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.

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.

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.

The B4 School Check includes the following:

• Child Health Questionnaire (Word, 278 KB)
• hearing and vision screening through sweep audiometry, tympanometry and distance visual acuity
• measurement of height and weight for recording in the Well Child health book and B4 School Check database
• behavioural and developmental questions using the Strengths and Difficulties Questionnaire (SDQ) and Parental Evaluation of Developmental Status (PEDS) tools
• an oral health screen using the Lift the Lip resource and check for enrolment in a school dental clinic
• health promotion and education – providing information resources, advice and support as appropriate
• referrals to appropriate health, education or social service where the B4 School Check has identified the need for such services.

The Well Child/Tamariki Ora Programme Practitioner Handbook is the primary resource for nurses and health professionals delivering the B4 School Checks to 4-year-old children. A revised version of the handbook was released in 2014.

Some DHBs use a predominantly primary health care-based service delivery model, while others use a more public health or Well Child nursing-based approach.

Regardless of the model of delivery, it is important that there is good engagement and collaboration between providers at all levels.

These screening protocols have recently been updated and are for use by Vision Hearing Technicians (VHTs) and other health professionals who are part of the National Vision Hearing Screening Programme.

Information about the National Vision and Hearing Screening Protocols

The B4 School Check was piloted from August to November 2007 in Whanganui and Counties Manukau DHBs.

A formative evaluation of the pilots informed the planning for the national roll-out of the service in 2008.

Download the full data dictionary for the B4SC database along with definitions:

• B4 School Checks Data Dictionary (PDF, 250 KB)
• B4 School Checks Data Dictionary (Word, 46 KB)

Researchers may apply for access to B4 School Check data for specific purposes. The dataset is now available via the Integrated Data Infrastructure managed by Stats NZ. To access it via the IDI, follow the Stats NZ process:

• Apply to use microdata for research (Stats.govt.nz)

The Ministry of Health can provide extracts of unit record data where certain conditions are met. Researchers who wish to access B4SC data outside of the IDI need to fill in the application form:

• Application for B4 School Check Data (Word, 145 KB)

Once downloaded and filled out, email it to serviceperformanceteam@health.govt.nz. Please allow several weeks for the approval process.  

Published data on indicators under the Well Child Tamariki Ora Quality Improvement Framework can be found at

• Well Child Tamariki Ora Quality Improvement Framework – Te Whatu Ora - Health New Zealand

  Indicators 14 to 18 under this framework are from B4 School Check.