Kids health: B4 School Check to be overhauled and children could be screened at younger than 4 years old

Ethan Harper's poor vision wasn't detected in his B4 School Check. Photo / Peter Meecham

A crucial health check for kids is under scrutiny because of concerns it could be missing serious problems and possibly even worsening inequality. As the Herald launches a new series on children's health, Isaac Davison and Emma Russell reveal that the way preschool kids are screened for health problems could be drastically changed.

An overhaul of one of the country's biggest health initiatives, the B4 School Check, is on the cards because of concerns that it widens the rich-poor divide and does not pick up problems early enough.

The part of the B4 School Check which tests a child's development is almost certain to be replaced because it has been found to favour middle-class white families, often at the expense of poorer Māori and Pacific kids.

And the free check, which takes place at 4 years old, could also be moved to earlier in a child's life to make sure that any problems are being addressed before they go to school.

The planned changes to the crucial initiative are one of the findings in the Herald's week-long series on children's health, which looks at five key areas - vision and hearing, obesity, behavioural problems, respiratory illness, and immunisations.

Other findings include:

• One in 20 children fail their before school vision test, and between 5 and 6 per cent fail their hearing test.
• Obesity rates have fallen among preschoolers across all locations, ethnicities and socioeconomic groups, but overall child obesity rates remain high.
• More New Zealand kids are being hospitalised for respiratory illnesses every year, and there are alarming rises in severe conditions which were previously only observed among the elderly.
• Behavioural and mental health problems, especially anxiety, are becoming more common, but early intervention services are not keeping up.
• Nationwide "immunity gaps" mean New Zealand babies will keep dying of preventable diseases.

Around 55,000 NZ kids get a free health check at age four every year. But Auckland DHBs believe the screening tests miss many serious problems. Photo / 123rf

When every child in New Zealand turns 4 they are offered a free B4 School Check to help identify health, behavioural and developmental issues which could affect learning. The aim is to help those children access health and learning support. Around 55,000 kids are screened a year at a cost of $10 million.

It is understood that a review of the whole Wellchild Tamariki Ora programme, which includes the B4 School Check, is running behind schedule, partly because of concerns raised by metropolitan Auckland DHBs who say the check isn't picking up serious problems and could actually be worsening inequality.

Auckland District Health Board community paediatrician Dr Alison Leversha said one of the screening tools used in the test worked well for about 80 per cent of New Zealand children, but did not work for the more vulnerable 20 per cent.

Leversha, who is on the advisory board for the Wellchild review, said the screening tool was open-ended and dependent on parent perception. It would "almost definitely" be replaced as a result of the review, she said.

Research based on students at Decile 1A schools in Glen Innes, Pt England and Panmure found the most disadvantaged families were more likely to say their child was okay because their development was typical for the community. Middle- and upper-income parents, on the other hand, were more likely to express concerns about their children and advocate for them.

Leversha said the alternative could be a developmental milestone check. Most children would complete it with their parents, but at-risk kids would get assistance from a nurse.

"You go through it with your parent and say 'At 5 years of age does your child use comparison words like bigger, smaller, taller? Or do they use past tense?' There's very specific examples and they're easier to understand and help guide parents at the same time about what they would be expecting."

She was also advocating for kids to have the test at younger than 4 years old. By the time kids had been diagnosed and referred with any problems they were often already at school, she said.

Ministry of Health chief adviser for child and youth health Dr Pat Tuohy acknowledged some of the concerns, saying the review provided an opportunity to look at how those tests were performing and how they could be improved.

He would not say whether the B4 School Check could be brought forward, but he noted that several screening checks took place before 4 years old.

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The series:

Today: Vision and hearing
Tuesday: Child obesity
Wednesday: Breathing problems
Thursday: Behavioural problems
Friday: Immunisation