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It has long been recognised and is becoming increasingly accepted that there are
many other pre- school children who need special care and observation of their disabilities.
It was therefore decided some years ago to try to assess the size and nature of this problem
in West Ham. To this end Health Visitors have reported to the Senior Medical Officer any
handicapped or potentially handicapped child under 5 years who came to their notice. Wherever
possible their reports included the findings of the clinic medical officer.
These arrangements have enabled the Senior Medical Officer to get a clearer picture
of those pre- school children whose development was giving cause for anxiety and in particular
tos:
(a) have some idea of the numbers of pre- school children likely to come within
the various categories of handicapped children;
(b) colleot and co-ordinate reports from various hospitals, voluntary organisations
etc., with whom contact had been made and who had some interest in the child;
(c) contact the child's general practitioner as appropriate;
(d) try to ensure that the child is receiving all necessary care and treatment, and
is being kept under observation, when indicated and, with the parents1 consent,
to refer the child for testing by the Psychologist;
(e) when appropriate, to refer the child to the School Health Service so that
ascertainment may be considered (in practice ascertainment has only been
carried out under the age of five when it would fulfil some useful purpose,
e.g. to get the child admitted to an institution or special school).
The salient findings are that each year some 70-80 pre-school children are known
to b$ handicapped and that nearly half of them have retarded mental development - which
must be of quite marked degree to be clearly apparent at this age.
Some of the Needs
The existence of some 70 to 80 potentially handicapped pre-school children presents
a substantial problem in medical care. The early years are often a critical period in the
child's development; wise and skilled management at this stage may help towards a satisfactory
adjustment enabling the child to make the fullest use of the potentialities left to him.
Moreover, many parents could benefit from skilled counselling in the numerous problems
presented by their children and their own attitude towards them.
The survey has brought out the fact that it is difficult under present arrangements
to maintain the continuing and frequent observation which is needed in the handicapped
child's best interest. Parents have been very co-operative in bringing their children for
testing, but it seems that they have sometimes been disappointed to find that no further
appointment or provision has been made for them.
The continuity of care and supervision which is needed could be provided by the
Health Services through the medium of a special clinic for children whose physical and
mental development was not proceeding within normal limits, supplemented by some form
of day-time care.
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