THE CASE

Your primary care paediatric practice has recently decided to review its preventive care practices before deciding which to include in a new computerised record system. You know that these practices vary considerably among group members, even as to how many check ups a child really needs. The value of some specific manoeuvres, such as the Adams forward bend test for scoliosis, for which adolescents are often referred from school, is doubted. You determine to find the best evidence for common preventive health interventions for children.

Background

Routine checks on apparently healthy children are an important part of preventive services available for children. In developed countries outside the United States, paediatricians are trained to practise as hospital based specialists providing clinical care, while general practitioners and public health nurses are responsible for preventive care, including care of healthy children.1 In the United States, general paediatricians provide both preventive and clinical care and spend as much as 40% of their time checking healthy children.2

The major objective of these check ups is maintenance of health and prevention of disease. This is traditionally accomplished by repeated evaluations of healthy children under five heads: screening, health promotion, disease prevention, patient management, and follow up.

A routine check up includes history taking, physical examination, observation of parent-child interaction, …