B4 School Check information for early learning services

The B4 School Check is a free health and development check for every child in New Zealand. It takes place when a child turns 4 years old and is the last Well Child check before the child starts school.

The B4 School Check is an opportunity for early childhood educators and health professionals to work together to support the health, development and wellbeing of young children by identifying and following up on any health or development issues before they start school.

When a child turns 4, their B4 School Check is due. If a parent or caregiver hasn’t heard from us, it’s important they contact their local provider to organise a check.

By having the Check as close as possible to a child’s 4th birthday, it means there is time to connect families to health and support services before the child starts school, and provide information to parents about specific health and development issues for school age children such as nutrition, exercise and activity, and dental care.

For more information about B4 School Checks and your involvement, contact your local provider.

What happens in a B4 School Check?

A registered nurse will carry out the B4 School Check. They will spend about 45 minutes checking the child’s:

  • general health and development
  • height and weight
  • teeth
  • social and emotional wellbeing
  • immunisation status.

The child’s vision and hearing will also be screened by a vision and hearing technician – this may happen at a different time.

Why is the B4 School Check so important?

The Check is a chance for parents and caregivers to ask questions, learn more about their child’s health and development, and be reassured their child will have the best start at school.

The Check is an opportunity to connect families to health and support services for further assessment of any issues identified.

A comprehensive health and development check of children who are 4 years old can pick up health and development issues that would otherwise only become apparent as a child gets older. It is important this happens before the child starts school and the next stage in their learning.

The important role of early learning services

Education and health have critical roles to play in this important check.

Your connection with and observations of children are important to the B4 School Check.

The learning and development information you provide in the B4 School Check is highly valued by parents, caregivers and both the Ministry of Health and the Ministry of Education.

A person responsible under your service’s license will be asked to complete a Strengths and Difficulties questionnaire (SDQ-T). The B4 School Check provider will supply the SDQ-T and outline the process for returning it once it has been filled in. (Sometimes the parent or caregiver will ask you to complete the SDQ-T.)

The SDQ-T is a tool to identify where a child may need further help before they start school. It focuses on a child’s strengths that can support the child, as well as any difficulties the child is experiencing, such as, difficulties with concentration, behaviour or getting along with others.

The SDQ-T asks for your observations, using your professional judgement, about a child’s interactions as the child participates in the early childhood education environment.

The B4 School Check is an opportunity for health professionals and early education service providers to work with parents and caregivers to ensure a child can reach their potential.

We need your help to:

  • promote the B4 School Check by reminding parents and caregivers that it’s free
  • encourage parents and caregivers to say ‘yes’ to the Check
  • work with nurses to complete the questionnaire for early learning services on the child’s strengths and difficulties (SDQ-T)
  • support and encourage parents and caregivers to attend appointments if referrals have been made.

Questions and answers

What happens if an issue is identified during the Check?

If concerns or difficulties are identified during the Check, the child and their parents or caregivers are offered information and support. This could include referral to health, education or social support services.

Why is the SDQ used?

There are a range of assessments available but the SDQ was considered by the Ministries of Health and Education to be the most appropriate for use in the B4 School Check.

The SDQ is a tool to identify where a child might need further help before they start school. It focuses on a child’s pro-social strengths and any needs, such as any difficulty with emotions, concentration, behaviour or getting along with others, which could benefit from further discussion and/or assessment.

The SDQ reflects current understanding about risk and resilience, and the impact these have on a child’s development and learning. Evidence shows early identification and intervention improves development and social outcomes for the child, family and whānau.

The SDQ is used by several other countries and is well respected by specialists and researchers. It was selected over other tools for identifying social and emotional needs because it is widely used and accepted internationally by people working in child health, development and education. It is also quick to use and easy to score. It is based on the long-used Child Behaviour Checklist and Rutter questionnaires but puts more emphasis on a child’s strengths rather than just their difficulties.

How does the information in the SDQ get used?

Along with information from the other components of the B4 School Check, information from the SDQ is used to support children by identifying their strengths and whether a child and their family and whānau need additional support and/or intervention before starting school.

The B4 School Check nurse combines the information gained from both the home (SDQ-P) and early learning (SDQ-T) environments. The SDQ is better at identifying strengths and difficulties if both a parent and a teacher complete the questionnaire.

The nurse then discusses this information with the child’s parent or caregiver. Identification of particular concerns or difficulties may lead to an offer of referral to services or may just require advice and support from the nurse.

Can I add comments to the SDQ?

Yes, if you have additional comments, please feel free to write these on the questionnaire.

Should I involve parents or caregivers when I complete the SDQ-T or discuss my observations with the child’s parents or caregivers?

The SDQ-T is a record of observations of a child in a social, learning environment. It is good practice to discuss these observations with the child’s parent or caregiver.

What should I do if I have concerns about a child’s health or development?

The B4 School Check is a general check – it is not designed to pick up every health or development problem.

If you have concerns about a child or feel they need additional support, please do not wait to raise these with the child’s parents or caregivers, with Special Education, or with other appropriate support agencies.

What happens to the information collected as part of the B4 School Check?

The results of the B4 School Check are given to the child’s family doctor. Early learning services are given the child’s vision and hearing assessment results. Any further sharing of information requires consent from the child’s parent or caregiver. 

Information collected as part of the B4 School Check is stored in the national B4 School Check information system. The purpose of this information system is to ensure each child is invited to participate in a B4 School Check and all services beyond the basic check are requested and acknowledged by the service provider (eg, enrolment in dental services, repeat testing for vision and hearing).

The information system also provides non-identifiable information for monitoring the performance of the B4 School Check programme and for tracking the population health status of 4-year-olds. Researchers may apply to use this information.

Any identifiable information stored can only be accessed by authorised people who are working with the child, coordinating the B4 School Checks, or managing the information system.

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