Lennart Köhler

VISION SCREENING OF FOUR-YEAR-OLD CHILDREN

Included in a general health control of an un‐selected population of 2 447 four‐year‐old children, a vision screening was performed, using a visual acuity test (Marquez‐Bostroms hooks), cover test and Wirt Fly Stereo test. The screening could be carried out in 98% of the children. 364 children (15.2%) were referred because of newly detected visual defects, and 358 children (15.0%) were professionally examined. Of these, 40.8% had a visual acuity of ≤0.6 and 5.9% of ≤0.1. Functional amblyopia was found in 12.3% and manifest strabismus in 10.3%, The main error of refraction was hyperopia (≥ 2.5 D), diagnosed in 28.5%, while myopia was infrequent, 3.9%.

Food Intake and Growth of Infants between Six and Twenty‐six Weeks of Age on Breast Milk, Cow's Milk Formula, or Soy Formula

ABSTRACT. In 59 normal infants attending well‐baby clinics, food consumption was registered until 26 and growth until 52 weeks of age. They were either breast‐fed or formula‐fed with a cows milk product or a soy protein product. The average consumption of breastmilk was 746, 796, 722 and 689 g/day at 6, 14, 22 and 26 weeks respectively. Bottle‐fed infants received larger volumes, and at 6 and 14 weeks were the calculated total energy intakes significantly higher than in breast‐fed infants. No differences were seen between the feeding groups with respect to length and the sum of four skin folds. The soy formula‐fed children, who happened to be 200 g heavier at birth, had lower weight gains during the first 6 weeks than the other two groups. Thereafter, the average weights of the soy formula group did not differ from the other groups. At 3 months, the soy formula‐fed children displayed a slower mineralisation and maturation of bone, but the difference was no longer significant when re‐examined at 6 months. Formulas based on soy protein isolates seem to be acceptable as substitutes for cows milk formulas in feeding normal infants.

VISUAL DISORDERS IN 7‐YEAR‐OLD CHILDREN WITH AND WITHOUT PREVIOUS VISION SCREENING

ABSTRACT. An analysis of visual defects among 310 children referred from a vision screening of 2178 7‐year‐old children revealed a 50% frequency of significant eye defects among the referrals (7% of screened children). Of the screened children, one group (1530 children) had previous visual screening three years earlier. The other group (648 children) had no previous vision screening until the age of seven. A comparison between the two groups showed that the risk of finding a new significant eye disorder in a school entrant was more than 6 times greater for a child who was not examined in his preschool years, and the risk of finding an ambiyopic child was more than 10 times greater. The results do indicate the need for continuation of the present vision screening program of pre‐school children.

DENTAL HEALTH OF FOUR-YEAR-OLD CHILDREN

An unselected population of 1 567 four‐year‐old children in one urban and one rural community in Southern Sweden were investigated for dental disorders as part of a general health control. The mean number of defs (decayed, extracted and filled surfaces) was 7.73 in Lund (urban) and 13.07 in Dalby (rural). The number of caries‐free children was 26.4% and 11.4%, respectively, and the number of “emergency‐cases” was 10.6% and 21.7%, respectively. Significantly better oral health was found in higher socio‐economic groups. A regression analysis showed that the most important factors for the prevention of caries and gingivitis were infrequent between‐meal eating, tooth‐brushing with help from the parents and oral administration of fluoride at an early age, in that order.

AUDITORY SCREENING OF FOUR-YEAR-OLD CHILDREN

Children with defective hearing may be handicapped in their ability to communicate as well as in intellectual, emotional and social development (I 3 ) . Most severely deaf children are now detected at an early age, but partially hearing children, if not examined, may be undetected throughout pre-school age (6, 11) as their symptoms are not always well understood by parents or teachers (10, 13). The need to identify hearing impairment as early in life as possible is well recognized, but simple screening methods with proven high sensitivity and specificity are not available until the child is some years old (1, 3 , 7, 13). To be effective, a screening program of this kind must be included in the organized general health service program for children. The present study reports on a screening for hearing defects in 4-year-old children as a part of a general health control.

Physical health of ten-year-old children. An epidemiological study of school children and a follow-up of previous health care.

