Use of personal child health records in the UK: findings from the millennium cohort study
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7536.269 (Published 02 February 2006) Cite this as: BMJ 2006;332:269All rapid responses
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Whilst pleased that the PCHR is being used by the majority of parents
I agree with Tam Fry that measurement of weight alone is an insufficient
indicator that a child is growing well. I also agree with Sarah Manns that
the centile charts may be perceived by mothers as a "pass or fail" measure
of their mothering. This has been brought home to me recently by my 17
week old grandson being investigated for FTT [Failure to thrive] purely on
the basis of his not putting on weight as quickly as the centile charts
say he should. He has not lost weight and is developing as he should! At
no point has his length been recorded,other than at his 6 week check [his
birth measurement has been discarded because he was measured incorrectly].
Had his length been recorded correctly at birth, 6 weeks and at 3 months
the health professionals may have thought to compare his length centile
with that of his weight and found that he was indeed just finding the
correct centiles for his genetic background. Further from enhancing
communication between the baby's mother and the health professionals the
PCHR has alienated her, caused angst and certainly, despite reassurances
to the contrary, the feeling that she is a bad mother. To her the 'red
book' has become an item of dread and not one that will be of benefit in
the future. I wonder how many other new mothers feel the same way? I
sincerely hope that "the ethos behind the PCHR is improved communication,
enhanced continuity of care, and increased parental understanding of their
child's health and development" is maintained and it is not used solely
for measuring and recording a baby's weight and possibly causing
unnecesary distress for some mothers.
Competing interests:
None declared
Competing interests: No competing interests
The personal child health record [PCHR] is identified by Walton at al
(2006) (1) as a record of children’s growth, development, and uptake of
preventative health services, designed to enhance communication between
parents and health professionals. This rapid response draws attention to
the role of the centile charts that are a feature of the PCHR and their
application to babies born prematurely.
Ongoing research exploring the term ‘catch-up’ (Manns ongoing PhD)
indicates that rather than enhancing communication, the PCHR may reduce
opportunities for communication. The messages that mothers receive from
health professionals when completing centile charts may be negative,
leaving some mothers distressed and feeling they have failed as a mother.
It is known that children born prematurely are harder to feed and may
struggle to gain weight in line with centile parameters. Consequently,
centile charts may be perceived by mothers as a ‘pass or fail’ measure of
their mothering.
This internal judgement negatively influences attendance at local baby
clinics. This may be ameliorated if they attend outpatients clinics linked
to neonatal units. However, these babies may be discharged early on in
their lives, raising the risk of maternal isolation and reducing contact
with health professionals. Our concern is that these mothers may
subsequently miss much needed opportunities for support from health
professionals.
(1)Walton S, Bedford H, Dezateux C ‘Use of personal child health
records in the UK: findings from the millennium cohort study. BMJ 2006 Vol
332 269-270
Competing interests:
None declared
Competing interests: No competing interests
The Foundation welcomes research on the use of the Personal Child
Health Record [PCHR] and the number of parents who use it. It has to
question however the authors' reliance solely on infant weight as a
criterion for its success.
Whilst they affirm that the PCHR should be the main record of a
child's growth and development, they fail to state that the Record neither
prompts nor gives space for infant length to be entered on the majority of
its developmental pages. As knowledgeable paediatricians will tell you,
weight by itself is fairly meaningless when considering if an infant is
growing well. It will not indicate whether it is underweight or
overweight for its size and both these diagnoses are crucial in infancy.
The plus side to the PCHR is that it allows any weight to be recorded
in the first place. The new child health programme in the National
Service Framework for Children, which the authors are happy to cite, calls
for no weight to be recorded at all in the first year of life!
Competing interests:
None declared
Competing interests: No competing interests
The personal child health record (PCHR) and the Maternal and Child Health (MCH) handbook
EDITOR- I read with interest the paper by Walton S et. al. 1 In
Japan, since 1948, the Maternal and Child Health (MCH) handbook has been
used as a personal medical record. The concept and system of the MCH
handbook are quite similar to that of the personal child health record
(PCHR) in the United Kingdom. Nevertheless, the MCH handbook differs in
that it is used to record both the child's history of growth and
development and the mother's history of pregnancy and birth. The MCH
handbook can be used in the continuous care of mother and child. Fujimoto
et. al. 2 report that although 81.6% of Japanese caretakers consider the
immunization record useful, approximately 60.6% of them would like more
information on child bearing. I believe that a better exchange of
information on personal medical records between British and Japanese
experts is needed to better foster improvement on the development and use
of personal medical records.
1 Walton S, Bedford H, Dezateux C.
Use of personal child health records in the UK: findings from the
millennium cohort study.
BMJ. 2006 Vol 332 269-270
2 Fujimoto S, Nakamura Y, Ikeda M, et.al.
Utilization of Maternal and Child Health handbook in Japan
Nippon Koshu Eisei Zasshi. 2001 Vol 48 486-494. (article is Japanese,
abstract is English)
Competing interests:
None declared
Competing interests: No competing interests