British Columbia Medical Journal, December 2010 issue Please download or visit this entire issue online at http://bcmj.org/issue/december-2010

1. council on
health promotion
Are routine child health visits really necessary?
The state of children’s development in BC
t is the last week of August. I am cally deplete our future stock of terized as having a “preoccupation
I seeing Susan (a fictitious patient)
in my office as a referral from her
family doctor. Susan is about to start
•
human capital.”1
Childhood vulnerability is rising. In
53 of 59 BC school districts, 30.35%
with training its infants and preschool-
ers for proper citizenship.”5
A century later our own govern-
kindergarten and her mom is worried of kindergarten children were vul- ment acknowledges and has planned
about her daughter’s asthma. I ask a nerable, up from 28.5% in 2008/9.2 action to reduce childhood vulnerabil-
few questions about Susan’s general • “Unnecessary early vulnerability in ity. In the report, 15 by 15: A Compre-
health and development and examine BC is costing the provincial econo- hensive Policy Framework for Early
her. She has not attended preschool my a sum of money that is 10 times Human Capital Investment in BC, it is
and her mom reports that she is very the total provincial debt load.”1 recognized that supporting children in
shy and she cried when she went to • Vulnerable children come from all their early years is crucial. The report
her new school for a visit. Susan has walks of life. It is a middle-class illustrates the importance of early
not learned her numbers or letters and problem, not just poverty related.1 human capital investments, and as a
cannot yet print her name. When she • Most childhood vulnerabilities are result the Government of British
does eventually speak, her words were avoidable and preventable.3 Columbia’s 2009 Strategic Plan com-
soft and hard to understand. It is mitted to “lowering the provincial rate
becoming clear that Susan is not ready of early vulnerability to 15% by fiscal
for kindergarten. year 2015/16.”1
Almost one-third of BC children Almost one-third Healthy children are more likely
eligible for kindergarten are not devel- of BC children eligible to become healthy adults, thereby con-
opmentally ready. Such children are tributing to the future workforce and
for kindergarten are not
described by Dr Clyde Hertzman as economy; as we so often hear, chil-
having “developmental vulnerabili- developmentally ready. dren are our future. Through routine
ty.” They exhibit significant delays in health assessments, family physicians
their physical, socio-emotional, or will, no doubt, encounter children with
language-cognitive development. A developmental issues that merit con-
child’s early development, of course, Helping children to be as healthy cern. By way of a systematic approach,
has a significant influence upon that as they can be is hardly a new concept. family physicians are perfectly posi-
child’s health, well-being, learning, The public health movement (1880– tioned to identify and assess children
and behavior, and the effect spans the 1920) brought in reforms that had an with developmental vulnerability and
child’s life course. Here are some facts immediate and positive effect on the assist in providing interventions that
about the state of children’s develop- well-being of Canadian children and will ultimately lead to a reduction in
ment in British Columbia: “came to regard youngsters as its most this vulnerability. The American Aca-
• “Today only 71% of BC children important clients.”4 With prevention demy of Pediatrics, for example, rec-
arrive at kindergarten meeting all as the aim, the movement led to the ommends children be seen routinely
the developmental benchmarks they establishment of two specialized serv- for “health supervision” visits. The
need to thrive both now and in the ices: one targeting infants and the timing and purpose of each visit is
future.”1 other targeting school-age children. well detailed in the AAP Policy State-
• “29% are developmentally vulner- By the end of World War One, English ment and clearly organized in the AAP
able.”1 Canadians came to recognize that publication Bright Futures: Guidelines
• “At three times what it could be, the intervention needed to occur prior to Continued on page 533
current vulnerability rate signals age six, and physicians, along with
that BC now tolerates an unneces- social workers, teachers, and psychol- Visit
sary brain drain that will dramati- ogists, began to focus on the preschool
years as well as the school-age years.
