Selective medical examination at school entry: should we do it, and if so how?

A prospective study was conducted on 82 consecutive 5+ examinations performed by four school doctors over a period of two months. The aim was to assess the impact of applying selection criteria for examination. Information gathered included immunization status, history of previous developmental assessments and previous detection of problems, and the result of the examination for each child. Forty-three per cent of children were up to date with their immunizations, 66 per cent had had a six-week check and 38 per cent and 17 per cent had been assessed at 15 months and 2 1/2 years respectively. Forty-eight problems were detected in 37 children (45 per cent), of which 27 had not been previously detected. Of these, 19 were detected by the school nurse before the examination as a result of hearing (nine) and vision (10) testing and measurement of height and weight (one). Of the remaining problems, four were presented by the parent, one by the teacher and two were detected by the school doctor. If a policy of selective examination had been in place in which children were called for examination only if they had never been assessed before, or where there were no records of a previous assessment, or if their immunizations were incomplete, or they had previous problems, or the school nurse or teacher or parent had expressed concern, all but four children would have been examined. It was concluded that this particular method of selection would be unproductive and that a system whereby the school nurse was responsible for screening and selection for examination would be preferable.(ABSTRACT TRUNCATED AT 250 WORDS)