Rationality of routine health examinations by physicians of 18-month-old children: experiences based on data from a Swedish county.

Abstract

The aim of the present study was to evaluate the rationality of health check-ups by a physician of 18-month-old children. The study population consisted of all 4075 children in Uppsala county who were 18 months old in 1994 and should have had a routine health examination at that point. Information about the 18-month health examination came from primary data in a longitudinal child health register regarding all children of preschool age. The children in the study population were classified into two main categories, namely children with no newly detected health problem (92.6%) and children in whom a new health problem was detected (3.3%). Data from the register and other sources were analysed to categorize the health problems by severity and type and to determine who (parents, nurse or physician) had identified each. Among the 4075 children in the study population, 135 children were identified as having a newly detected health problem. One-third of them were actually healthy (false positive). Among the 92 verified new health problems (2.3%), 48 were minor, 42 were moderate and 2 were severe. More than half of the moderate health problems were transient infections. The main conclusion of the study is that, under current conditions in Sweden, it would be reasonable to replace the 18-month examination by a physician with an examination by a nurse, this examination being particularly orientated towards developmental and psychosocial problems.