Return to Scenario ListShow Learning Points most relevant to Phase 1:

Before school check

Clinical Discipline(s)/Organ System(s)
General Practice, Paediatrics, Psychiatry/Health Psychology
Progress Test Topic(s)
Child health
During your GP attachment you attend the 'Before-School' check with the practice nurse on a 4.5 year old Samoan boy, with his father attending. His father mentions that his son does not like to play with other children and plays with the same dinner-plate, holding it as a steering wheel and repeatedly turning it around in his hands. He also likes to watch their garden windmill for prolonged periods and dislikes going with the family to their large social church gatherings. His father says he is not speaking as much as his siblings did at the same age.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Normal human growth, development and speech through the life span
   - Immunology and microbiology of common vaccine preventable disease
   - Nutrition
Clinical and Communication Skills 
   - Administer a screening questionnaire to parents
   - Recognise what is needed to perform a hearing, visual and oral health screen
   - Observe the administering of parental questionnaires to identify developmental and behavioural problems
   - Perform, document and interpret height and weight measurement
   - Perform a physical examination of a child including assessing normal major developmental milestones, assessment for dysmorphsim, neurocutaneous stigmata, assessing hearing and vision
   - Knowledge of common causes of developmental delay
   - Knowledge of common pervasive developmental disorders such as autism and how these are assessed such as presenting features of autistic spectrum disorder in young children
   - Know how to refer child to specialist services if the child appears to have problems that need further investigation
   - Explain advice and support for parents about child health and development including provision of education about healthy eating and healthy activity
   - Evaluate common behavioural problems of infancy and early childhood
   - Explain to caregivers about seeking help for common symptoms in childhood including discussion on vaccine preventable disease; knowledge of immunisation protocols and contraindications
Personal and Professional Skills 
   - Obtaining consent from parents for participation in screening and well child checks
   - Role of the general practice in health prevention
   - Evaluating social history, screening for domestic violence/safety
   - Understand how family and school dynamics can influence behaviour
   - Communicate empathetically with child and caregivers; recognition of discussion of delayed development and pervasive developmental disorder can cause significant stress in the caregivers
Hauora Māori 
   - Determine the whānau situation for the child and family
   - Identify and address barriers to access to healthcare
   - Strengths of whānau - support of extended family, including older family members, in caring for preschoolers
   - Appropriate engagement and consultation with whānau
Population Health 
   - Epidemiology New Zealand of accidental and non-accidental mortality and morbidity in children
   - Legal requirements regarding seatbelt and car restraints for children and infants
   - Preventative health regarding safety from accidents in the home, driveway and around water for preschoolers
   - Understand preventative health and how promotion of health and wellbeing in preschool children plus early identification of behavioural, developmental or other health concerns may affect child's ability to learn
   - New Zealand Immunisation Schedule
   - Understanding the inequitable distribution of child health outcomes, and the social determinants of child health
   - Access to local or national multidisciplinary neurodevelopment and/or child psychiatry services
   - Audiology and newborn screening
Conditions to be considered relating to this scenario
behavioural problems (enuresis, tantrums, antisocial behaviours, shyness), growth abnormalities, immunisation delay
Less common but 'important not to miss'
visual or hearing impairment, developmental delay, autistic spectrum disorder, emotional/physical neglect or abuse
Related Scenarios
[6 week check ]

New Zealand Immunisation Handbook

Note the following sections:
  • National Immunisation Schedule  - Table 1 Introduction
  • General Immunisation Principles and Processes for Safe Immunistion - Chapters 1 and 2
  • Vaccination questions and addressing concerns - Chapter 3
GP long case -  Jacob (Hearing Issues - Long Case)