Child health surveillance (CHS) has evolved greatly over the past 30 years from a proactive screening process by health professionals to a more passive approach of child health promotion (CHP), which places the main responsibility for detection of developmental problems on carers. The impetus for this change came from the Hall Report (1989), which reported a lack of evidence for CHS. Although research on developmental screening is sparse, some data show that use of structured methods for identifying deviations from normal increases the pick-up rate of abnormalities, compared with informal or parent-initiated methods. The majority of countries recommend a universal 'CHS' type of programme, in contrast to the UK and some other European countries. Alternatives to universal CHS include 'targeting' which, however, has been criticised for including too many 'normal' children and missing those who are most in need. CHS and CHP are basically primary care activities but require essential support from secondary paediatric services. There are concerns about the competence and numbers of general practitioners and health visitors who deliver child healthcare. Both these professional groups are under great pressure because of continuing reorganisations of the National Health Service in the UK. Politically driven agendae complicate the fundamental aim of enhancing child health at the primary level and it is vital to keep the focus on providing high-quality services to the most needy children. CHS has evolved beyond CHP to a Healthy Child Programme (HCP). Hopefully this is not an 'emperor's new clothes' situation and will improve outcomes. A major problem is the 'inverse care law', and reliance on carers runs the risk of excluding those children who need most input. Inequality is currently a headline problem and the change from CHS to HCP may not have helped. More research is urgently needed to resolve uncertainty about the application of these fundamental procedures for secondary preventive of childhood disability.

The phenotypic nonspecificity of many forms of X-linked mental retardation has hampered attempts to classify them into clinically homogeneous groups. One such condition, described by Clark and Baraitser [1987: Am J Med Genet 26:13-15], has been the subject of a single pedigree report to date. We now describe a further pedigree whose affected members share many manifestations with those reported by Clark and Baraitser, and we consider the possible distinction between this condition and Atkin-Flaitz syndrome.

We read with interest the January edition of Archives containing three thought-provoking articles on the autistic spectrum. The article by Harrison et al, 1 which described the two source ''capture recapture'' technique as a means of determining ''true'' prevalence, provided an enlightened alternative to using conventional, ''passive'' ascertainment of point prevalence. We conducted an 18-month retrospective audit of our social communication clinic for children in Enfield. The primary aim was to compare our clinic with the recommendations set by the National Autism Plan 2 ; however, it also raised issues on:

The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7-11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0.26%, 95% confidence interval (CI) 0.14-0.44]. The estimated average annual incidence of hepatitis B was estimated to be 29.26/100 000 children (95% CI 16.00-49.08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5.00 and 12.49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.