The Importance of the Child Health Check
MissC recently had her 18 month check. While not a complete disaster, it was hardly the experience I would have hoped for.
It had been ten months since MissC's last child health visit and the last time I had checked in with a health professional about whether she was on track. Although she seemed pretty normal I was hoping for an objective opinion on the issue.
Unfortunately, at least in Western Australia cutbacks seem to have derailed the child health checks so rather than the nurse doing an assessment you have to report their behavior on a checklist and they talk to you about it in a noisy hall with little privacy.
I was rather less than impressed.
Apparently however this is not isolated to WA. In the U.K. they have also moved away from routine checks to targeted checks. This appears to be primarily based on financial and staffing issues rather than evidence as to the benefits of the check ups.
I was having a look to see if there was some sort of press release about this and I found something even more shocking. Only 30% of parents were even bothing to take their child to their 18 month checks and only 9% were taking them to their 3 year check ups (http://www.ccyp.wa.gov.au/stateofcyp/files/CCYPChildhealthchecks.pdf)
People you need to take your children to their development checks.
Why?
For one thing because if there's something wrong, the child health check can pick it up, assess the severity of it and get you referred for treatment quicker. One retrospective UK study found that 68% of school aged children with developmental disorder had been referred for assessment due to the child health check. 15% of those not referred from a child health check were older than 3.5 when they were finally referred for assessment (Tebruegge, Nandini & Ritchie 2004). In Australia, few children are diagnosed before the age of 3 in spite of signs being present earlier (Barbaro, Ridgway & Dissanayake 2011) but additional training of child health nurses and the uses of specialised tools to screen children for autism or other developmental disorders (such as those used in Japan - Honda et al 2009) can increase this diagnosis rate. Early intervention is agreed to be all important in the treatment of these conditions so early diagnosis is paramount.
Well I know there's nothing wrong with my child.
You sure? No niggling little concerns?
Well....
Remember that there is data showing that structured methods such as those used by child health nurses increase pick up rates in comparison to informal or parental report (Bellman & Vijeratanam 2011). Even if the behavior is not a sign of a developmental disorder, which is likely you will still receive evidence based advice on how to deal with the behavior. Finding this information on your own is difficult.
No.
There are other benefits for the child health check outside of the detection of developmental disorders.
There is the access to evidence based advice that may be for things you have not yet encountered such as toilet training or tantrums.
They also weigh and measure them. Although you may have scales at home, children of this age are notoriously difficult to measure accurately so a length measurement by a professional is always an asset. Additionally the large benefit of weighing and measuring a child lies in the plotting of any changes on a growth chart and the correct interpretation of this information so a review of their height and weight by a health care professional is essential in the maintenance of their good health (NHMRC Dietary Guidelines for Children and Adolescents 2003).
They check their eyes and teeth
References
Barbaro, J. Ridgway, L. & Dissanayake C. 2011. Developmental Surveillance of Infants and Toddlers by Maternal and Child Health Nurses in an Australian Community-Based Setting: Promoting the Early Identification of Autism Spectrum Disorders. Journal of Pediatric Nursing. Volume 26. Issue 4. 334-347
Bellman, M. & Vijeratnam, S. 2012. From Child Health Surveillance to Child Health Promotion: A Tale of Babies and Bathwater. Archives of Disease in Childhood. 97. 73-77
Honda, H., Shimizu, Y., Nitto, Y., Imai, M., Ozawa, T., Iwasa, M., Shiga, K. and Hira, T. (2009), Extraction and Refinement Strategy for detection of autism in 18-month-olds: a guarantee of higher sensitivity and specificity in the process of mass screening. Journal of Child Psychology and Psychiatry, 50: 972–981. doi: 10.1111/j.1469-7610.2009.02055.x
Tebruegge, M. Nandini, V. & Ritchie, J. 2004. Does Routine Child Health Surveillance Contribute to Early Detection of Children with Pervasive Developmental Disorders? An Epidemiological Study in Kent U.K. BMC Pediatrics 4:4
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n34.pdf
It had been ten months since MissC's last child health visit and the last time I had checked in with a health professional about whether she was on track. Although she seemed pretty normal I was hoping for an objective opinion on the issue.
 |
| Real normal |
Unfortunately, at least in Western Australia cutbacks seem to have derailed the child health checks so rather than the nurse doing an assessment you have to report their behavior on a checklist and they talk to you about it in a noisy hall with little privacy.
