An inter-district audit was carried out on the benefit to children of
universal school entry medical examination, the appropriate use of pro
fessional time and to establish a baseline against which to measure fu
ture changes in services to under-fives and schoolchildren. The school
health records of 1127 Cheshire schoolchildren, a random 10% sample,
were scrutinised. There were significant district variations. Overall,
45% of children had problems not previously noted: 21% were serious e
nough to be referred; 11% could have had their problems managed by a w
ell-trained school nurse but 9.8% would have required a medical examin
ation for detection and assessment. These included conditions such as
undescended testes, heart murmurs, squints and hernias and 8% required
immediate action. The selection criteria, based on the absence of a t
hree-year health check and/or parental or nurse concern, would have fa
iled to identify 217 of the 491 children with new problems, some of wh
ich were serious. Targeting only an area of high deprivation or poor h
ealth would equally miss significant conditions. The inter-district va
riation of the numbers and diagnoses of new problems detected at schoo
l entry, and the difficulty in predicting which children will have imp
ortant conditions, provide a good case for the continuation of the sch
ool entry medical examination for all children.