[Preventive examinations in infants and small children. A longitudinal study of practicing pediatricians]

A prospective study to evaluate well-child examinations was based on a sample of 750 children drawn at random from the patients of 15 practising paediatricians who participated in the study. These children were followed from the age of 3 months, when each who was vaccinated also received a specified examination, until the age of 5 years. Participation in the program of examinations was still 86% at the age of 18 months. By the age of 4 1/2, the participation rate had dropped to 40%. Between the ages of 3 months and 18 months, 11.2% of the sample had been diagnosed as having a pathological disorder. Of the 97 diagnoses, 35 were detected during the newborn period; 25 were detected by means other than the well-child examinations; and 37 were directly attributable to the examinations. 28 of the 97 diagnoses were still valid at the age of 5 years, and 5 of those children had a serious handicap. In an additional 59 suspected diagnoses (7.8%) only 6 could later be confirmed as a pathological condition. Of the 300 children who attended the last well-child examination at age 4 1/2, 45 (15%) had one or more pathological findings. Seventeen of the 45 diagnoses were detected between the 18-month exam and the 4 1/2-year exam, and 30 were detected at the time of the last examination. The number of diagnoses per physician varied. From each sample of 50 children per doctor, 1 to 20 children would have a disorder. Twelve of the 15 paediatricians were appreciative of the structured exam schedule, and most intended to continue with some parts of the program after the study's termination.