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.