Child health surveillance programmes aim to prevent disease, detect physical and developmental abnormalities, and promote optimum health and development. There is growing evidence over the past decade that early intervention can change the life course for disadvantaged children. The emphasis has shifted from detecting developmental problems to preventing them and, in recognition of this change, the term “child health surveillance programme” has given way to “child health promotion programme”. Putting this programme into practice calls for awareness of the evidence as to what works. The evidence supports the need for a universal preschool service for all families and targeted intensive home visiting for high risk children. Preschool intervention and education benefit all children but particularly those at risk of educational failure. Children’s Centres may offer the opportunity to provide a more effective integrated service. The shift from surveillance to promotion requires paediatricians to play several roles in a larger multidisciplinary and multi-agency team, contributing to health promotion as well as facilitating early identification and providing expert diagnostic and management services.

The current interest and investment in the promotion of optimum health and development for children is the result of emerging evidence that outcomes and life chances can be improved by preschool intervention programmes, coupled with growing concerns about health inequalities, educational under-achievement, juvenile crime, and social exclusion.¹ Such concerns are not new; efforts to address their root causes date from the 19th century when there was a major public investment in sanitary reform and other environmental improvements. In the first half of the twentieth century, the major health concerns were nutritional deficiencies and infectious diseases. As these scourges came under control, more attention could be devoted to child rearing issues, …