Children

Sir Michael Marmot’s review of health inequalities recommends that action in the early years is crucial to giving every child the best start in life to reduce health inequalities across the life course.  The foundations of many aspects of human development (including physical, intellectual and emotional) are laid in utero and in early childhood.

The importance of the health and wellbeing of children is well documented.  There is national recognition of the importance of health/behaviour during pregnancy and the early years of life, with significant emerging evidence related to neo-natal science.  In particular, the importance of early experiences, responsive parenting and secure attachment.

The following JSNA topics are the most significant factors that increase a child’s risk of poor life chances:

Wider determinants of health

Education

Children who achieve low educational attainment are likely to suffer from lower life chances.

Poverty

Growing up in poverty can affect every area of a child’s development and future life chances.  Children from low income households are less likely to achieve their academic potential, less likely to secure employment as adults, more likely to suffer from poor health, more likely to live in poor quality housing and they are more likely to reside in unsafe environments.

Behaviour and lifestyle

Alcohol misuse

Alcohol misuse during pregnancy poses a significant health risk to the unborn child.

Children living with parents who are dependent on alcohol are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse are at a higher risk of becoming alcohol abusers themselves.

Illicit drug use

Children living with parents who abuse drugs are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse drugs are at a higher risk of becoming drug abusers themselves.

Smoking

Smoking during pregnancy poses a significant health risk to both the mother and unborn child.

Parents who smoke around their children are significantly increasing their child’s risk of disease and ill-health.

Diet and nutrition

Breastfeeding gives a child the best start in life and is beneficial for the health of the mother.

Nutrition has a key role in the prevention and management of diet-related diseases (such as cardiovascular disease, cancer, diabetes and obesity).

Obesity

Obesity is one of the biggest risks to the health of the population. 

Obesity in children can lead to poor physical health (including increased risks for elevated blood pressure and Type 2 diabetes) and poor mental health (including low self-esteem, anxiety and depression).

Illness and death

Injuries

Injuries are a leading cause of death and illness of children and one of the most common reason for hospital admissions. 

Mental health

One-in-ten 5 to 15-year-olds has a mental health problem. Many continue to have mental health problems as adults.

Last updated: 2014-04-16 10:01:21
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1. What are the key issues?

Wider determinants of health

Education

A lower proportion of children in Redcar & Cleveland (55%) achieve 5 A*-C GCSEs (including English and Maths) compared to the England average (58%).

Poverty

A higher proportion of children in Redcar & Cleveland (27%) are living in poverty compared to the England average (22%).

Behaviour and lifestyle

Alcohol misuse

In Redcar & Cleveland little is known about the number of children affected by parental alcohol misuse.

A higher proportion of adults receiving alcohol treatment in Redcar & Cleveland (64.8%%) are parents compared with the England average (44.3%).

A higher proportion of adults receiving alcohol treatment in Redcar & Cleveland (23.6%) living with children compared to the England average of (28.5%).

A higher proportion of dependent drinkers in Redcar & Cleveland (12.9%) are in treatment compared the England average (4.4%).

Illicit drug use

Almost two-thirds (62%) of adults in treatment for substance misuse in Redcar & Cleveland have (or are living with) children.

Smoking

A higher proportion of adults in Redcar & Cleveland (23%) smoke regularly compared to the England average (21%).

A higher proportion of pregnant women in Redcar and Cleveland (24%) are smoking at time of delivery compared to the England average (14%). Redcar and Cleveland LA was ranked the 4th worst in the country for maternal smoking (2012/13).

Diet and nutrition

A lower proportion of mothers in Redcar & Cleveland (53%) initiate breastfeeding compared to the England average (75%).

Obesity

A higher proportion of reception age children (5-year-olds) in Redcar & Cleveland (10.4%) are obese compared to the England average (9.5%).

A higher proportion of children in year 6 (11-year-olds) in Redcar & Cleveland (21%) are obese compared to the England average (19%).

Illness and death

Injuries

A higher proportion of children (under 18-year-olds) in Redcar & Cleveland (190 per 10,000)) are admitted to hospital due to injury than the England average (123 per 10,000).

Mental health

It is estimated that one-in-ten children have a mental health condition. Local data is not sufficient enough to provide evidence of the scale of the mental health problems among children in Redcar & Cleveland.

A higher proportion of adults in Redcar & Cleveland suffer from certain mental health conditions than the England average.


