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Other systems (contd.)
Other unspecified malformations of
muscles skin and fascia 1
Pigmented naevus 1
Other malformations
Other and unspecified congenital
malformations 2
Multiple congenital malformations not
specified 2
Down's syndrome (mongolism) 3
For our own purposes the only children we
follow up are those whose defect is likely to
be a handicap to them in their future progress.
As the notifications are made within the
first 48 hours of birth often before a doctor
has examined the baby it is possible that a
considerable number of congenital defects
are not notified by this method, notably such
conditions as pyloric stenosis fibrocystic
disease, various congenital heart defects and
various renal defects. We therefore still rely
upon the hospital paediatricians for their cooperation
with regard to notifying these
defects
Joint Obstetric Child Health Project and
Observation Register
I am grateful to Dr Anne Jepson for the
following report
Aim, to determine whether the selective
population screening method is a practical
method of screening children for handicapping
conditions.
Twelve years ago there was increasing
concern about the number of children found to
have handicapping conditions It was felt
that the adverse effects of a handicap on the
normal development of many of these school
children would have been lessened by earlier
diagnosis and treatment. Dr Fisch suggested
that a register should be compiled of children
thought to be particularly at 'risk' of developing
a hearing loss and Dr Robert Lindon suggested
that all local authorities should maintain a
register of children known to have a handicapping
condition or who were likely to
develop such a condition Dr Mary Sheridan
amplified the principles set out by Dr Fisch
and Dr Lindon, and at the same time drew
up a list of factors occurring during pregnancy
and the perinatal period which appeared to
be connected with the subsequent development
of a handicapping condition Many local
authorities, including Hounslow began to
keep At Risk' or 'Observation' registers The
latter is a more satisfactory name for these
registers, since the chiIdren are in fact under
observation, but the factors which determine
their inclusion on these registers are referred
to as 'risk factors'.
The early detection of any handicap is
vitally important. The severity of the condition
can then be lessened by early diagnosis and
treatment For example the limb deformities
which develop in a child with cerebral palsy
can be greatly ameliorated by early treatment
and the prognosis for speech and language
development in the deaf child is greatly
improved when a hearing loss is diagnosed
within the first eighteen months of life. Early
detection also enables the child's family to
make the adjustment to his problems at an
early age and helps them to come to accept him
as an individual in his own right The authorities
concerned in child care are also alerted to
future needs and are able to plan suitable
services Lastly, early detection enables
research to be carried out into the effects of
early treatment and makes possible the comparison
of different methods of treatment
At present there are three methods of
detecting children with defects or developmental
delay Firstly the symptomatic method which
relies on the children being brought for treatment
after the onset of symptoms which ha/e
become apparent to the parents Often this
may be too late for the most effective treatment
to be given For example the treatment of a
dislocated hip is effective and relatively simple
within the first few weeks of life but much less
so later on. The second method is total population
screening. By this method the whole
population is examined or screened for defects
In theory this is the most satisfactory method
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