Potential uses of screening in the care of school –age children and adolescents

Problems of growth and development, including physical, neurological, mental, and psychosocial development.

Why .to detect children who are not thriving and developing normally  and refer them for further evaluation and follow –up . follow –up does not necessarily require the services of highly specialized personnel. It may include community based interventions at the primary care level, e.g.,special attention from teacher and families to minimize learning difficulties or deal with emotional problems affecting development.

Who . all school age children and adolescents.

How and when. All sources agree on the importance of monitoring growth and development at the time of school entrance ( around the age of 5-6years ) . preschool records should be reviewed at that time. The united kingdom child health surveillance programme recommends checking and recording height on a centile chart on school entrance, with further checks during the school years only if a particular concern arises, physical examination should be carried out only if there is a specific reason for concern. The Canadian task force recommended checking height, weight, and head, arm, and chest circumferences on school entrance and once more around the ages of 10-11years . however, this was primarily for screening for hormonal problems, which may be too rare, and whose definitive diagnosis and treatment may be too expensive, to warrant high priority for inclusion in routine screening in a primary health care context.

Who has produced guidelines on the monitoring of physical growth and development in developing countries (who, 1986,c). the home-based child s record is an excellent tool for the monitoring of growth and development throughout the school years by trained primary care personnel.

It is to be hoped that children with nutritional problems will have been identified during infancy and the preschool year and will already be under special surveillance. It would therefore seem rational for mass screening to check and record heights and weights (if scales are available )to be carried out at school entrance and for measurements to be repeated only if there are grounds for concern. Locally appropriate standards can be used but the greatest emphasis should be placed on detecting the child who is not growing at an adequate rate according to her or his own baseline, rather than those who do not conform to absolute norms of height or weight . primary care workers or teachers should be able to carry out such screening with proper training. Because problems of physical growth related to nutritional status would be expected to be more prevalent in poorer countries, more frequent screening may be desirable In these countries; this should, however, be done only if there are resources not only for screening but for effective intervention. For exposure may be more worth while than efforts to identify all those affected, whose antiparasitic treatment would have only a transient effect at best (tanner et al .,1987)

The Canadian task force recommended mass screening for behavioural and developmental problems on school entrance, with further screening in school age children if warranted by earlier assessments the UK working party was not In favour of formal screening for psychiatric or behavioural problems. Both groups recommended enquiry about sources of concern to parents as the mechanism for screening psychosocial development on school entrance. Language use, motor skills ,and social interaction of children starting school should be routinely assessed by health workers or teachers. Many children s preschool health records specify developmental milestones and can thus guide assessment. Once children enter school , their school performance should indicate their mental development and point to any behavioural or learning disorders. Teachers should be trained to assess psychosocial development as a part of routine periodic assessment of children. In addition, during each visit for routine care, parents should be asked about any aspect of their child s psychosocial, as well as physical, development that is causing them concern ; this fits an early detection model.

Resource levels requires. Low for initial detection by teachers or primary care workers; medium or high for definitive diagnosis. Low, medium, high , or very high for intervention, depending on the nature of the problem. Some problems may be addressed by providing additional psychosocial or economic support for the family or food supplements for the child.

Recommendation on screening early detection . screening of overall development recommended in school entrance, with further assessments if concern is expressed by teachers or parents .the routine formal growth monitoring or developmental testing of school age children is not re commended as a priority. Resources are better spent on primary prevention by promoting education and the status of women, as well as training teachers to detect potential problems of development at an early stage and make appropriate referrals.

Research priority. To develop accurate inexpensive ways for primary care workers or teachers to assess problems of  overall physical and psychosocial development and address such problems, making optimum use of the resources locally available.