The effectiveness of routine health examinations at 2, 6, 9 and 12 months of age: experiences based on data from a Swedish county

Aim The aim of this study was to elucidate the role of health surveillance for infants during the first year of life in detecting severe health proble ms. Two central questions were addressed: (1) what health problems were det ected by routine health examinations at the Child Health Centre at the 2-, 6- and 12-month check-ups by a physician and at the 9-month check-up by a n urse; and (2) to what extent did the health examinations contribute to earl y identification of children with following key abnormalities: congenital h eart disease, congenital dislocation of the hip, abnormalities as registere d at the habilitation centre and severe hearing impairments? Material and inclusion criteria The study population included all children in Uppsala county, born January 1995 to October 1996, who had participated in at least one of the four health check-ups. There were 3107-3487 children in the respective check-ups. Method Data from a county health register as well as child health records a nd information regarding referrals were analysed to categorize the health p roblems by type, severity and action taken, Data on children with key abnor malities were obtained from specialist units. Results The rate of suspected new health problems varied between 1.9% and 2 .8% at the respective check-ups. Of the new problems detected by the physic ian, 21%-36% were false-positive, 34%-44% were minor and 10%-15% were moder ate. Only two severe health problems were detected among all the children d uring the four check-ups. Of all key abnormalities, 20% were detected by wa y of child health surveillance during the first year of life. Implications Severe health problems and key abnormalities in infants were d etected only to a limited extent through routine health examinations at 2, 6, 9 and 12 months of age. The minor and moderate problems detected justify a health surveillance programme, but the organization and content of the p rogramme could be reconsidered.