 

Last updated: 16/04/14

2. What commissioning priorities are recommended?

Wider determinants of health

Education

Support families to access education at the earliest point to improve early language and communication development to increase school readiness.

Ensure quality childcare and early years education provision.

Increase the uptake of the “two year old offer” for non-statutory education age children.

Reduce the achievement gap between primary and secondary school age pupils by increasing the support given to children and families during the transitional period.

Increase the number of schools using the common assessment framework (CAF).

Revise the early year’s strategy.

Poverty

Implement the Redcar and Cleveland Childhood Poverty Strategy:

Action Plan Targets

  • Parental Employment / Adults skills
  • Financial Support
  • Housing / Neighbourhoods
  • Education / Childcare / Health / Family support

Behaviour & lifestyle

Alcohol misuse

Establish a substance misuse steering group.

Conduct a service review to aid the commissioning of a robust drug and alcohol service, including targeted work with young people (ASGARD).

Reduce the number of alcohol-related hospital admissions.

Improve the communities awareness of the health risks associated with alcohol consumption.

Ensure adequate capacity for residents wishing to access community alcohol treatment.

Collate qualitative and quantitative data to assist the partnership gain a better understanding of the community’s needs.

Illicit drug use

Establish a substance misuse steering group.

Conduct a service review to aid the commissioning of a robust drug and alcohol service, including targeted work with young people (ASGARD).

Smoking

Have a functioning local Tobacco Control Alliance with a strategic action plan accountable to the health and well-being board.

Deliver stop smoking service which are accessible to communities at times and venues which are appropriate to increase patient choice.

Develop service level agreements which require all health professionals (including staff from primary and secondary care, midwifery and mental health) to raise the issue of smoking through a brief intervention and refer to Stop Smoking Services for support.

Increase the number of providers able to offer stop smoking support to pregnant smokers.

Implement Baby Clear within the acute trust, to intervene at the earliest point of pregnancy.

Ensure all midwives are routinely screening for carbon monoxide and referring those recorded with a smoking status into to specialist stop smoking service.

Diet and nutrition

Implement evidence-based best practice to maximise breastfeeding initiation and continuation. 

Ensure appropriate support services are in place and health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods.

Increase the promotion and uptake of the national ‘Healthy Start’ initiative (particularly vitamin supplements) to both professionals and the target audience.

Increase the number of peer supporters for breastfeeding.

Obesity

Investment in the development and delivery of a children & young people’s weight management pathway/service.

Establish a service for maternal obesity.

Illness and death

Injuries

Ensure adequate resources are available for local partnerships and prevention strategies.

Mental health

Undertake a needs analysis of the emotional health and wellbeing of children and young people

Last updated: 16/04/14

3. Who is at risk and why?

Wider determinants of health

Education

Children are at greater risk of low educational attainment if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses substances;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a poor school attendance record;
  • Suffer from poor mental health; and
  • Have a learning disability.

Poverty

Children are at greater risk of being subjected to the effects of poverty if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Live in a single parent family; and
  • Are a looked after child.

Behaviour and lifestyle

Alcohol misuse

Children are at greater risk of being subjected to alcohol misuse if they:

  • Live in a deprived area;
  • Have a family member who misuses alcohol;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family; and
  • Are a looked after child.

Illicit drug use

Children are at greater risk of being subjected to illicit drug use if they:

  • Live in a deprived area;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child (they are four times more likely to use illegal substances than children raised in a household); and
  • Are in contact with the criminal justice system.

Smoking

Children are at greater risk of being subjected to passive smoking if they:

  • Live in a deprived area;
  • Have a family member who is a smoker;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment.
  • Live in a single parent family; and
  • Are a looked after child.

Diet and nutrition

Children are at greater risk of having a poor diet and poor nutrition if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth;
  • Have a learning disability; and
  • Are from a black or minority ethnic group.

Obesity

Children are at greater risk of being obese if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth; and
  • Have a learning disability.

Illness and death

Injuries

Children are at greater risk of being injured if they:

  • Live in a deprived area;
  • Are under-5 years old (under 5-year-olds are more vulnerable to unintentional injuries in the home);
  • Are over-11 years old (11 to 18-year-olds are more vulnerable to unintentional injuries on the road);
  • Have a disability or impairment (physical or learning);
  • Are from a black or minority ethnic group;
  • Live in accommodation which potentially puts them more at risk (including multiple-occupied housing and social and privately rented housing); and
  • Are a 1 to 14-year-old boy (twice as likely to die of injuries than girls).

