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brain damage, and mental subnormality. A blood test (Guthrie test) has been developed and is
carried out on the sixth day of life by the midwife. The blood samples are collected on a special
filter paper which is posted to the regional centre for processing. A number of other rare diseases
including histidinaemia and homocystinuria are excluded by the laboratory investigations now
undertaken.
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 1971, and the progress which has been made since that time to change the emphasis of the
centres to that of developmental screening has continued.
The standard of service for each child is set out under the management by objectives procedure
and involves seven examinations during the first five years of life. These examinations should take
place on or before the sixth week, at six months, at twelve months, at eighteen months and at 2
years of age. Thereafter examinations are arranged at approximately yearly intervals until the child
commences at school.
Arrangements to modify the child health centre programme were implemented during the
year allowing a greater proportion of medical resources to be allocated to this important work.
Most sessions were transferred to the afternoons where experience has shown that parents find it
easier to attend. In consequence the proportion of child health centres at which a medical officer
was present increased by one quarter to 94.4%. The attendance at individual child health centres
was, however, variable, and some centres were unable to complete a full programme as set out above
in respect of every child because of limitations of medical man-power. Arrangements were completed
by the end of the year to transfer medical officers from less well attended sessions to those
where the need was greater but the difficulties of inadequate accommodation in some clinics
sometimes militate against the provision of all the medical sessions which are required.
In consequence special emphasis has been given to the child who is considered "At risk"
particularly in respect of the first four routine examinations. At the time of the birth notification the
department is advised of factors affecting the pregnancy and the birth which may increase marginally
the risk of handicap in the child. Every effort is made to ensure that all of these children are examined
at appropriate intervals so that by the age of two years any handicaps will have been identified. All
children are discharged from the "At Risk" register at this stage but those who have been found to
have some handicap are followed up at appropriate intervals in order that special educational
facilities may be provided.
The condition of non-accidental injury syndrome (the so-called "Battered Baby") has shown
a need to extend this "At Risk" concept. A special section of the Observation Register has been
created which allows special emphasis to be given to the potentially battered child. Observation
and support are usually all that is necessary but because of the risk that staff changes may lead to
loss of contact, health visitors are asked to visit such families at their discretion, and according to the
prevailing situation but to report briefly to the central register at monthly intervals. If a report is not
received it is requested so that the child is not overlooked. In this way early deterioration in the
family atmosphere can be detected and preventive action taken to avoid serious damage to the
child. Research has shown that, whilst any child is potentially at risk, the syndrome is far more likely
in certain groups, and it is upon them that preventive action must be focused. The assistance of the
social services department or officers of the National Society for the Prevention of Cruelty to Children
is particularly appreciated in this important work. During 1972 a total of 24 children were placed on
this special register of whom 12 were referred to the social services department and 6 were taken
over by N.S.P.C.C. officers. Four names were removed from the register. In some cases it is necessary
for all the various agencies to meet together to discuss a common policy concerning a particular
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