Child health promotion, screening and surveillance

After the Second World War, as the incidence of infectious and nutritional disorders declined, professionals and parents began to seek more precise diagnosis and more effective therapy for children with cerebral palsy, mental handicap and related disorders. Although a handful of exceptional men and women had shown what could be accomplished (Shonkoff & Meisels, 1990), the prevailing view was that little could be done and indeed parents of these children were not infrequently advised to "put them in an institution". In the 1950s and 60s, new ideas began to create a more optimistic climate of opinion. It was thought that much, perhaps most, disability was caused by perinatal complications and was therefore potentially preventable; and that early intervention (e.g. physiotherapy for cerebral palsy) might lead to cure or at least substantial improvement. Research in child psychology offered a more scientific basis for the assessment and management of developmental disorders. A sense of urgency was created by the prevalent belief that the child's developing nervous system and psychological functioning were far more amenable to intervention in the first few months or years of life than subsequently (Anastasiow, 1990), and that if suitable therapy was not provided then, the opportunity would be lost for ever. This notion of a "critical period" in development, together with optimism regarding the possibility of intervention, led to a sense of urgency which was responsible for a gradual change in the provision of child health services. Previously, the paediatric health professional had simply waited for the parent to seek advice--the "passive" or "reactive" approach.(ABSTRACT TRUNCATED AT 250 WORDS)