The 6-8 week review form is generally completed at around 6-8 weeks after the birth of the child and is often a health visitor and GP combined review.

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https://www.isdscotland.org/Health-Topics/Child-Health/Child-Health-Programme/Child-Health-Systems-Programme-Pre-School.asp

The 6-8 week review form is generally completed at around 6-8 weeks after the birth of the child and is often a health visitor and GP combined review. Examples of information collected include: feeding of baby (breast, bottle or both); parental concerns (feeding, appearance; behaviour; hearing; eyes; sleeping; movement; illness; crying; weight gain and other); development (gross motor, hearing & communication, vision & social awareness); physical (length, weight, heart, hips, testes, genitalia, femoral pulses and eyes); diagnoses/concerns (Read coded); sleeping position (prone, supine and side). Identification data such as name, address, GP etc. are also checked and updated.

HDR UK

National Services Scotland

CHI no

Demographic / Birth details

Child’s ethnicity as stated by their primary carer

Ethnicity

Name of General Practitioner where the child is registered on CHI

Results of the child’s newborn hearing screening relating to right and left ears

Newborn Hearing 
Screening Results 
(R & L)

Country of birth of child / parents / grandparents

TB risk status

Gender

Date Health Visitor first visit was completed

Date of visit / review / assessment

Is child regularly exposed to second hand smoke within their home, car, and/or care environment from any source?  Exposure in the home means anyone smoking anywhere inside the house or on the doorstep with the door open.  Regularly means once a week or more frequently.  If the child is exposed to vapour from e cigarettes only, they should not be classes as exposed to second hand smoke.

Child exposed to 2nd hand smoke

Is the child routinely exposed to more than one spoken language in their home and/or care environment?

Bilingual/multilingual

Is the child’s primary carer a current smoker?  Primary carer refers to the adult living (at least most of the time) with the child who provides most day to day care. If a carer uses e cigarettes only, they should not be classed as a current smoker.

Primary carer current smoker

Start of scheduling period the child health review was scheduled to take place

Scheduled date of review

If any pre-printed demographic data is incorrect it should be updated in the Change of Details box 
Updated Health Visitor identification number for Health Visitor responsible for the child’s care

Change of

Is the child currently (at the time of the review) looked after by the Local Authority for any reason?

Current LAC status

General Practice or community clinic where the child should be scheduled to receive child health reviews

Treatment Centre

Has child received Vitamin K by intramuscular injection  or orally?

Vitamin K given

Name/address/ postcode

Does the child routinely sleep on their front (prone)? on their back (supine)? on their side?

Sleeping

Health Visitor identification number for Health Visitor responsible for the child’s care

Health Visitor

Is English the main language spoken in the child’s home?

Is English 1st language at home?

Carer(s) present with child at review.  Primary carer refers to the adult living (at least most of the time) with the child who provides most day to day care.

Carer present with child (At Review)

Blood Spot Results for the child relating to the following conditions: PKU: Phenylketonuria, TSH: Congenital hypot, CF: Cystic fibrosis, MCD: Medium chain acylhyroidism, HBO: Haemoglobinopat-CoA dehydrogenase deficiency hy, HCU: Homocystinuria, MSU: Maple Syrup Urine Disease, GA1: Glutaric Aciduria type 1, IVA: Isovaleric Aciduria. Health/screening departments from the national screening laboratory.  Results are input into SIRS by administrative staff then printed onto 6-8 week CHSPPS forms generated for children.

Blood Spot Results for the child relating to the conditions

During the child health review, has the child’s carer raised specific concerns about any of the areas listed?

Concerns raised by carer

Method of feeding that the child has received over the 24 hours prior to their child health review. 
B  (breast milk only) 
F  (formula milk only) 
M  (mixed breast & formula milk) 
O  (other) 
U  (unknown)

Current feeding

Feeding details

Since birth has the child ever been put to the breast to feed or been given expressed breast milk?

Ever breast fed

From birth has the baby only ever been fed breast milk and no other liquids or solids apart from medicines or vitamins?

Always exclusively breast fed

Age of the baby when they were last breastfed (either put to the breast to feed or given expressed breast milk)

Child’s age when breastfeeding stopped: weeks, days

Duration of recall/ follow up appointment to be scheduled 
S (short) 
M (medium) 
L (long)

Appt

Issues / Issues Status / Read Coding.   Recall & Unscheduled reviews

Date of the previous review where the recall/follow-up was requested

Recall requested on

List of any issues likely to be relevant to the child’s ongoing health, development, or wellbeing.  Up to 4 issues can be recorded on any one form.  Extra forms can be used to record additional issues if required.  There is no upper limit to the number issues that can be recorded on the system.

