‘Purple book’ helps maintain early connections with health, according to experts Anne-Marie McHugh and Dr Yvonne Anderson.


All babies and children in Western Australia are offered six free child health and development assessments – also known as the ‘purple book’ appointments – by their local community child health nurse.

Anne-Marie McHugh

Dr Yvonne Anderson

These are offered just after birth, at or around 2, 4, 12, and 24 months, and before starting school.

Unsurprisingly, the COVID pandemic and ever-increasing demands on family life have impacted on the usual routine checks for many families, with 12-month attendance rates currently at around 50% and 30% at two years. 

We need all health professionals to encourage families of the value of the ‘purple book’ appointments to ensure we reach and engage with as many families as possible. 

There are a range of reasons why these assessments are so crucial to child health. The most sensitive period of human brain development is in the early years of a child’s life. It is a key period for shaping the capacity for learning, development, health and social and emotional wellbeing over the life course. 

Universal health assessments offered by community child health nurses are designed to ensure that babies and children requiring extra support from health services are identified early. 

Engaging early with community health nurses allows for knowledge-sharing with caregivers, enabling them to receive guidance about ‘what to expect’ in a child’s behaviour, growth and development in the immediate and long term. 

The assessments focus on ways to provide positive experiences and environments for optimal child development, which in turn, often reduces the anxiety often experienced by new parents and caregivers. 

Wide-ranging topics

Themes covered in the assessments are broad, including attachment, supporting fathers, settling babies, breastfeeding, when to introduce solids, child behaviour, injury prevention and sleep, to name a few. 

“By seeing the child health nurse we can ask if something is concerning us about our children’s development, nutrition or habits and get advice and new knowledge.” (Feedback from the Midland Child Health Checks Project client surveys.)

Population screening and ongoing surveillance of growth, health and development in early childhood is internationally recognised best practice.

A key function of universal child and family community health services is to identify early disability and delay, or health issues (both physical and socioemotional) and support the developing caregiver and infant/child relationship. 

Community health nurses serve as a gateway to a range of other early childhood services such as the Child Development Service, parenting/carer education and support, primary health care, social support, and specialist health services.

Children and families identified early with additional needs can then receive the support they need to achieve the best possible health, development and wellbeing. 

“Meeting and working with you all has helped not only my daughter but my husband, my son and myself so much separately and as a family as we walk through life and live with anxiety. For that I am truly grateful.” (Caregiver feedback received by clinical psychology, Child Development Service.)

Prevention, early identification and intervention during the early years, when there is the greatest developmental plasticity, increases the odds of favourable child development outcomes and makes sound economic sense when compared with remediation later in life.

It is hoped that this approach will increase the likelihood of children achieving their social, educational and personal aspirations. The free service for parents and carers of children aged 0-5 provides not just development checks, but also support, education and information on all aspects of parenting.

When we take a population and preventative approach to child health rather than focusing on a single condition, we not only have the opportunity to identify a range of issues for babies and children, but we have the privilege of partnering with families early in a child’s life course. 

This partnership not only means better health and developmental outcomes, but means we are learning from families to provide better, more accessible healthcare services. 

All health professionals are encouraged to remind families of purple book appointments for their baby or child, which can be made by phoning 1300 749 869. 

ED: Anne-Marie McHugh, Co-Director of Nursing for Community Child Health, is a registered nurse and midwife with experience managing child and school health services. Dr Yvonne Anderson, Associate Professor of Community Child Health, is a paediatrician working in community health, in partnership with Curtin University and Telethon Kids Institute.