[Health checkups for children of 3-4 years of age in the Hauts-de-Seine department (France): results and prospects].
BACKGROUND
A mission of the department's State Maternal and Child Welfare Service is to organize the first checkups for children attending nursery schools. Here, we present the data of the Hauts-de-Seine department (France).


METHODS
All of the PMI physicians who carry out checkups of children aged 3 to 4 years in the nursery schools of the department, contributed in this study by random drawing a sample of 1914 children, born in 2001, who were in the 1st year of nursery school in 2004-2005. The data gathered concern the children's way of living, their personal and family antecedents, vaccinations, the results of the clinical examination, tests of hearing, vision, and language, the existence of special health or educational programs for children with handicaps or illnesses (PPS and PAI), as well as the types of health insurance coverage the children have.


RESULTS
The median age of the children at the time of the checkups was 3 years and 8 months. Half of the children had had some kind of childcare from before the age of 1 year. Two-thirds of the children spend more than 25h a week at school. Twenty-seven percent of the children had already been hospitalized, due to accidents in 5 % of the cases. One child out of 20 lives in a nuclear family that has experienced a serious familial disease. Thirty percent of the children speak or understand a second language. Fifteen percent of the children have poor health insurance coverage. 8.5 % of the children were overweight, 1.6 % were obese, 3.9 % were too thin. 2.5 % were in school with PAI programs,and 0.4 % with PPS programs. As a result of the checkups, 30.1 % of the children were referred (28.3 % for children who have both social security and mutual insurance), including 4.7 % for hearing tests, 13.7 % for vision, 4.4 % for dental checkups, 6.3 % for anomalies of the general examination, 2.7 % for psychological difficulties, 2.6 % for serious language difficulties. 28.9 % of the parents received advice (26.4 % for children who have both social security and mutual insurance) for psychological difficulties, language issues, DTCPH (diphtheria, tetanus, whooping cough, poliomyelitis and hemophilus) and Measles, Mumps, Rubella (MMR) vaccination boosters, and 56.1 % when we add the recommended hepatitis B vaccination. Children who are in schools in priority education zones represent 12.1 % of them. These 2 subgroups are distinguished for a large number of variables, which reflect the very early appearance of social inequalities in terms of health care. Children who went to the Child Welfare Service represented 35 % of the sample, children who are in schools in priority education zones represent 12.1 % of them.


CONCLUSIONS
The complete and systematic medical exam for children in nursery school at the age of 3-4 years old, the key age for screening, give occasion to appreciate global children's health. There should be thinking on the national level about how to group the results of the departments.
Bois
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Service départemental de PMI, conseil général des Hauts-de-Seine, 92015 Nanterre cedex, France. cbois1@cg92.fr
Guillemot
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D002675:Child, Preschool; D005260:Female; D005602:France; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008403:Mass Screening; D009313:National Health Programs; D010808:Physical Examination; D012017:Referral and Consultation; D012578:Schools, Nursery; D013334:Students; D014611:Vaccination