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Tasmanian child health nurses are required to perform a number of health and development checks on infants and children at the following recommended ages: 2 weeks, 4 weeks, 8 weeks, 4 months, 8 months, 12 months, 18 months, 3 1/2 years (DHHS 2014). Child health nurses are guided by the checks in the 'blue book' which is given to new parents at the birth of their child and is known more formally as the ‘personal health record’. The DHHS recommends that parents bring their children for these checks (terminology used is ‘these checks are offered to parents’) as ‘babies

grow rapidly and minor difficulties can become serious health or developmental problems if left’ (DHHS 2014). This book was first published in 1995 and reprinted in 2010 and is divided into five sections: contents/appointments, consultation notes, health information, growth charts, and assessments.

The contents/appointments section is a table of contents and a page with a grid/table allowing parents to write in their appointment dates and times. This section also includes a ‘dear parent (congratulations on your new baby)’, ‘your rights (to health,

confidentiality and privacy)’, ’need help (emergency contact numbers)’, ‘child health services in each state of Australia’, ‘contact numbers for parenting lines’, and the

‘Child Health Association Tasmania (CHAT) information’. In the consultation notes section, there are blank pages for both parents and child health nurses to write notes about the checks and a page in which a number of developmental milestones such as

‘smiles’, ‘babbles’ ‘rolls over’ ‘first tooth’ are noted – with an area left for parents to write notes about these milestones.

Within the section entitled ‘health information’ are a number of pages that discuss the following issues: safe sleeping (Sudden Infant Death Syndrome), sleeping and settling, crying, breastfeeding (and blocked milk ducts/mastitis and storing human milk), feeding with bottles, starting solid foods, minor ailments, your child’s teeth,

keep your child safe, sun protection, car safety, toilet readiness, postnatal depression. The final sections refer to per centile charts that track the growth (weight, length and head circumference) of the infant/child and the routine

assessments or ‘checks’. These checks are described as ‘health assessments (which) are one way of identifying concerns about your children’ (DHHS 2010). In each health assessment, or check, there are ‘topics for discussion’ around the time of the assessment (at 2 weeks, 4 weeks, 8 weeks, 4 months, 8 months, 12 months, 18 months, 3 1/2 years) and these relate to the cognitive, social and physical

development of the child and are entitled ‘These are topics you may wish to discuss

with your Child Health Nurse’. Of all the topics, there is one recurring towards the end of each list of topics (at each health check) called ‘maternal health/wellbeing’ that parents ‘may wish to discuss’. Finally there is the issue of immunisation, information about vaccine preventable diseases and a vaccine record.

Of greatest interest for mental health promotion within this personal health record is the information given by the parent run volunteer service ‘Child Health Association Tasmania (CHAT)’ which commenced in 1917. In this information, the Association states ‘would you like to: have fun, make friends with other families in your area,

find out what’s available in your community for you and your children, get lots of information and tips on child development, health and parenting?’ They also state that they have ‘pram walking groups, CHAT and play sessions, family outings,

information sessions, and resources libraries – all at various locations around Tasmania.’ These activities depict clear evidence of community initiation and engagement. Furthermore, they include social networking with free access Tasmania wide and also state that advocacy for parenting is part of their remit (chatas 2014). Hence the information within the personal health record describing the work of the CHAT depicts a strong inclusion of mental health promotion for parents in

Tasmania, should they partake in CHAT’s activities.

There is little evidence, in terms of guiding comments within the health record, that any form of mental health promotion is delivered other than the information provided by CHAT. The personal health record appears to be based on surveillance charts that were instigated in the 1980s (Jeffs &Harris 1993) with little evidence of inclusion of more recent bio-ecological and strengths-based frameworks. These health checks

form a crucial part of reassuring parents that their children are developing at ‘normal’ rates and importantly pick up any deviations for onward referral. However, they do little to promote current parenting capacity other than through reassurance and health literacy: although both of these are important. Overall, the record is discourse-

oriented to ‘concerns’ throughout the document rather than strengths, in turn guiding the child health nurse to discuss only concerns and the parent to discuss only deficits. Identification of concerns and deviations from the norm is crucial in the care of families, in order that they receive appropriate care and so this personal health record is a key tool for child health nursing and for parents – but not for mental

health promotion.

In short, I am highlighting that again child health nurses are using a protocol which is effective in bringing parents to the service, only for the protocol to be deficit-based and as such parents only engage in ‘what causes illness’ as opposed to ‘what creates health’.