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and the technical difficulties experienced in the previous year when the test was introduced have
been resolved as the nursing staff have had greater opportunity to become skilled in obtaining
samples. The test is carried out on the sixth day of life by the midwife, and involves pricking the
baby's foot to obtain drops of blood of a specified size. These are collected on a special filter paper
which is posted to the regional centre for processing.
The regional laboratory has now extended its screening facilities and since July 1971 tests
for the diseases of histidinaemia and homocystinuria have been carried out on the specimen
collected for the detection of phenylketonuria. It is anticipated that further rare diseases may
ultimately be included in this single screening procedure.
There were no cases of phenylketonuria or of similar metabolic errors detected in the Borough
during the year.
CHILD HEALTH CENTRES
Dr. V. M. D. N. Shaw—Principal Medical Officer (Personal Health)
The modern concept of a child health centre was outlined on page 28 of the annual report
for 1970. The gradual change in emphasis so that developmental screening received major priority
has continued but was limited by the reduction in the number of medical sessions allocated to
this important work some years ago. Arrangements were completed by the end of the year to
restore the medical supervision to previously agreed levels, and the work received added impetus
through the introduction of management by objectives which required the explicit statement of
the standard of service required.
The aim of the child health service is to diagnose major handicaps as early as possible and to
provide services which will enable the handicapped child to live as normal a life as possible. The
major handicaps are significant defects of hearing, vision, motor control and mental development.
In the child health centres screening tests should be applied to all children at least four times
during the first two years of life. This is estimated to involve approximately 2,200 examinations
per month, each examination taking at least ten to fifteen minutes. Current resources do not allow
this standard to be achieved for all children in the Borough, and some attempt must be made to
select a group most likely to show handicap. Although many have criticised the concept of the
"at risk" register, there is some evidence that when resources do not allow the satisfactory
screening of all children, priority should be given to those considered to be "at risk". Accordingly
attempts are being made to ensure that children on this register receive adequate developmental
screening.
There are a number of children whose mothers do not recognise the need for the service
which the child health centre provides, and therefore choose not to avail themselves of the facilities
offered. Until more family doctors become interested and skilled in the developmental assessment
of children, the observation of this group will largely depend upon the health visitor. She is the
member of the child health team who has most to contribute concerning the home background
of the child, and it is important that she should be skilled particularly in testing vision and hearing
in the young child. Methods of screening have been especially devised so that a standard procedure
is applied throughout the Borough. The health visitors have received special training in the
techniques of screening of hearing and vision in babies and young children, and the initial screening
of babies between the seventh and tenth month has been entrusted to them. Although it is not
yet possible for such tests to be carried out on all children it is hoped to develop a total screening
programme in this age group at the earliest possible date. Where the results of screening tests are
doubtful the child is examined by one of the medical officers who may if necessary, refer the child
to the hearing clinic at Heston for a specialist opinion.
Recent research has suggested that some cases of deafness in children are caused by previously
unsuspected cases of rubella (German measles) in pregnancy. As a result of this observation
arrangements were completed for blood samples to be taken from all children referred for specialist
hearing screening, and from their mothers. These samples were forwarded to the Institute of
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