The Healthy Kids Check - is it evidence-based?

OBJECTIVE: To assess whether the components of the Healthy Kids Check (HKC), a preschool screening check recently added to the Australian Government's Enhanced Primary Care Program, are supported by evidence-based guidelines or reviews. DATA SOURCES: Guideline and MEDLINE databases were searched for guidelines and systematic reviews published between 2000 and 2008 that were relevant to screening, prevention or well-child care in primary health care, and including children of preschool age. Search subjects reflected the HKC components: growth, weight, obesity, vision, hearing, oral health, enuresis, encopresis, allergic disease and food allergies. STUDY SELECTION: 34 relevant guidelines or reviews were retrieved. DATA EXTRACTION: For each component of the HKC, guidelines addressing the presumed rationale for screening, or the test or tool required to implement it, were reviewed. Relevant evidence-based and consensus-based guideline recommendations were assessed as either supporting or opposing components of the HKC, or stating that the evidence was insufficient to recommend screening of preschool children. DATA SYNTHESIS: Guidelines were often inconsistent in their recommendations. Most of the components of the HKC (eg, screening for chronic otitis media and questioning about toilet habits) are not supported by evidence-based guidelines relevant to the primary care setting, though a number of consensus-based guidelines are supportive.
CONCLUSIONS: There is currently a dearth of evidence relevant to child health surveillance in primary care. The components of the HKC could be refined to better reflect evidence-based guidelines that target health monitoring of preschool children.