Assessing changes of hospital admission in preschool children. Critical evaluation.

In discussing social class differentials in childhood mortality and morbidity a recent report on the British child health services suggests that it is possible to identify children at risk, and a government publication has indicated that health visitors (community nurses) could do this. The National Survey of Health and Development, a longitudinal study of over 5000 children regularly investigated from birth so far to age 31 years, gives an opportunity to test the usefulness of these propositions, since it has complete illness records of the study population and health visitors' assessments of their home circumstances, maternal care, and use of child welfare services. This study shows that these assessments were not particularly successful in identifying children at risk of hospital admissions for certain illnesses, even when more than one hospital admission or a serious illness later occurred. The maximum reduction of hospital costs by such identification would be little better than one-third and there would be an unquantifiable, but very real, stress imposed on families in which children were wrongly identified as at risk. It is suggested that further development of health visitors' work as family nurses would give a more effective form of child health care by providing greater sensitivity of surveillance, by involving parents in preventive care, and by making appropriate use of health visitors' skills.