Childhood screening and immunisations

Immunisation is the safest and most effective way to protect children from disease. Health practitioners and early years professionals have the responsibility of explaining this to parents and carers as well talking to and listening to parents about their concerns.

Emphasis should be on when and why immunisation is necessary, how safety and risk are understood and weighed, and what to do if immunisations are missed. 

Immunisation Scotland is a comprehensive online guide to immunisation and vaccines. Find out why immunisation is important, when to immunise, what vaccines are available and how they protect against serious diseases such as measles, mumps, whooping cough and polio.

Immunisation and Screening and inequalities in 3-5s

Immunisations and screening tests for health problems help reduce health inequalities by preventing infections and securing appropriate early treatments and other supports.

Immunisation rates are lower among children living in deprivation and some other groups experiencing inequalities.

Quick links:

What are health inequalities?

The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."

For a fuller discussion, please see Inequalities in the Early Years.

Policy context

Activity in this area is consistent with commitments and priorities detailed in The Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, a range of NHS Scotland's Quality Indicators, and is relevant to Scotland's national practice model for child-centred services - Getting it Right for Every Child (all external links).

What are the screening tests and immunisations for 3-5s?

Between the ages of three years and four months and five years of age, all children are routinely immunised against diphtheria, tetanus, polio, pertussis and measles, mumps and rubella. Where appropriate, they may also be immunised against hepatitis B and tuberculosis. All routine immunisations are organised centrally by NHS Scotland.

Most children are given a hearing and sight test just before or at entry to primary school. These tests are organised and delivered at a local level by health boards and their timing and availability may vary.

For more information on routine immunisations, please visit the schedule pages at Immunisation Scotland (external link) or download A guide to childhood immunisations up to 5 years of age (external link)

When are immunisations given and what are they?

Between 3 years 4 months and 5 years:

  • DTap/IPV or dTap/IPV - protects against Diphtheria, tetanus, pertussis (whooping cough) and polio
  • MMR - protects against measles, mumps and rubella (German measles)

For a comprehensive overview of routine immunisations, the vaccines used and answers to common questions, please visit the immunisation schedule pages at Immunisation Scotland (external site).

How do inequalities impact on childhood immunisations and screening in Scotland?

Overall rates of childhood immunisations in Scotland are high and exceed the 95 per cent target rate. (ISD Scotland: Childhood Immunisation Statistics 2012 (external Link)).

However, there is a social gradient whereby rates are lowest among children in the most deprived areas and highest in the least deprived areas, as measured by Scottish Index of Multiple Deprivation 2009 quintiles (ISD Scotland: Primary Immunisation Uptake Rates by Deprivation 2011 (.xls download 192kb)).

Chapter 2 of NICE Public Health Guidance 21: Reducing differences in the uptake of immunisations (external link) lists other risk factors for not being properly immunised which including a number of groups known to be at greater risk of experiencing health inequalities. Please see the list below under identifying those at risk.

Identifying those at risk

Health visitors and GPs should routinely ask parents and check immunisation records in handheld notes (the 'Red Book') as well as other available records whenever they are in contact with a child.

Children in the following groups are identified as being at increased risk of not following the full routine programme of immunisation:

  • those who have missed previous vaccinations (whether as a result of parental choice or otherwise)
  • looked after children (children in local-authority care)
  • those with physical or learning disabilities
  • children of teenage or lone parents
  • those not registered with a GP
  • younger children from large families
  • children who are hospitalised or have a chronic illness
  • those from some minority ethnic groups
  • those from non-English speaking families
  • vulnerable children, such as those whose families are travellers, asylum seekers or are homeless.

(Ch.2 NICE Public Health Guidance 21: Reducing differences in the uptake of immunisations (external link))

A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families of younger children.

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Articles in this topic

Professional support materials

Information for the public

  • External Resource

    Immunisation timeline: Immunisation Scotland

    Full details of the immunisations available in Scotland, the diseases they protect against and when they should be given.

    • When was this published? 9/27/2010
  • External Resource

    Ready Steady Toddler!

    A website for the public with information, tips and advice for bringing up toddlers.

    • When was this published? 9/30/2010
  • External Resource

    You and your little child

    Book for parents with learning disabilities with children aged 1 - 5 years. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Toddler! To order contact

    • When was this published? 2/15/2011