HEALTH VISITORS' ROLE IN PREDICTION OF EARLY CHILDHOOD INJURIES AND FAILURE TO THRIVE

Abstract

Health visitors (registered nurses) in Aberdeen, Scotland, administered a brief “maternal attitude questionnaire” and recorded a subjective assessment of mother-child interaction at age 3-4 months on all 7,700 births within the city. During the first two years of life, 1,388 (20%) of these children presented with an injury or failure to thrive (FTT). This index group was matched at age 2 with children from the original group who had no such findings. Within the index group, 76% were seen for accidents, 10% for overtly negligent injuries, and 14% for suspected non-accidental injury or FTT. The questionnaire revealed no significant differences between the index and control groups; however, analysis of the health visitors' subjective assessments revealed that twice as many index children as control children received assessments of “moderate” to “great concern.“ A comparison of outcome variables within the index group revealed that these ratings related significantly to two variables: the higher the level of concern, the more likely an injury would be non-accidental and, within this group, the more likely an injury would be a serious hospitalized case. Of the total study population (2,776), 10% (218) were rated as “moderate” to “great concern.“ Two-thirds of these 218 children later presented with injuries or FTT which might have been prevented by intensive intervention.