THE HSE HAS failed to ensure that all children under the age of six receive developmental health checks, increasing the risk that health and support needs are not identified early, the Ombudsman for Children has found.

The Ombudsman’s ‘Milestones Missed’ report, published this morning, warned that changes introduced in 2022 to manage pressure on community nursing services have left some children without routine assessments.

It also found inadequate systems for keeping track of children in temporary accommodation and major gaps in information about checks that are delayed or missed.

According to the report, the HSE has fully accepted the findings and committed to establishing a national oversight group to implement the report’s recommendations.

The investigation followed complaints from families concerned about missed checks for their children.

Public health nurses assess children’s growth and development, identify concerns and refer them for further support. Their work also includes advising parents and identifying child protection and welfare concerns.

Under the National Healthy Childhood Programme, children should have five core contacts with a public health nurse: a home visit in the first three days after coming home, and checks at three months, nine to 11 months, 21 to 24 months and 46 to 48 months.

However, a prioritisation procedure introduced by the HSE in 2022 categorised patients according to clinical urgency, dependency and vulnerability.

The HSE said this directed resources towards higher-risk cases. The Ombudsman’s office found that its prolonged use had reduced access to routine checks in several areas.

It found that the HSE had “failed to ensure the effective delivery of a universal health examination service to all children under the age of six”.

Our new report, Milestones Missed, has found that some children under six in Ireland are missing out on these important assessments. We're calling for every child to have access to these checks at the right time, no matter where they live. Read our findings here: www.oco.ie/library/mile...

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— Ombudsman for Children's Office (@ocoireland.bsky.social) November 3, 2026 at 10:16 AM

The report warned this increased the risk that developmental, behavioural, emotional and health needs would not be identified and addressed in time.

It stressed that missing a check did not “in itself indicate that a child has been harmed”, but could delay referrals, assessments and early intervention.

The Ombudsman’s office said incomplete data made it difficult to establish exactly how many children had missed checks and why.

Figures provided in response to a parliamentary question showed that 85.8% of babies received their nine-to-11-month assessment before their first birthday in 2025.

The office estimated that nearly 7,700 babies may not have received that assessment on time, using the remaining 14.2% and the number of births registered that year.

The report raised particular concerns about children living in homeless and international protection accommodation, where frequent moves can disrupt contact with services.

It found no uniform mechanism for tracing these children and ensuring their health records transfer when they move.

This created a “foreseeable risk that developmental concerns, welfare concerns and child protection concerns may go unidentified”, it said.

The report recommends a plan to ensure all children receive their checks within a reasonable timeframe, with a system to automatically identify those who have missed them.

It also called for outreach clinics in homeless and international protection accommodation, better transfer of records, stronger support for nurses’ safeguarding work and national reporting on delayed and missed checks.

In its response to the investigation, the HSE accepted the findings and acknowledged that the prioritisation decisions were regrettable and had affected child health services.

It said a national oversight group would oversee a clear, time-bound programme to implement all four recommendations.

Calls for more nurses

The HSE told investigators that recruiting and retaining public health nurses had been a “serious national challenge” for several years and was the main reason for introducing prioritisation.

The report said there was limited evidence that frontline capacity had increased despite additional funding.

Responding to the findings, the Irish Nurses and Midwives Organisation called on the HSE and Department of Health to fast-track recruitment.

The union’s general Secretary Phil Ní Sheaghdha said acknowledging the report was not enough.

“They must back up their regret over missed care with the recruitment and further training of public health nurses,” Ní Sheaghdha said.

“Recruitment must become a top priority in this sector of nursing, with increased training places, increased supports for students in the sector, and focus on funded capacity.”

Ní Sheaghdha said members were doing everything possible to maintain vital checks, but the pressure was unsustainable.

“Our members are doing everything in their power to ensure vital care and health checks in the community are not missed, and that the HSE’s prioritisation policies are adhered to,” she said.

“But the strain of keeping this all going is unsustainable, and the effects are being seen.”