Summary  List of issues

Indicates the status of each listed issue 
0	(referred/assistance requested) 
1	(issue ongoing) 
2	(no longer has issue) 
3	(amend issue) 
4	(no information available) 
5	(issue/code incorrectly recorded) 
6	(discharged due to DNA – did           not attend)

Issue status

Recall/ follow up appointments are in addition to the national schedule of universally offered child health reviews and are only requested by Health Visitors when clinically necessary. 
The interval specified must be greater than 4 weeks to ensure adequate time is available for the results of the current review to be input into CHSP-PS and the recall appointment invitation issued. Note Recall to GP is only on the 6-8 Week & Recall Forms

Recall to  HV/GP in

Reason why an unscheduled review form has been completed for the child 
1 (transfer into caseload) 2 (outwith age range for routine      contact) 
3	(change of HPI – Health Plan  
    Indicator – outwith routine contact) 
4	(referral outwith routine contact)

Reason for using this form

Read code relevant to each issue listed by the Health Visitor responsible for the child health review (see above)

Read code

Reason for recall

Reason for recall as noted n the previous review form

Reason for Recall

Review carried out 
-on examination 
-by telephone 
-by review of notes

Record of specific actions the Health Visitor intends to take to support the child/family following the child health review. 
‘Provide’ indicates that the Health Visitor and/or associated skill mix team will directly provide the specified additional support (only relevant for some options). ‘Signposted to’ indicates that parents have been given details of specified local services and how to access them. 
‘Discuss with’ indicates that the Health Visitor will formally discuss the child/family with the specified service to inform future management plans. 
‘Request assistance from’ indicates that the Health Visitor will formally refer the child/family to the specified service, whilst retaining responsibility for oversight of the child’s wellbeing and outcomes as their GIRFEC named person. 
W ‘Refused’ indicates that the carer has been offered provision/ signposting/ discussion/ referral to the specified service but has refused this.

Future Action

Scoring of the developmental assessment undertaken as part of the child health review relating to the specific development domains

ASQ Score

Developmental / ASQ Scores / Tools

Results of the developmental assessment undertaken as part of the child health review relating to the specific developmental domains 
C - Concern newly suspected means that the concern has been identified for the first time as a result of the assessment undertaken within the child health review. 
P - Concern/ disorder previously identified means that the child was known to have developmental delay or a specific developmental disorder prior to the child health review being undertaken.

Development 
-Speech, Language 
  & Communication 
-Problem Solving 
-Emotional/Behavioural 
-Gross Motor 
-Personal/Social 
-Vision 
-Fine Motor 
-Hearing

Occipito-frontal circumference in centimeters to one decimal place

Child’s weight in kilograms to two decimal places

Weight

Child’s length or height (depending on child’s age/form) in centimeters to one decimal place

Length / Height

Results of the physical examination undertaken as part of the child health review relating to the organs specified (right and left where applicable) 
N (normal) 
A (abnormal) 
D (doubtful or uncertain) 
I (not done/incomplete)

Physical examination 
-Heart 
-Hips (R and L) 
-Testes (R and L) 
-Genitalia 
-Femoral pulses (R & L) 
-Eyes (red reflux) (R & L)

Date on which growth measurements were taken

Date measured

Record of any validated developmental assessment questionnaires/ tools completed as part of the child health review 
01	PEDS (Parents’ evaluation of       developmental status) 
02	PEDS:DM (Parents’ evaluation       of developmental status:       developmental milestones) 03 ASQ 3 (Ages and stages       questionnaire version 3) 
05	SDQ (Strengths and difficulties       questionnaire) 
06	ASQ:SE (Ages and stages       questionnaire: social and       emotional version 2) 07 SSLM (Sure start language       measure) 
08 M-CHAT (Modified checklist for       autism in toddlers) 
10	Other (indicates a different       validated developmental       assessment questionnaire was       administered as part of the child       health review) 
11	None

Tools

Signature and name of the health professional(s) completing the CHSP-PS form

Signature Print name

Health Plan Indicator / Support Needs Status / Parental Consent

Health professional(s) directly involved in delivering the child health review 	Must complete one box with Y (yes)

Practitioners involved in review:

Professional identification number of the health professional(s) completing the CHSP-PS form

ID No:

Child’s status on the Support Needs System 
0	(Not active on SNS) 
1	(Active – not yet notified to doctor) 
2	(Active – not yet assessed) 
3	(Active – being assessed) 
4	(Previously on SNS) 
8 (No planned assessment)

Support Needs Status

Updated Health Plan Indicator recorded at the end of the child health review. See Health Plan Indicator variable above for full definition. 
C (core) 
A (additional) 
U (unknown)

Updated HPI

Summary indicator of the child’s overall need for ongoing support. 
An additional HPI indicates that the child (and/or their carer) requires sustained (>3 months) additional input from professional services to help the child attain their health or development potential.  Any services may be required such as additional Health Visitor support, parenting support, enhanced early learning and childcare, specialist medical input, etc. 
C (core) 
A (additional) 
U (unknown)

Child Health Systems Programme - 6-8week review

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