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Fewer than 5% of New Zealand children who have before-school health checks record abnormal scores, but not all of them are referred for further assessment, University of Otago research has found.
More than 90% of eligible 4-year-olds had free voluntary checks of childhood health and development since 2013.
All children with two or more concerns raised by the check should be referred to specialist services, such as speech or language therapists, but an article published today in the New Zealand Medical Journal said as many as two-thirds of children might be missing out.
It was possible nurses used clinical judgement to decide which children needed specialist services or tailored advice, or children might already have been identified as being at risk before receiving a check and were already receiving help.
"It is also possible that the low referral rates are due to services having been unavailable in some areas," authors Noni Richards, David Reith, Michael Stitely and Alesha Smith said.
People in deprived areas were usually at risk of missing out on health services, but in this context referrals increased with increasing deprivation scores.
"Two possible reasons for this could be a higher rate of health problems in children of higher deprivation groups, and that children from areas with lower deprivation scores were more likely to have already been referred to further services for developmental concerns before they attended the before-school check."
The checks identified children who had been missed earlier for referral, the authors said.
"Despite a large cohort of children who have been identified and referred for assessment ... there is also a significant group who have not been referred.
"To understand the reasons for this, further investigation is required."