Background: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism. Objective: To identify VAD in preschool children by the serum 30-day dose-response test ( þ S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community. Design: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30-45 days after supplementation in order to determine the þ S30DR. Results: In all, 74.5% (140/188; 95% confidence interval: 68.3-80.7%) of the children presented þ S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 mmol/l, respectively; Po0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the þ S30DR value. Conclusions: The prevalence of VAD in the study group was elevated. þ S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country. Sponsorship: The study was supported

Objectives: To identify the prevalence of iron deficiency in the population studied, as well as verifying if such deprivation is associated with vitamin A deficiency. Methods:One hundred seventy-nine children, > 24 months and < 72 months of age, with no diarrhea and/or fever at collection were studied. Vitamin A deficiency identification was carried out through serum 30-day doseresponse test. Samples of peripheral blood from fasting children was obtained for hemoglobin counts, serum iron, and unsaturated iron binding capacity assays. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained.Results: 35.8% (64/179) of the children presented iron deficiency and 75.4% (135/179), vitamin A deficiency. 29.1% (52/179) of the children presented both iron and vitamin A deficiencies. Iron deficiency was not associated with vitamin A deficiency. A separate analysis for each hematimetric index also demonstrated no significant difference between children with or without vitamin A deficiency. Children aged 24 to 36 months presented significantly higher prevalence rates of iron deficiency (p = 0.0005) as did children with diarrhea and/or fever during the 15 days preceding the study (p = 0.003).Conclusions: Although iron deficiency was not associated with vitamin A deficiency, high rates of both deficiencies were exhibited in a healthy population with low malnutrition indices. Such situations are known as hidden hunger. Younger children presented a higher risk of iron deficiency as did children with diarrhea and/or fever during the 15 days preceding the study.

Objective: To present, in an essay form, two distinct views on well-child care.Methods: Using several different methods of historical analysis, the two most common views on well-child care are presented: the positivist one, whose foundation is essentially based upon historical facts, and that of social criticism, concerned with how historical facts are inserted in society at different levels.Results: The coexistence of two distinct views on well-child care reveals two conflicting ideologies, but it does not invalidate the two different types of knowledge. Conclusions:Even though the understanding of well-child care through a historical approach does not allow for definitive conclusions on what it is or what it will be, it encourages reflections on more practical meanings, namely: the possibility to consider practices that gather an ensemble of positive knowledge without disregarding their limitations, and the formulation of well-child care practices concerned with social care, determined by several aspects, instead of by ideological interest.J Pediatr (Rio J). 2005;81(1):7-13: Well-child care, history, ideology.

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