duplicate previous post!

[laurac]

When we lived in Camberwell HV called to do my daughters 2 year check over the phone - more than a year late! Was all a bit pointless. Had 8 month check for my youngest a few weeks ago and was told that a lot of places are cutting the 2 year check although HV attached to the Townley Road clinic are continuing to do it.

[pommie]

we didnt even bother with our daughters 2 year check. I think if you feel your child is developing well, talking etc then not to bother.

[mumof3girlies]

Having worked as a HV in Southwark and now work in child protection/children's services in Southwark I am acutely aware that the health visitors in East Dulwich are absolutely snowed under - mainly with new babies and an average caseload of a health visitor in ED has up to 25 new babies born a week - you can imagine it's like fighting fire, the demographic in ED has changed so much in the last 10 years, services are struggling to keep up with the extremely high numbers of babies being born - the issue of primary school places is testimony to that. I am not sure Buggie that making comments like "HVs are generally rubbish" is very constructive, especially from someone who is a nurse and works in the NHS, we are all up against it in the current NHS climate where there is no funding and posts are being cut on a daily basis.

But on the subject of the validity of the 2 yr check I would recommend that if you have no concerns about your child, particularly their speech, it's not the end of the world to miss it but if you have any concerns at all about their speech/development/growth definately chase it up with your HV. However it is worth bearing in mind that many HVs due to staffing shortages have to prioritise to only doing 2 yr checks for families with child protection concerns, so are unable to offer routine checks to otherwise 'normal' families, not ideal but that is the current situation and not that they need a kick up the ar*e as previously speculated. Most HVs are working with caseloads of up to 700 families - quite a feat on 37 hours a week of work!

I would encourage writing to the PCT and to PALS if you are unhappy with the HV service as this is the only way 'management' will finally realise that you cannot run an adequate service with so little staff.

[buggie]

I am not sure Buggie that making comments like "HVs are generally rubbish" is very constructive, especially from someone who is a nurse and works in the NHS, we are all up against it in the current NHS climate where there is no funding and posts are being cut on a daily basis.

I agree that that one part of my post wasn't constructive, but can you pick fault with the rest of the sentence or post?? I went on to talk about the lack of funding/shortages in staffing in your profession and advised continued support of them/gentle lobbying via PALS when service hasn't met expectation.

However, the issues are split like a fork, down one prong there is the shortage of HV's and subsequent long waits in baby clinic, the HV's being unable to give a more personalised service which comes as a shock especially if a mum has been with one of the community midwifery teams. Would take a guess that the shortages in staff/funding also lead to a shortage of team days/training updates that would help ensure correct/up to date advice.

On the other fork is the inconsistent/incorrect/inappropriate advice given - before I had my baby I'd have parents attending A&E who (while often not attending due to) would ask for advice/report concerns on what their HV had told them/had got them worried about things that would turn out to be fine.

Ironically, one of the big things causing concern would often be related to weight, and I had issues myself with this. Bugglet was nearly ref up to out pt's as she was below the 0.4th centile - she was tiny at birth and had consistently put weight on but was shadowing the 0.4th centile (actually staying on a consistent line) and I was told that she needed to be ref'd to out pts - thus bringing back to the surface worries and insecurities I'd had about how well she was feeding and at the same time feeling that I couldn't put my foot down and say I didn't want her ref'd as I thought it could label me as "difficult" (and as a fellow health professional I didn't want to be obstructive). Luckily, it turned out the referral would need to come from a GP and having had them rush us in to see the GP, he agreed that there wasn't a problem and that while tiny, she was hitting milestones on the button and showed no signs of being unwell.

I then had the HV tell me her daughter had been "just like mine, and just tiny, and grown up and v well now" I wanted to ask her how she'd have felt had someone put her through what she'd put me through about her daughter's growth.

All the Mum's I know have had experiences with HV's that have been far from ideal - both on the forum and in real life. Looking on Mumsnet as well shows it's by no means only a local issue, the real question should be, what can be done/what can we do to try and improve provision and service?/is proper research needed to establish what is needed to support the area?

[Saffron]

Just out of curiosity what training do HVs receive? I ask b/c of having received such conflicting advice myself from HVs. HVs are stuck trying to do it all in some cases it seems. People want advice on lactation, weaning, sleeping, teething, weight-gain, jabs, PND etc. From my experience, it seemed that a lot of the advice that I got was unscientific and based simply on their opinions.

I mind don't friendly opinions. What I can't abide is opinion masquerading as fact. (And it's not just HVs who seem to have this problem!)