ABSTRACT. At 10 years of age, all 223 children in a school district underwent a physical examination and a screening for vision and hearing defects within the school health services. The purpose of the study was to detect health problems of importance for the day‐to‐day functioning of the child. In 26.1% significant deviations were found. Physical disorders comprised 11.7%, visual defects 11.7% and auditory impairment 2.7%. The vast majority of significant health problems were previously known and in only 4.4% of the 223 children newly detected, 0.9% by the physical examination, 2.7% by the vision screening and 0.9% by the auditory screening. The most frequent health problem of all was allergy in 13.5%, in 5.4% regarded as functionally important. Minor orthopaedic deviations and motor disturbances were common but not often considered to affect the functioning of the child significantly. As a whole, the childrens health was very good and the outcome of the physical examination at this age was not impressive. It is evident that the physicians role in the school health system needs to be reconsidered.

PHYSICAL HEALTH OF 7‐YEAR‐OLD CHILDREN An Epidemiological Study of School Entrants and a Comparison with Their Preschool Health

Abstract. At 7 years of age, all 649 7‐year‐old children in a school district underwent a physical examination, a vision screening and an auditory screening. 210 of the children were previously examined in an extensive health control at 4 years of age. The purpose of the present study was to describe the childrens health situation and to evaluate the special health control performed at 4 years of age. In 15% of the children, functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Children who had passed the special health control at 4 years of age had fewer newly detected important health problems and more previously known ones than other children, which means that many children with above all visual defects but also motor disturbances, bacteriuria and testis retention, were detected and treated earlier than would have happened without the special control at 4 years. It is concluded that the “ordinary” preschool Child Health Services did fulfill their purpose to detect handicapping disorders in an acceptable way; by the introduction of the special health control at 4 years of age, this function was further improved.

TESTING FOR HYPERMETROPIA IN THE SCHOOL VISION SCREENING PROGRAMME

The need and accuracy of a hypermetropia test, recommended as a screening test in Swedish schools, was evaluated in a series of 118 8‐year‐old children not wearing glasses. The distant visual acuity was determined without correction and with plus spheres of two different strengths, +1.5 D and +2.0 D respectively. When compared to the objective refraction and with an arbitrary limit of hypermetropia of +2.5 diopters, it could be shown that neither of the hypermetropia tests fulfilled the criteria of an adequate screening test. Except for two children all hypermetropics beyond +3.0 were previously known. The reading skills of the children were estimated by their teachers. No correlation was found between the degree of hypermetropia and reading difficulties. The results indicate that the hypermetropia test could be omitted from the regular vision tests of schoolchildren, at least in areas covered with an efficient pre‐school vision screening.

PHYSICAL MASS EXAMINATIONS IN THE SCHOOL HEALTH SERVICE

Abstract. At 7 years of age, all 649 children in a school district underwent a physical examination, a vision screening and an auditory screening. The purpose of the present study was to analyse the value of the routine physical examination within the school health services. In 15% of the children functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Most disorders of importance were detected by the nurses screening examination and rather few by the doctors physical examination. It seems advisable to introduce screening procedures in the hands of nurses also for the physical examination. The role of the school physician in the general health surveillance would then be mainly to control and verify specific observations or suspicions of disease or handicap noted by the school nurse. His time and attention could instead be directed towards important tasks, which are now often neglected, e.g. health education, and care of sick and handicapped children in the school setting.

Chronically ill and handicapped children in the Nordic countries

There are no clear cut definitions of the concepts “chronic” or “handicap”, but they change with time and place and also with authors, their background and training, and their reasons for writing. The meaning of the word handicap has changed through the years and the development clearly shows society’s changing attitude to handicapped people. In the past, to be handicapped meant permanent bodily injury. The handicapped person was looked on as deviating from an accepted norm and was cared for by special institutions and organizations. In the 1960’s the mentally retarded were included among the handicapped. Today handicap is a relative and dynamic concept which varies from individual to individual depending on their other resources and special situation. Consequently, the handicapped person is not primarily an abnormal person but an ordinary person with special needs. WHO’S classification ( I ) of the consequences of illness at three levels can be used to illustrate the new approach: Impairment: any loss or abnormality of psychological, physiological, or anatomical structure or function. Disability: any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Hrndicap: a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.