Screening, Screening Programs and the Pediatrician

For a pediatrician to evaluate his position and role in the health care of children, he must have clearly delineated what he means by "health." If, in addition, the pediatrician is to consider his stance with regard to screening, he must specify what he means by "screening," and outline what constitutes a "screening program." HEALTH The pediatrician's commitment to child development and the "welfare of children" suggests that he is interested in far more than biological survival or the absence of disease. His relative commitment to the two poles of this conceptual continuum–biological survival vs total human formation and growth–will strongly affect his approach to health screening. With one commitment, he will choose to put money and time into identifying comparatively rare but potentially fatal or crippling conditions; with a different perspective he may advise that resources be devoted to identifying conditions which are much more common but less physically dangerous. With one viewpoint, he will devote energy to identifying and helping children with language delays and other learning, social and emotional problems. With the other viewpoint, he may elect to screen only for heart disease, PKU, sickle cell disease and tuberculosis. Although the choice may often be pragmatic rather than philosophical, the pediatrician must agree with Richmond and Weinberger that any consideration of the child "must include elements of the entire social milieu in which children develop–the educational system, the social system, the physical and emotional environment itself."1 SCREENING Such an expanded concept of health requires a definition of screening which is less restrictive than the one recommended to the World Health Organization (quoted by Frankenburg2 in his symposium).