Is it the case that HVs don't have time to attend training days? Are there not enough training days? Who sets the training topics, and where do they get their data?

In particular, I found that HVs had little good knowledge of breastfeeding-related issues. For example, exclusively bf babies often *appear* slow to gain weight, when in fact the opposite is true: formula fed babies generally gain weight quickly. Therefore *supposed* slow weight gain in bf babies is not a sign that the mother's milk is low. And neither is the inability to mechanically express milk a sign of low supply.

On the otherhand, one very helpful HV advised me that we would probably qualify for child tax credits, which I would have had no idea about otherwise.

Excluding training and under-staffing issues, perhaps the problem with HVs is a perceptual one? So many people seem to want advice from HVs, but the HVs' real concerns are related to screening. They are on the lookout for problems. So they have to have a criteria for 'normal'. If your baby doesn't fit into this criteria, then the HV can refer you on to someone else.

Here's where the perceptual problem comes in. The perception is that you'll be assessed on a rational and even basis and referred to the proper specialist. But that isn't always the case. Maybe instead of lecturing advice or giving referrals like royal mandates (ok, not all HVs do this, I know...), HVs should offer parents more options about which specialists might be able to help.

For example, does the mother of an exclusively bf baby who *might* be gaining weight slowing need a referral to a dietitian or a lactation consultant? It's a matter of opinion, not fact. Surely the mother should have some choice in the matter?

Well that's my diatribe for the morning. To bring the discussion back to topic... Whether or not you take your child to the 2 year developmental check with your HV might depend on how you perceive the HV's role in your child's welfare.

If you don't have any concerns for your child, then you probably don't need to go. And from the sound of it, you'd be freeing up time for someone who might have a serious problem with their child's speech or hearing etc, to get a personal contact point within the NHS.

[buggie]

Saffron - All HV's are trained nurses, but majority are (I believe) adult trained. Know when I did my training we were advised to do Adult branch rather than Chikd branch which seemed strange but i believe things have now changed.

My comment on training/team days was based on experience in my own area - if you're short staffed the pressure is on to cover you so you're unable to do them - in A&E we can't close for a couple of hours for staff training/meetings and can imagine similar pressure in the community.

[Moos]

Defensive responses to criticism on an informal public forum are also unhelpful. NHS staff are also entitled to express their opinions based on personal experience! Most of the criticism I've read of HVs (see my previous post for my personal views and experience of HVs) has had less to do with the heavy case load HVs have to deal with, and more to do with poor advice or unhelpful attitudes experienced.

[Fuschia]

What I find particularly weird about hvs is surely all heLtj professionals are onloged to only give advice within official guidelines, so assuming that is the case , why do hvs not do that in relation to breastfeefing and weaning?

[mumof3girlies]

I really don't want to get into an extended exchange about the criticism of HVs etc etc (imminent house move and extensive renovation) but just want to respond to some comments - this is the first time I have commented on the many negative comments on HVs on EDF, haven't previously felt the need and I do accept that there are HVs out there who are quite old-fashioned/out of date but it is my profession and has been for 10 years and I do have professional pride so Moos please do excuse me for picking up on one comment which I found I felt was unfair, and I would say I was offering an alternative perspective rather than being defensive actually.

I completely accept the criticism that a lot of HVs give conflicting advice and I too have found this as a mother, however the role of health visitor is incredibly broad - child development, public health, parenting, child protection and family support. I have worked in many areas of the NHS over the last 20 years, oncology, sexual health, HIV and midwifery and I can honestly say that it was much easier to become an 'expert' in a more specific subject area. I am merely reflecting on whether the role of the HV needs to be re-defined and I also really think that more consultation with families who use the the service would be crucial.

I also wanted to add that HVs are all human and we all have a different range of experience and cannot give a uniform answer on every single topic we are questioned about, we do however follow the NICE guidelines on weaning, management of diarrhoea, and the baby friendly initiative guidelines for breastfeeding for example. On the subject of training - just wanted to clarify that training is offered on a wide variety of subjects but it is down to individual HVs to choose which training they attend and some don't see it as a priority and are quite resistant to learning about new practice and research. I guess I am coming from a place of being very aware that health visiting is a challenging job and HVs are visiting families who are on the fringes of society and often live in very deprived and sub-standard housing situations, I was assaulted by a group of 15 boys on an estate in the Elephant and Castle which ultimately led to me taking a job which is office based and more managerial. Not being defensive just illustrating where my motivation lies for contributing to the thread..:).

edited for typos