Abstract: Objective To conduct a preliminary screening of the primary health issues among preschool children in extremely high-altitude areas of Tibet, providing a basis for future large-scale epidemiological investigations. Methods Health examinations were conducted on children from a kindergarten in a county in northern Tibet, where the average altitude exceeds 5 000 meters. The examinations included general physical assessments such as age, gender, height, weight, oral health status, thoracic visual inspection, and auscultation of the lungs and heart. Children with potential cardiac abnormalities identified during the general examination were further evaluated using echocardiography. Results A total of 128 Tibetan preschool children underwent general physical examinations, including 61 boys and 67 girls, with an average age of (6.7 ±0.6) years (range: 3.5–7.5 years). Among them, 43.8% (56/128) with suspected cardiac abnormalities based on auscultation or physical examination underwent echocardiography, revealing 10 cases of congenital heart disease, yielding a screening positivity rate of 7.8%. Additionally, 21 children (16.4%) were diagnosed with malnutrition, including 15 cases of stunting and 6 cases of wasting, while 9 children (7.03%) exhibited overnutrition, including 5 cases of obesity and 4 cases of overweight. Signs of rickets sequelae were observed in 37 children (28.9%), manifested as costal margin flaring, pigeon chest, square skull, funnel chest, and other thoracic deformities. Poor oral hygiene was prevalent, with a dental caries rate of 76.6% (98/128). Four children (3.13%) had congenital deformities (3 cases of polydactyly and 1 case of submucous cleft palate), none of which had undergone surgical correction. Seven children (5.47%) presented with skin diseases (5 cases of verruca vulgaris, 1 case of vitiligo, and 1 case of porokeratosis), all of which had not received appropriate treatment. Conclusions Preschool children in extremely high-altitude areas of Tibet may exhibit a high prevalence of congenital heart disease and nutritional disorders, coupled with poor parental awareness of medical care and insufficient knowledge of child health. There is an urgent need for large-scale screening initiatives and enhanced training of primary healthcare providers in child health to facilitate early detection and timely treatment of these conditions.