Healthy kids check effectiveness must be reviewed and further developed

The role of the Healthy Kids Check in prevention and early intervention remains important but its effectiveness as a one-time check must be reviewed and developed further, according to research and an editorial published in the Medical Journal of Australia.

The Healthy Kids Check (HKC) was introduced by the Australian Government in 2008 for all 4- year-olds before commencing school and was designed to detect early "lifestyle risk factors, delayed development and illness" as well as "introduce guidance for healthy lifestyle and early intervention strategies".

Research led by Dr Rae Thomas, a senior research fellow at the Centre for Research in Evidence- Based Practice at Bond University on the Gold Coast, showed that general practitioners using the HKC were "identifying important child health concerns ... using appropriate clinical judgement for the management of some conditions, and referring when concerned".

The researchers conducted a medical records audit of two Queensland general practices, finding 557 files for children who underwent an HKC between January 2010 and May 2013.

They found that 21% had problems detected during the HKC and that of those, 20% related to speech and language; toileting, hearing and vision accounted for 15% each; and behavioural problems accounted for 9%.

Of the 116 children with problems detected during the HKC, 19 (3% of the total sample) had those problems confirmed, resulting in a change of clinical management.

"We estimated that the change in clinical management to children with health concerns directly relating to the HKC ranged between 3% and 11%", allowing for missing data, and unclear medical records, the researchers wrote.

"GPs use HKC screening to conduct opportunistic examinations that extend the parameters of the HKC, identifying other clinically meaningful child health concerns. "However, they may be hampered by limited means of detection with little evidence of effectiveness."

"We also have no knowledge of the cost-effectiveness of the HKC", the authors noted. "Given the significant child health concerns detected throughout the medical records and at various time points ... in our study, we must consider the value of a single-point assessment, which has components of limited evidence."

Further research was essential, they concluded.

"A longitudinal, prospective cohort study of children undertaking the HKC is needed to understand the long-term outcomes of children with identified health concerns, and to determine whether interventions help or harm."

In 2012, an expert panel was set up to review a replacement for the HKC - the expanded HKC (EHKC) - which would be administered to all 3-year-olds and designed to assess parents' concerns about health, development and behaviour as well as a physical assessment of the child.

Professor Frank Oberklaid, director of the Centre for Community Child Health at the Royal Children's Hospital Melbourne, wrote in an MJA editorial that prevention was a "hard sell to government" and provided many challenges, but that policy initiatives such as the EHKC are an important first step in developing an evidence-based prevention and early intervention agenda.

"Making the check part of Medicare removes a potential financial barrier for uptake but still does not ensure that all children, especially those at risk, are seen in a timely fashion. "It is to be hoped that the government persists with the ongoing review and informed evolution of the child health check", he concluded.