Medical examinations at child welfare clinics

EBM Guidelines
Jan 27, 2021 • Latest change Aug 13, 2021
Jutta Airaksinen, Heidi Alenius and Kirsi Mustonen

Table of contents

Extract

  • In Finland, all children are routinely examined by a doctor at 4–6 weeks, 4 months, 8 months, 18 months and 4 years. Between these examinations, a public health nurse carries out further health check-ups.
  • The examinations at the ages of 4 months, 18 months and 4 years are more extensive, with closer examination of the overall situation of the child and his/her family.
    • The public health nurse and the doctor, together with other professionals, as necessary, assess the child’s health and development and the wellbeing of the whole family.
    • Assessment by the day care or preschool staff can be included by written permission of the child’s parents/guardians.
  • Altogether, the child should be examined 9 times before the age of 1 year and 6 times between the ages of 1–6. At each visit to a doctor/nurse, the child should be weighed and his/her height and the head circumference measured; growth should be monitored using growth charts.
  • The child’s overall development consists of
    • physical health and development
    • neurological development
    • psychosocial development
    • risk factors and protective factors.
  • The doctor is responsible for screening for any diseases or developmental abnormalities and interprets the results of examinations made by the nurse.
  • The main task of the doctor is to draw conclusions regarding any suspected abnormalities, risk factors and protective factors, i.e. the child's overall development. He/she should then explain his findings to the family and work together with the family to plan any necessary further measures. This way, the health of the whole family can be promoted. Further information on a child’s neurological and mental development can be obtained by special tools, e.g. the Bayley Scales of Infant and Toddler Development (Bayley-III). Find out about local availability.
  • Structured assessment may facilitate
    • trust in the assessment results, understanding their significance and forming a holistic view
    • neutral discussion on any developmental issues, accepting and valuing the child and the parents.
  • It is most important for the child’s prognosis to provide him/her with an experience of being accepted.
    • Both the parents and the child need to feel that they are seen and heard.
  • A Let’s Talk (LT) discussion https://mieli.fi/en/let%E2%80%99s-talk-about-children-lt3 will promote the child’s development particularly in difficult situations in life. The method can be learned through training.
  • Each doctor-nurse team should agree on division of labour in detail, combining and utilizing the experience and expertise of each as well as possible.
  • Before a medical examination session, the team should review the data they have on the families they will see.
  • It is important to recognize a child's maltreatment Suspected child abuse: identification and actions5. If maltreatment is detected, a child welfare notification must be submitted. The parent should be referred for treatment, as necessary. A parent’s hostile attitude to his/her child endangers the child’s normal development.
  • It is the duty of a health care professional to report also to the police when he/she in his/her work suspects that a child has been subject to sexual or other type of abuse or battering. Find out about locally relevant legislation and practices.
  • Each child welfare clinic must have a designated responsible physician whose work should include practical clinical work at a child welfare clinic. The responsible physician will:
    • be responsible for the medical quality, organization and up-to-dateness of the child welfare clinic;
    • ensure continuing education and initiation of new physicians;
    • participate (personally or authorize another physician to participate) in interprofessional teams associated with the child welfare clinic.

Read full article of Medical examinations at child welfare clinics

Search terms

Addresses [Publication Type], Cardiovascular Abnormalities, Child Development, Cryptorchidism, Hearing Disorders, Hearing Loss, Heart Diseases, Hip Dislocation, Infant, Language Development Disorders, Mass Screening, Muscle Hypotonia, Muscle Tonus, Neurologic Examination, Paediatric psychiatry, Paediatrics, Psychiatry, R62.0, Spasms, Infantile, Speech, Startle Reaction, Strabismus, Visual Acuity, Walking, Z00, Z00.0, Z00.1, ankle dorsiflexion, asymmetric tonic neck reflex, child health surveillance, child, preschool, femoral pulse, grasp reflex, head protective reflex, head weight bearing, health examination, motor development, red reflex, toe-standing, unilateral finding, walking reflex, weight bearing