Identification of health problems at 18 months of age – a task for physicians or child health nurses?

Abstract

Several studies have questioned the rationality of repeated routine health examinations by physicians during the first years of life. The aim of the present study was to evaluate the population-based 18-month health examination and compare the yield of new health problems identified by physicians in 1994 with the yield identified by child health centre (CHC) nurses in 2000. Two populations of children were invited to their 18-month health examination during one year, the first in 1994 and the second in 2000. In 1994 the population consisted of 4075 and in 2000 of 2968 children who were registered in Uppsala county, Sweden, for census purposes in December 31 each year. Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. On the whole few new verified health problems were detected by the health examinations at the 18 month health examinations: 2.3% in 1994 and 1.7% in 2000. In 1994, when the physicians carried out the examinations, the most common health problems were somatic problems, particularly moderate transient infections. In 2000, when the nurses carried out the examinations, the dominant problems were speech problems. Peculiarly enough a couple of children with the same severe health problems, gluten allergy and problems in the autistic spectrum, were identified both in 1994 and in 2000. In addition the nurses in 2000 identified seven children with severe speech problems. No additional severe health problems were identified by the physicians in 1994. According to the present study, there is no evidence that health examinations carried out by nurses are of lower quality in detecting health problems than those carried out by physicians. The organization and content of the health surveillance programme ought to be reconsidered with respect to available resources and importance of the close relationship established between nurse and family already in the newborn period.