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43
Child Health
The fall in the number of births and of children under 5 in the area has continued. This is the main
reason for a decrease in the number of visits by health visitors. Another reason is the increasing use of the
telephone. More and more mothers telephone centres to ask for advice and many visits are therefore
unnecessary.
The number of attendances at child health centres shows the same downward trend. Because of the
relatively small numbers it has been possible to institute a policy of serial developmental screening of the
total child population. This has involved a re-distribution of work load as between nursing and medical
staff. The Health Visitors have been required to assume greater responsibility for general advice on infant
feeding and child management, thus freeing the doctors to concentrate on the more time consuming, but
vitally important, examinations involved in developmental screening and to devote more time to parent
counselling. A special survey was undertaken in 1971 to see how far total screening of children under 5
years of age was being achieved, records being kept of the actual work done by medical officers in the
clinics. The number of children screened at key ages were as follows:-
Age No. Screened Estimated No. in Population
About 6 weeks 2,024 2,596
About 6 months 1,870 2,360
About 1 year 1,646 2,100
About 2 years 1,320 1,900
About 3 years 833 1,600
About 4 years 671 1,500
In addition to these examinations carried out in child health clinics, serial screening was undertaken by
some G.Ps. in their surgeries, by medical officers in day nurseries and nursery schools and in two hospital
paediatric departments. It can be concluded therefore that at least 90% of children under 1, and 80% aged
1-2 were screened, but after that age the proportion fell to about 50%. For a variety of reasons mothers
have always been less anxious to bring their children to the clinics after the first year. Screening of the total
population in 1-5 age group is not practicable and some selection has to be made in order to ensure that the
vulnerable, those most likely to have developmental defects, are brought forward. These are the children
that health visitors make a point of following up; children with deprived home backgrounds, and children
who fail to thrive. Health visitors are usually successful in persuading the mothers of such children of the
value of a developmental examination, and of the need to attend when necessary for a special appointment.
As a result of developmental screening, children who are retarded or who show any other deviation from
the normal are placed on the register of handicapped children for special observation and follow up. Many
of them will benefit from a period of training in a special nursery or from admission to an ordinary day
nursery. There are others who display behaviour disorders, or who are understimulated at home who may
be recommended for admission to play groups, or to part-time observation nursery groups run by the health
department in the health clinics. The selection of children for special nurseries and nursery groups is one of
the primary objects of developmental screening and one which, as is shown in the next section, may make a
significant contribution to the child's development and adaptation to school entry at 5 years.
Educational classes of all kinds, child management, home management, sewing, cookery, mothers' and
fathers' clubs continue to be run at the health clinics, chiefly by health visitors with help from the ILEA
who provide specialist teachers. The educational and social opportunities provided in the centres are well
recognised by the mothers and in some areas these are becoming increasingly popular. Lessons in English
language for non-English speaking mothers are held at some clinics, and these are again well supported.
Tribute must be paid to interpreters, many of them voluntary, who assist in the clinics. In Westminster with
its embassies, consulates and trade missions, there are many staff families in need of help. Hotels,
restaurants and hospitals are largely staffed by foreign workers so that provision must be made for Indians,
Pakistanis, Italians, Spaniards, Portugese, Maltese and Chinese as well as English speaking immigrants from
the West Indies and Africa.
At one centre a group of mothers with their children meet weekly to discuss their problems with a
psychiatrist. This arrangement has been running for some years and has proved to be an admirable
opportunity for preventive psychiatry; not only do the individual mothers receive help in the management
and understanding of their children, but the local authority staff also learn how to handle the many
emotional difficulties that arise.