Delivering high-quality child health care in general practice.

This month's BJGP reports an observational study of screening for testicular descent which makes the claim that such screening is worthwhile in older boys. 1 The authors advocate the reinstatement of the previous screening regimen for testicular descent at 9 months and 3.5 years. 2 Is this a sensible recommendation? The current UK National Screening Committee evidence-based programme recommends screening for undescended testes (UDT) at birth and at 8 weeks but not for older boys. A previously published audit of delayed orchidopexy concluded that ascent of a previously scrotal testis was the likely cause for late diagnosis of UDT rather than a failure of screening. 3 This would explain the consistently high mean age at which boys undergo orchidopexy reported from all over the world, despite the introduction of 'aggressive' UDT screening. 4 It is increasingly recognised that ascending testes are more common than previously thought and are more likely to have a history of being retractile. 5 Although most retractile testes do not require surgery, 6 they should not be considered a normal variant, as some can ascend in older boys necessitating orchidopexy. 7 The regular follow-up of boys with retractile testes is recommended rather than the introduction of a more general screening programme for older boys. Screening for early childhood illness is important and can be done well in general practice. For most children, the early detection of congenital conditions, such as hip dysplasia, cataract, coarctation of the aorta, and UDT, can make a real difference to their future health. The key issues for us as GPs are the timing of the screening, our competency to undertake the necessary examinations, and the practice resources required to deliver the programme. As the optimal management of retractile and ascending testes remains controversial, we believe that our current focus should be on ensuring our competency to carry out the 6-to 8-week examination, actively following up all infants who default on their screening appointments, and opportunistically screening any boy at a later date if there is parental concern. The delivery of high-quality child health care remains a core component of general practice. All GPs should be competent and be able to demonstrate that they are proficient in recognising and managing acute and chronic illness in children, and in organising their practices to administer timely health promotion and preventative care to all children and their parents. Developing and maintaining competence in the care …