Is pre-school child health surveillance an effective means of detecting key physical abnormalities?

Background. The effectiveness of child health surveillance (CHS) screening is still being questioned. There has been little work on the quality of CHS provided in primary care following the shift in provision encouraged by th e 1990 Contract. Aim. To determine the effectiveness of primary care CHS screening for five physical conditions: undescended testes, congenital heart disease, squints, developmental dysplasia of the hip, and congenital hearing loss. Method A prospective study of a one-year cohort of children born to mothers registered with one-quarter of general practices in a single health author ity. At age 15 to 18 months, all referrals for the five physical conditions were traced through hospital record systems and copies of CHS reviews from the children's personal child health records. Results. From an initial cohort of 2308 babies, 1972 (85%) were followed up . Four hundred and thirteen (21%) children had been referred for one of the five physical conditions. Of the children referred, 395 (91%) were referre d directly from CHS reviews. Forty-nine (12%) children were found to have a n abnormality requiring treatment or follow-up and, of these, 41 (84%) were referred from CHS. The sensitivities of CHS screening for the five conditi ons were generally high, but the false-positive rates were also high, espec ially for developmental dysplasia of the hip and hearing loss. Conclusion. The majority of children with undescended testes, congenital he art disease, squints, developmental dysplasia of the hip, and congenital he aring loss presenting during the first 18 months of life are detected by ch ild health surveillance.