Visual impairment in childhood: insights from a community-based survey.

BACKGROUND: The concept of visual impairment (VI) in childhood has changed over the last 30 years. There has been a decrease in the number of children with an isolated visual problem and an increase in the numbers with VI and coexisting neurological disability. This study aimed to produce a profile of VI in childhood with a view to informing future services and to raise awareness of the need for comprehensive assessment including developmental remediation and educational advice. METHODS: Children with a VI were identified from multiple sources including hospital- and community-based paediatricians and statutory blind registers. RESULTS: Seventy-six children with a VI were identified giving a childhood prevalence of 1.61 per 1000. Thirty-two per cent had a normal pattern of development. Global delays/severe learning difficulty were found in 43%. Only 21% of the children had an isolated VI. Additional medical problems were present in 79% of which cerebral palsy, occurring in 33%, was the most common. Nine per cent of the children were classified as totally blind. Cortical visual impairment was diagnosed in 45%. Twenty-two per cent of the children were registered blind or partially sighted. CONCLUSIONS: Most cases of VI in children did not appear on the statutory blind or partially sighted registers, thus these have limited value for service development. The implications for practice highlight the need for early assessment and advice from a co-ordinated team to optimize visual potential in childhood.

The Child Protection Register: a tool in the accident and emergency department?

AIMS: To determine the number of children on the Child Protection Register (CPR) attending the accident and emergency (A&E) department and the referral source, diagnostic category, and frequency distribution for such attendances. To determine whether lack of knowledge that a child is on the CPR results in failure to suspect non-accidental injury (NAI) if the standard indicators of NAI have been sought. METHODS: Access to the CPR was obtained. Records of each child attending the A&E departments of the United Hospitals Trust between June 1994 and May 2000 were reviewed. RESULTS: Over the six years 191 children were on the CPR. Seventy nine (41%) attended A&E departments on 206 occasions. Frequency of attendance ranged to 18 with a mean of 2.6. Self referral was the commonest source of referral (81%) followed by general practitioners (13%), 999 calls (5%), and a small number from schools (1%). Most presentations involved trauma-upper limb (21%), lower limb (14%), and head injury (8%). Almost all cases of trauma were adjudged to be consistent with the history and NAI not suspected. Common childhood illnesses accounted for the remainder of presentations. Only six children were identified as being on the CPR at the time of presentation. Concerns were raised in two other cases and concerns should have been raised in three other children. Social Services were alerted on five occasions directly by the parents themselves. CONCLUSIONS: It is concluded that in the absence of knowledge of the status of a child on the CPR attending the A&E department, that screening for the standard indicators of NAI is adequate to detect most cases of NAI.