7th June 2019, Volume 132 Number 1496

Noni Richards, David Reith, Michael Stitely, Alesha Smith

The Before School Check (B4SC) is a health and development screening programme that assesses the school readiness of four-year-olds prior to school entry in New Zealand. The programme aims to…

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The Before School Check (B4SC) is a health and development screening programme for four-year-olds. It captures information on the height, weight, vision, hearing and emotional and physical development of over 90% of four-year-old children in New Zealand. We found that less than 5% of children had problems with emotional and physical development. We also found that children from socioeconomically disadvantaged areas were more likely to be referred for extra assessment.



Describe the data obtained through the Before School Check (B4SC) and report on the outcomes and referral rates of the B4SC measures.


Cross-sectional study of B4SC data collected between January 2012 and December 2016.


After excluding duplicate entries, 287,572 children from the B4SC database were included for analysis. Two or more significant developmental concerns (assessed by the by Parental Evaluation of Developmental Status (PEDS) questionnaire) were identified in 14,177 (4.9%) children. Less than four percent (n=10,941) of children had abnormal Strengths and Difficulties Questionnaire (SDQ) scores of 17 or more, indicating concerns about emotional and behavioural development. Eight percent of children (n=24,147) had BMIs in the 98th centile or above. Only half (56%) the number of children meeting the criteria for referral in the PEDS and SDQ assessments were referred or already under care. A quarter (25.2%) of all children in areas with the highest deprivation scores were referred for further assessment in at least one of the measured domains compared with 14% of children in areas with the lowest deprivation scores.


The B4SC database provides an overview of the development of four-year-old children in New Zealand. Less than 5% of children had abnormal scores in assessments that measure neurodevelopment, however not all children who met the referral criteria were referred to other health services. Rates of referral increased with increasing deprivation score.

Author Information

Noni Richards, PhD Candidate, School of Pharmacy, University of Otago, Dunedin;
David Reith, Associate Professor, Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin; Michael Stitely, Associate Professor, Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin;
Alesha Smith, Senior Lecturer, School of Pharmacy, University of Otago, Dunedin.


Noni Richards, School of Pharmacy, University of Otago, 18 Frederick St, Dunedin.

Correspondence Email


Competing Interests



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