Mental health

Children are at greater risk of having poor mental health if they:

  • Live in a deprived area;
  • Face three or more stressful life events (three times more likely than other children to develop emotional and behavioural disorders);
  • Have stressful family situations;
  • Have a family member with poor mental health;
  • Live in rented accommodation;
  • Are in local authority or residential care;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a learning disability;
  • Have a  physical disability; and
  • Have a serious or chronic illness.
Last updated: 16/04/14

4. What is the level of need in the population?

Summary of child health and well-being in Redcar & Cleveland.

Source: Child and Maternal Health Observatory - ChiMat

Wider determinants of health

Education

It is clear from the scatter chart below that the electoral wards in Tees with the least proportion of children who have five or more GCSEs graded A* to C, are those with higher proportions of children living in a workless household.

Children in workless households v GCSE results, Tees electoral wards, 2010

The chart below shows that in Redcar & Cleveland, the proportion of 5-year-olds described as “good” (in the early years foundation stage profile) compared with those who receive 5 or more GCSEs graded A* to C has remained fairly static over the last six years, there has however been a large decrease in the last year.

Poverty

The chart below shows that Redcar & Cleveland has a higher percentage of children living in poverty than the England average.

The map below shows the percentage of children living in poverty for the electoral wards in Tees.

The wards with the highest proportion of children living in poverty in Redcar & Cleveland are Grangetown, South Bank, Kirkleatham and Loftus.

Tees map to % Children living in poverty, borough rank, by ward, Tees, 2010

Behaviour and lifestyle

Alcohol misuse

Content under development

Illicit drug use

The chart below shows that Redcar & Cleveland is estimated to have a higher rate of opiate and/or crack cocaine users than the North East and England average.

Smoking

The chart below shows that the proportion of pregnant women in Redcar & Cleveland who are recorded as smoking at the time of delivery is reducing each year. However, the proportion still remains higher than the North East average and significantly higher than the England average.

Diet and nutrition

The chart below shows that the proportion of women in Redcar & Cleveland who are breastfeeding at their 6-8 weeks health review has remained static each year. However, the proportion still remains lower than the North East average and significantly lower than the England average.

Obesity

The chart below shows that the prevalence of obesity of reception (5-year-olds) children in Redcar & Cleveland has increased over the last three years for both males and females. In 2009/10 the prevalence of obesity for females reduced slightly.

The chart below shows that the prevalence of obesity of year 6 (11-year-olds) children in Redcar & Cleveland is reducing each year for males, but increasing each year for females. In 2009/10 the proportion of males reduced to below the England average.

Illness and death

Injuries

The chart below shows that Redcar & Cleveland is estimated to have a higher rate of hospital admissions due to falls (under 5-year-olds only) than the North East and England average.

The chart below shows that the rate of hospital admissions due to injury (under 18-year-olds only) in Redcar & Cleveland is increasing year on year. This rate remains higher than the North East average and significantly higher than the England average.

Mental health

The chart below shows that Redcar & Cleveland is estimated to have a higher rate of adults with depression than the England average. This information must be treated with caution as the awareness of people with depression is estimated to be greatly under-recorded.

Last updated: 16/04/14

5. What services are currently provided?

The local Family Information Service (FIS) provides a range of information on all services available to parents and also hold up-to-date details of local childcare and early years provision:

http://www.stockton.gov.uk/citizenservices/learning/fis/

Please refer to individual JSNA sections for topic specific services.

Last updated: 16/04/14

6. What is the projected level of need?

Wider determinants of health

Education

As a result of the updated OFSTED schedule of inspection, it is likely that there will be an increased number of Redcar & Cleveland schools judged to be ‘satisfactory - requires improvement’. These schools will require co-ordinated support packages in order to bring about strong and sustainable improvement within the 24 months stipulated by OFSTED.

Poverty

Behaviour and lifestyle

Alcohol misuse

Unable to identify the local projected levels of need.

Illicit drug use

It is difficult to project the level of need due to the complex nature of illicit drug use.

Smoking

Content under development.

