A Rotorua paediatrician says doctors are seeing the effects of poor housing conditions and overcrowding on children - and that is "only the tip of the iceberg".
Lakes District Health Board community paediatrician Dr Belinda Coulter said doctors were seeing numerous children with respiratory illnesses and skin conditions that were contributed to by the child's living conditions.
She said in the children's unit they only saw the worst cases, such as youngsters with pneumonia needing oxygen and intravenous treatment.
"We know that we are only seeing the tip of the iceberg."
Housing issues in Rotorua have hit the headlines, with Waiariki MP Te Ururoa Flavell speaking out about the shortage of decent housing and increasing numbers of people turning to his office for help.
Dr Coulter said poor housing had been a problem for a long time, but the recent publicity had made everyone more aware and had given families the courage to speak up about their circumstances.
"It is worrying to hear of wet and mouldy walls."
She said the types of illnesses contributed to by living circumstances tended to impact more on the most vulnerable, especially children under 1.
Dr Coulter said paediatricians routinely asked about housing circumstances and cigarette smoking.
"We are always happy to provide letters of support and when circumstances are particularly bad our social workers also get involved. We maintain close relationships in Rotorua with agencies who can assist families around their housing needs.
"Paediatricians are very keen to look at the whole picture and help a family as much as possible with any factors which may contribute to the child's illness.
Dr Coulter said respiratory illnesses, such as the common cold, bronchiolitis and pneumonia, could be attributed to poor housing because the illnesses spread more readily when people lived in very close contact, and the severity was higher when people were stressed.
Skin problems were also linked with poor housing, she said.
"We see kids with skin infections that have got out of control. We also see kids who have suffered kidney damage as a consequence of their skin infection."
Dr Coulter said the "most famous" illness linked with poor housing was probably rheumatic fever - something they had to teach doctors from the US and UK to diagnose because it was so rare in those countries.
Rotorua GP Harry Pert said it was well known that damp houses, cold houses and old housing stock had an impact on children's health.
He said just yesterday morning he saw a child whose mum was concerned about their housing conditions. "There is much more awareness now."
Dr Pert said he did know of people coming in asking for medical certificates to support them changing houses.
Western Heights Primary School principal Brent Griffin said poor housing and an inability to afford heating were issues families in his community faced.
He said sometimes families were staying in houses that were cold and damp because there was little other option.
Mr Griffin said the school was "incredibly well resourced" through public health to carry out things like throat swabbing to prevent rheumatic fever.
"There are a lot of good systems but that doesn't change the fact people are being rented damp poor housing often at an exorbitant price."