Audit from preschool developmental surveillance of vision, hearing, and language referrals

Article Abstract:

In Britain, recommended child health surveillance includes examination of sight, hearing, and language of preschoolers. This screening system has been criticized in using nonspecialists to identify visual defects and other aspects of the examination process. An inner-city health authority was audited to determine the efficiency of its screening program. The outcomes of at least 180 referrals in each area were studied. Referrals were provided for 184 children to ophthalmology, 285 children to audiology, and 195 to speech therapy. Children had to wait from 63 to 180 days between the time of referral and the first assessment. Specialized clinics were attended at least once by 80, 75, and 64 percent of these children in the respective groups. About 25 percent in the first two groups and 11 percent in speech therapy were discharged after the first visit. Fifteen, 18, and 8 percent did not attend the clinics after the first visit, and after two years, 23, 15, and 13 percent of children were still in ophthalmology, audiology, and speech therapy. Ophthalmologic referrals were justifiable for 55 percent of children, and 20 of 29 children with problems were given treatment. Five out of six children who squinted were left under observation but not otherwise treated. Discharge from ophthalmic treatment did not appear to follow consistent guidelines. Half of the children who were sent to audiology because of hearing problems recovered spontaneously. Children who were sent to general practitioners for medical treatment did not recover as fast as those given surgical or other treatment. Language problems occurred in 80 percent of children referred to speech therapy. Only a small proportion of children had more than 11 sessions of speech therapy, due to low compliance. The study shows a high incidence of visual, hearing, or language problems in inner-city children which did not spontaneously improve, requiring treatment. Parental awareness was not adequate to identify these problems. Better explanation to parents of the importance of speech therapy was needed. Other aspects of screening, such as shorter waiting times for appointments and outcomes of treatment should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Preschool children, Vision disorders, Hearing disorders, Speech disorders

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Screening for neuroblastoma

Article Abstract:

A neuroblastoma is a malignant tumor that develops from immature nerve cells. It is one of the most common forms of solid tumor in children, occurring in 6 to 10 out of every million children each year. It is most common in the adrenal glands, but it can occur in any part of the sympathetic nervous system. These tumors metastasize (spread) quickly to the lymph nodes, liver, lungs, skull, skeleton, and other organs. If the tumor is diagnosed during the early stages of disease and is completely removed by surgery, the rate of cure is high (95 percent survival at five years). In some cases, the neuroblastoma may regress spontaneously without treatment. However, in many cases the symptoms of disease are nonspecific (loss of appetite, malaise, limb pain) and greater than 50 percent of the children have advanced disease that has spread to other parts of the body by the time the condition is diagnosed. In these cases, the prognosis is very poor. Even with combined surgery, chemotherapy and radiotherapy, only 25 percent of these children will survive for five years. When a neuroblastoma is present it causes substances called catecholamine metabolites to appear in the urine. Therefore, urine tests have been used to screen children for neuroblastoma. The tumor must reach a critical size before it can be detected by the urine test, however. Most tumors are between 10 and 50 grams when they are detected. Antenatal ultrasound scanning can be used to detect neuroblastomas before birth. Most screening for neuroblastomas is performed at six months of age, but this may not be the ideal time because some tumors may be too small to be diagnosed at this time. Additional screening performed at 18 months may detect the more aggressive tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Neuroblastoma, Tumors in children, Pediatric tumors

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