Diet and nutrition

Obesity

Obesity prevalence is forecast to rise for both adults and children.  The trend has been upward for decades, and suggests that by 2030 41-48% of men and 35-43% of women could be obese. The most recent data suggests that the rise in obesity is levelling off.  However, more than one-quarter of adults are already obese and there is a serious and growing burden of obesity-related ill-health.

The Foresight report suggests an increase in the prevalence of obesity among people aged under 20 to around 15% by 2025.  The proportion of boys having a healthy BMI will be 45% while for girls only 30% will be in the healthy weight category (Government Office for Science , 2007).

Percentage of children predicted to be obese by age and sex, England, 2004 and 2025

Gender

Age

2004

2025

Boys

6-10

10%

21%

11-15

5%

11%

All under 20

8%

15%

Girls

6-10

10%

14%

11-15

11%

22%

All under 20

10%

15%

Source: Foresight report

 

For children, there is evidence from the last three to four years of HSE data that the increase in child obesity is slowing. This is also evident from the local NCMP data. Forecasts to 2020 show encouraging signs that the rising trend may be levelling out, suggesting that there will be considerably lower proportions of overweight and obese children and young people than previously estimated McPherson et al, 2011). While it is encouraging that the trend in child obesity is levelling off, and may reduce in the future, the forecast prevalence of obesity and overweight remains high.

Forecasts for overweight and obesity in children and young people in 2020, England

Gender

Age

Overweight

Obese

‘Foresight’ forecast 2007

McPherson forecast 2011

‘Foresight’ forecast 2007

McPherson forecast 2011

Boys

2-11

22%

17%

20%

13%

12-19

25%

18%

19%

6%

Girls

2-11

34%

17%

14%

10%

12-19

35%

29%

30%

9%

 

Illness and death

Injuries

Mental health

Unable to identify the local projected levels of need.

Last updated: 16/04/14

7. What needs might be unmet?

Wider determinants of health

Education

Content under development.

Poverty

Not all families in Redcar & Cleveland are claiming the benefits they are entitles to.

Behaviour and lifestyle

Alcohol misuse

More robust data is required in order to identify the number of children affected by parental alcohol misuse.

More robust data is required in order to identify the number of children misusing alcohol.

Illicit drug use

Further consultation is needed to understand service users’/provider’s needs in order to know what needs are unmet.

Smoking

Redcar & Cleveland have the highest number of women continuing to smoke during pregnancy in Tees and are the fourth highest nationally, thus failing to give their child the best start in life.

Diet and nutrition

There is currently a limited number of peer supporters to help breastfeeding mothers.

Interventions for families such as antenatal classes, breastfeeding support groups and weaning groups are under utilised by those least likely to follow national guidelines and are in need of support, which may indicate a need for one-to-one targeted support.

There is currently limited access to healthy star vitamins.

There is limited knowledge and use of nutritional standards in early years settings.

Obesity

There is limited capability and capacity building within the workforce to ensure frontline staff are trained to consistently and sensitively raise the issue of weight and offer appropriate interventions and support.

There is a lack of preventative services focusing on a life course approach.

Targeted weight management service provision is required for those identified at risk (i.e. BME communities, learning disabilities, maternal obesity, men, under 5-year-olds, areas of high deprivation, specialist weight management support and for those with mental health needs).

Connection of weight management pathways and services is required. Stronger links need to be made with ‘Map of Medicine’ and Clinical Commissioning Groups (CCGs) to ensure a co-ordinated approach.

If current prevalence trends continue, demand for weight management services will outstrip capacity.

Illness and death

Injuries

Access to data for childhood injuries is currently not available.

Mental health

Due to the lack of a robust mental health needs assessment for children and young people, it is difficult to assess what needs are unmet.

Last updated: 16/04/14

8. What evidence is there for effective intervention?

Wider determinants of health

Education

Fair Society Healthy Lives a review of health inequalities (2010); Sir Michael Marmot http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

Poverty

The foundation years: preventing poor children becoming poor adults (2010); Frank Field http://www.nfm.org.uk/news/77-family-policy/486-frank-field-final-indpendent-report-on-poverty-and-life-chances

Behaviour and lifestyle

Alcohol misuse

Preventing harmful drinking (PH 24) (2010) www.nice.org

Alcohol-use disorders (CG 100) (2010) www.nice.org

Illicit drugs

Drug Misuse: psychosocial interventions (CG 51) (2007) www.nice.org

Smoking

Quitting smoking in pregnancy and following childbirth (PH1) (2006) www.nice.org

School-based interventions to prevent smoking (PH23) (2010) www.nice.org

Preventing the uptake of smoking by children and young people (PH14) (2008) www.nice.org