www.gpscbc.ca
This article has not been peer reviewed. Canada emerged as a nation charac-
www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 503

2. pulsimeter cohp
in memoriam
must either send the sample to a Continued from page 503
centralized testing facility, which for Health Supervision of Infants,
can take several days, or make an Children, and Adolescents, third edi-
educated judgment and administer tion, which includes helpful screening
an antibiotic cocktail. Both options questionnaires.6
have serious negative and occa- As a pediatrician in British Col-
sionally fatal consequences. umbia, I only encounter those chil-
SFU graduate students Mona dren who have been referred to me by
Rahbar and Suman Chhina develop- my family physician colleagues. As
ed the first set of prototypes, which such, I am limited in my ability to
were tested in labs in India last year. reduce childhood developmental vul-
The researchers from India vis- nerability. I look to you to help in this
ited SFU and spent two weeks work- regard. Children may be only 25% of
ing with the graduate students and the population, but are 100% of our
performing tests using nonpatho- future.
genic bacterial strains provided by —Wilma Arruda, MD, FRCPC
SFU researcher Fiona Brinkman. Chair, Child and Youth Committee
The prototype chips were then Trevor J.G. Thompson, MD
tested in India using the real bacte- References
rial strains, and the results helped 1. Kershaw P, Anderson L, Warburton B, et Dr Trevor J.G. Thompson
formulate the next generation of al. 15 by 15 A Comprehensive Policy 1925–2010
chips. The new chips have been Framework for Early Human Capital Trevor Thompson was born in King-
sent to India for more detailed test- Investment in BC. Vancouver: Human ston, Ontario, and graduated in
ing and may move on to field trial. Early Learning Partnership, University of medicine from Queen’s University
British Columbia; 2009:1. in 1950. He was a life member in
the College of Family Physicians
Dance wins 2. Human Early Learning Partnership
(HELP). Early Development Instrument of Canada. He studied tropical
writing award Fact Sheet. www.earlylearning.ubc.ca/ medicine in Portugal, served as a
The BCMJ is pleased to announce wp-uploads/web.help.ubc.ca/2010/ missionary in Kenya, and on return
the winner of the 2009 J.H. Mac- 09/EDI-Fact-Sheet-PDF_2010-09-03.pdf to Canada worked in BC and
Dermot Prize for Excellence in (accessed 5 November 2010). Ontario. He retired many times, but
Medical Journalism: Dr Derry 3. Human Early Learning Partnership continued to make house calls and
Dance. Dr Dance was a UBC med- (HELP). Nearly one in three BC children worked most recently with the Tril-
ical student when he was the lead enter kindergarten vulnerable [news lium Gift of Life. He enjoyed work-
author of “Removal of ear canal release]. 27 October 2009. www.early ing with people from all over the
foreign bodies: What can go wrong learning.ubc.ca/wp-uploads/web world, from different backgrounds,
and when to refer” (2009;51[1]:20- .help.ubc.ca/2010/01/News-Release- cultures, and religions. He is sur-
24), coauthored with Drs M. Riley 3rd-data-collection-Oct-27-09-2.pdf vived by Patricia, his wife of 55
and J.P. Ludemann. (accessed 5 November 2010). years, five sons, 16 grandchildren,
The MacDermot Prize, which 4. Sutherland N. Children in English-Cana- and two great-grandchildren. His
comes a $1000 cheque, honors Dr dian Society, Framing the Twentieth-Cen- main interest and passion outside
John Henry MacDermot (1883– tury Consensus. Toronto: University of of medicine was the love of his
1969), who became the editor of Toronto Press; 1978:39. family and church. He also loved
the Vancouver Medical Bulletin at 5. Strong-Boag V. Intruders in the nursery: music, theatre, and ballroom danc-
its formation in 1924. He remained Childcare professionals reshape the ing. He was a member of the Chris-
at the helm until 1959, when it years one to five, 1920-1940. In: Parr J tian Medical and Dental Associa-
became the BC Medical Journal. (ed). Childhood & Family in Canadian His- tion, the Chess Association of
He was editor of the BCMJ until he tory. Toronto: McClelland and Stewart; Canada, Kin Canada, and Rotary
retired in 1967. Dr MacDermot 1982:160-178. International, being a Paul Harris
was also past president of both the 6. American Academy of Pediatrics. Rec- Fellow. He loved the things many
VMA and the BCMA. ommendations for Preventive Pediatric of us take for granted.
Congratulations, Dr Dance. Health Care. Pediatr 2000;105:645-646. —Patricia O’Meara
Kingston, ON
www.bcmj.org VOL. 52 NO. 10, DECEMBER 2010 BC MEDICAL JOURNAL 533