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Child Health for determination of rubella anti-body titre, and thus assist in the diagnosis of cases
of rubella syndrome.
It has been the practice for some years to examine babies at birth to exclude the possibility
of a congenital dislocation of the hip. This examination may have been repeated at four to six
weeks, but after this age no further attention has normally been given to the condition. During
the year a report by an orthopaedic surgeon suggested that dislocation of the hip may occur at
any time up to two years of age, so that continued screening for the condition is necessary in the
child health centres. The necessary further tests were introduced to ensure a regular screening
programme until the child is walking satisfactorily.
The widespread introduction of developmental screening is a relatively new concept, and
there has been a natural desire on the part of the doctors employed in the child health centres to
receive specialist training in this work. A planned programme of training was therefore devised
to assist with the work, and to provide equivalent facilities for local authority medical officers to
those which their hospital and general practitioner colleagues currently enjoy. One doctor received
specialised training in the assessment of infants and small children, and has subsequently been
able to apply her new skills. One of the Principal Medical Officers attended a course in the assessment
of hearing loss in young children, and he was subsequently able to organise the training
courses for health visitors. Specialist week-end courses in paediatrics, gynaecology and dermatology
have provided valuable post-graduate training but much longer periods of study will be necessary
for those wishing to specialise in developmental paediatrics. Preliminary arrangements were made
for one medical officer to be seconded for six weeks specialist training, and for another to be
seconded for a full academic year.
Co-ordination and Co-operation
The child health services provided by the department do not exist in isolation but are organised
in conjunction with those provided by local hospitals and by family doctors. Efforts continue to
be made to promote closer co-ordination and co-operation between the three separate parts of
the service. Co-operation must, of course, be a two-way process, and although every effort is
made to promote such concepts, the department's efforts are not always reciprocated. Circular
HM(71) 22 concerning hospital facilities for children instructed Regional Hospital Boards to
ensure that as far as possible "firm arrangements are made for the transfer of information on child
patients from hospital staff to . . . the Medical Officer of Health". Although such information is
almost always available when specifically requested and consultants provide most helpful reports,
it has proved impossible to secure the firm arrangements suggested by the circular for every child.
The local authority may not be aware of its likely responsibilities for a particular child without
prior warning from the hospital service, and it is to be hoped that the concept of a team approach
with professional workers from different services and even different disciplines bringing their
joint skills and responsibilities to the assistance of the patient will not have to wait until 1974 to
find its complete expression in the area.
Welfare Foods
The welfare foods provided through the local health authorities were modified during the
year. Vitamin "C" as well as Vitamins "A" and "D" being added to National Dried Milk. Orange
juice and cod liver oil were replaced by multi-vitamin drops and tablets. In addition it is the practice
in this area to permit the sale of certain specified proprietary foods at a cost slightly less than that
available in local shops. The primary objectives of a child health centre are to promote health,
to advise on the developmental progress of children and to provide health education. The sale of
welfare foods is unlikely to assist these objectives, and existing policies must be kept closely
under review in the light of local circumstances.
The distribution of welfare foods has been aided for many years by a stalwart band of voluntary
helpers. Their personalities have added an extra friendliness to the session, and their assistance
is much valued in the department. The retirement of one of these ladies is always a moment of
particular sadness and it is disappointing to note a declining number of volunteers available for
this work. The child health centre can provide a fruitful area for voluntary effort, and it is to be
hoped that others will come forward to assist on a voluntary basis in this valuable work.
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