I was rather less than impressed.
Apparently however this is not isolated to WA. In the U.K. they have also moved away from routine checks to targeted checks. This appears to be primarily based on financial and staffing issues rather than evidence as to the benefits of the check ups.
I was having a look to see if there was some sort of press release about this and I found something even more shocking. Only 30% of parents were even bothing to take their child to their 18 month checks and only 9% were taking them to their 3 year check ups (http://www.ccyp.wa.gov.au/stateofcyp/files/CCYPChildhealthchecks.pdf)
People you need to take your children to their development checks.
Why?
For one thing because if there's something wrong, the child health check can pick it up, assess the severity of it and get you referred for treatment quicker. One retrospective UK study found that 68% of school aged children with developmental disorder had been referred for assessment due to the child health check. 15% of those not referred from a child health check were older than 3.5 when they were finally referred for assessment (Tebruegge, Nandini & Ritchie 2004). In Australia, few children are diagnosed before the age of 3 in spite of signs being present earlier (Barbaro, Ridgway & Dissanayake 2011) but additional training of child health nurses and the uses of specialised tools to screen children for autism or other developmental disorders (such as those used in Japan - Honda et al 2009) can increase this diagnosis rate. Early intervention is agreed to be all important in the treatment of these conditions so early diagnosis is paramount.
Well I know there's nothing wrong with my child.
You sure? No niggling little concerns?
Well....
Remember that there is data showing that structured methods such as those used by child health nurses increase pick up rates in comparison to informal or parental report (Bellman & Vijeratanam 2011). Even if the behavior is not a sign of a developmental disorder, which is likely you will still receive evidence based advice on how to deal with the behavior. Finding this information on your own is difficult.
No.
There are other benefits for the child health check outside of the detection of developmental disorders.
There is the access to evidence based advice that may be for things you have not yet encountered such as toilet training or tantrums.
They also weigh and measure them. Although you may have scales at home, children of this age are notoriously difficult to measure accurately so a length measurement by a professional is always an asset. Additionally the large benefit of weighing and measuring a child lies in the plotting of any changes on a growth chart and the correct interpretation of this information so a review of their height and weight by a health care professional is essential in the maintenance of their good health (NHMRC Dietary Guidelines for Children and Adolescents 2003).
They check their eyes and teeth
References
Barbaro, J. Ridgway, L. & Dissanayake C. 2011. Developmental Surveillance of Infants and Toddlers by Maternal and Child Health Nurses in an Australian Community-Based Setting: Promoting the Early Identification of Autism Spectrum Disorders. Journal of Pediatric Nursing. Volume 26. Issue 4. 334-347
Bellman, M. & Vijeratnam, S. 2012. From Child Health Surveillance to Child Health Promotion: A Tale of Babies and Bathwater. Archives of Disease in Childhood. 97. 73-77
Honda, H., Shimizu, Y., Nitto, Y., Imai, M., Ozawa, T., Iwasa, M., Shiga, K. and Hira, T. (2009), Extraction and Refinement Strategy for detection of autism in 18-month-olds: a guarantee of higher sensitivity and specificity in the process of mass screening. Journal of Child Psychology and Psychiatry, 50: 972–981. doi: 10.1111/j.1469-7610.2009.02055.x
Tebruegge, M. Nandini, V. & Ritchie, J. 2004. Does Routine Child Health Surveillance Contribute to Early Detection of Children with Pervasive Developmental Disorders? An Epidemiological Study in Kent U.K. BMC Pediatrics 4:4
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n34.pdf
Great article and I agree. I take my children to the hospital quite often! Better safe than sorry. Especially when it comes to getting the right probiotics.
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