Milestones Missed: An investigation into the HSE’s Public Health development checks for children

Milestones Missed: OCO calls on State to take urgent action to ensure all children receive universal developmental health checks  

An Ombudsman for Children’s Office (OCO) investigation has found the State has failed to ensure the effective delivery of universal public health development checks to all children under the age of six in Ireland. The OCO’s Milestones Missed report published today (November 3^rd) outlines our concerns that changes made to the HSE’s system for Public Health Development Checks in 2022 have led to some children missing out on vital developmental checks from Public Health Nurses (PHNs). These changes replaced universal access to development checks, with a prioritisation system. The OCO has found the lack of complete and available data on how many children have missed their checks, and why, also makes it difficult to get a complete national picture of the scale of the issue.  

The OCO has been contacted by families over the years, worried about the impact on their children of missing their checks and the long-term consequences on their development and potential access to services and supports. We believe this has significant implications for children’s rights. We are also concerned that children living in emergency accommodation and in the international protection system are at particular risk due to the transience of their living arrangements.  

The OCO makes four recommendations aimed at addressing the issues identified in our investigation. The OCO’s findings have been accepted by the HSE and it has committed to setting up a National Oversight Group to implement our recommendations. These include putting a plan in place under the National Healthy Childhood Programme (NHCP) to ensure all children receive their checks; making special arrangements for children in temporary accommodation to access PHNs; strengthening the child protection and safeguarding role of the PHN; and developing a national system for collecting data and monitoring PHN child health services.  

Commenting on the Milestones Missed report, Ombudsman for Children, Dr Niall Muldoon said: 

“The first years of a child’s life are essential for their development and wellbeing and can have lasting implications for their health, learning and future outcomes. The universal child developmental health checks carried out by Public Health Nurses in Ireland are a critical part of those early years.  

“As every parent will know, the Public Health Nurse (PHN) plays such an important role for families, not only in identifying any developmental concerns and making referrals to appropriate intervention services, but also for offering support and advice to parents.  

“The early identification of developmental concerns is vital to enhancing outcomes for children and ensuring they receive the necessary services and supports needed at the right time.  As a mandated person under the Children First Act, the PHN is also an invaluable part of our national safeguarding structures. 

“Compounding this issue is the lack of any complete data sets from the HSE, so we can’t actually definitively say how many children have missed their checks, and why.  However, if we take a PQ response from the Minister for Health in January 2026 for example, the figures suggest that around 14.2% of children did not receive the 9 to 11-month developmental assessment within the recommended timeframe the previous year. With around 54,000 births registered in 2025, this equates to around 7,700 babies.  

“The situation is worse in different parts of the country, with blackspots identified in different areas. We are also particularly concerned about those families in transitory living arrangements where frequent changes of address make it especially challenging to access PHN services. It is also happening at a time when children are already facing unacceptable delays in access to assessment and intervention through Child Disability Network Teams (CDNTs), Primary Care Teams, and Child and Adolescent Mental Health Services (CAMHS). 

“There is a clear recognition from the HSE in our engagement throughout this investigation of the vital role played by our Public Health Nurses.  We welcome the HSE’s response to our findings and their commitment to setting up a National Oversight Group to drive the implementation of all four of our recommendations at a national level.  

“My Office will track the progress of this to ensure that the State is following through on its duty to children and restores universal access to development checks so that, regardless of where they live, every child receives them on time.” 

ENDS 

• 3 November 2026
• Type: Press Release