Aspects of health surveillance at Child Welfare Centres

Objective: To evaluate aspects of the health surveillance at Child Welfare Centres (CWC)particularly the promotion of mental development and health.Method, Subjects: In the main study, which this thesis is a part of, a cohort of children fromthe general population was studied with regards to their health and development during thepreschool years. This part of the study was designed to compare measures of the children'shealth and development using standard Child Welfare Centre (CWC) methods withprospectively collected information from the longitudinal project.Results: Study I. The first home visit to the newborn baby by the nurse at the CWC wasevaluated. Her assessments seemed valid in identifying families with stressful psychosocialconditions. When the general home situation was judged as 'poor' or 'dubious' the boys hadan increased risk to have a delayed mental development at 4-5 years of age.Study II. The four-year check-up at CWC was studied by means of a score. The score wasuseful in identifying children at risk of delayed mental and behavioural development on agroup level.Study III. A model combining the methods used in I and II together with other information atCWC was presented. The results indicate the usefulness of the concept of developmentalsurveillance. The results indicated that it was possible to identify children at risk ofdevelopment delay on an individual level.Study IV. Screening at CWC for Minimal Brain Dysfuncdon at 6 years of age showed thatchildren with an positive screening result at school-start may have exhibited signs of delayedpsychoneurological development and symptoms of psychopathology already at 4 years of age.Study V. Children experiencing psychosocial stress and exhiting psychopathologicalsymptoms were found to run a higher risk of having accidents than other children. Thisinformation could be useful in the accident prevention work at CWC.Study VI. Behavioural problems and psychopathology in preschool children were evaluatedwith both a categorical classification in the DSM-III, and a dimensional approach. High ratesof certain diagnoses, especially 'oppositional defiant disorder' and 'undersocialised conductdisorder' was found. In future studies, the results will be used in order to develop a CWC-questionnaire with the objective of identifying behavioural problems.Conclusions: The health surveillance programme at CWC, with regards to developmentaldelay and behavioural problems, has components that seem to be valid in identifying current,and to some extent future, health problems. However, the programme may need revision, e.g.adding tools to identify behavioural problems, and more clear cut advice to the staff on whenand how to intervene in a family where the child needs support and stimulation. Thesignificance of the observations in this thesis for the children's health during the school agewill be the object for future studies.Key words: Child health care, longitudinal studies, preschool children, psychomotordevelopment, child behaviour disorders, psychosocial stress, accidents, mass screening inchildren. ISBN 91-628-2067-2/pre