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Prevention and early detection in young children: challenges for policy and practice

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Review and further development of the Healthy Kids Check are crucial

Evidence-based systems of prevention and early intervention have long been a far-reaching goal for health planners and academics. This notion has assumed even greater importance in paediatrics because of the robust research now emerging about the early-life origins of a range of problematic health and psychosocial conditions later in the life course.1 Conditions as diverse as diabetes, cardiovascular disease, mental health problems and criminality have been linked to the environments experienced by unborn and young children. The idea of introducing a health check for children in order to detect emerging problems and risk factors, and offer treatment early in life, seems a natural and welcome policy response.

However, what seems such an intuitive concept faces a number of significant challenges in its implementation.2 These include the improbability of being able to check all children (with those most at risk being least likely to present for a check); the lack of reliable and valid measures in many domains (not fulfilling the scientific criteria for a screening test or program); the considerable developmental variability in young children (so that many problems are transient); and the difficulty in timely access to assessment and treatment services (cost, long waiting lists, and uneven coverage…