Diet and nutrition

Breastfeeding:

Promotion of breastfeeding initiation and duration: evidence into practice briefing (2006) (NICE) www.nice.org

Maternal and child nutrition (PH 11) (2008) www.nice.org

Obesity

Weight management before, during and after pregnancy (PH 27) (2010) www.nice.org

Behaviour change at population, community and individual levels (PH6) (2007) www.nice.org

Obesity (PH 42) (2012) www.nice.org

Health Development Agency (2003) The management of Obesity and Overweight.  Evidence Briefing http://www.nice.org.uk/niceMedia/documents/obesity_evidence_briefing.pdf

Illness and death

Injuries

Strategies to prevent unintentional injuries (PH 29)  (2010) www.nice.org

Preventing unintentional injuries among under-15’s in the home (PH 30) (2010) www.nice.org

Preventing unintentional injuries among under-15’s: road design (PH31) (2010) www.nice.org

Mental health

Social and emotional wellbeing in primary education (PH 12) (2008) www.nice.org

Depression in children and young people (CG 28) (2005) www.nice.org

Last updated: 16/04/14

9. What do people say?

Wider determinants of health

Education

Approximately 50% of the children and young people surveyed said they worried about school work and exams (this was more common among girls than boys and more common among children in Year 10). Most young people were positive about school and the help and feedback they received (although this declined with age). (TellUs4 survey, 2010)

Poverty

A regional (North East) consultation with children (on poverty) identified a number of priorities highlighted in the JSNA poverty topic.

Behaviour and lifestyle

Alcohol misuse

More than half (51%) of children and young people said that they have never had an alcoholic drink. About two-fifths (42%) said that they had consumed an alcoholic drink and 7% did not wish to say. The majority of all children and young people surveyed had not been drunk in the previous four weeks (68%). (TellUs4 survey, 2010)

Viewpoint (2011) recorded that 63% of the people surveyed stated that better education and raising awareness of the dangers of alcohol misuse would help tackle alcohol-related problems.

Illicit drug use

Content under development.

Smoking

Fresh has published some public opinions (2011) ranging from how to tackle smoking, quitting, protecting children and illegal tobacco, some of the outcomes were:

  • 75% of people in the North East think smoking should be banned in outdoor children’s play areas.
  • 78% of smokers in Teesside say the North East needs to do more to prevent children from starting smoking, this was mirrored within a local community consultation conducted within Redcar & Cleveland in 2011.
  • Smoking is a childhood addiction long before it becomes an adult choice. The average age current smokers started in Teesside was just 15.
  • Cancer Research UK estimates that children are three times more likely to become a smoker if parents smoke.

Diet and nutrition

Most children and young people had eaten fruit and vegetables the previous day (most commonly three or four pieces). (TellUs4 survey, 2010)

Obesity

There is a lack of local consultation and data on what people say about diet and nutrition-related issues. However local stakeholders have been consulted on the topic, including voluntary sector, primary care, early year providers, nutrition & dietetics, lifestyle providers, people with learning disabilities and older people care providers and their comments have been included throughout the obesity JSNA topic.

Satisfaction surveys completed by service users during 2010/11 show that all (100%) service users rated the Tier 2 child weight management programme as ‘good’ or above.

Illness and death

Injuries

Content under development.

Mental health

  • The majority of children and young people said that they have one or more good friends;
  • The majority of children feel happy with life and have someone they can talk to;
  • Boys are more likely than girls to feel happy about life while girls are more likely to talk to their friends when worried than boys are;
  • Young people who said they were disabled are less likely to say they are happy;
  • The most common worries for children and young people are about education and their future;
  • Year 10 (11-year-olds) pupils are more likely to worry about exams than younger people;
  • Girls are more likely to worry about exams than boys. (TellUs4 survey, 2010)
Last updated: 17/01/17

10. What additional needs assessment is required?

Wider determinants of health

Education

No additional needs assessment is needed at present.

Poverty

Content under development

Behaviour and lifestyle

Alcohol misuse

The Alcohol Action Plan ended in April 2013. An updated Plan for 2013/14 will be developed which will identify further needs assessment.

Illicit drug use

Undertake an in-depth analysis and review to determine best practice in prevention/treatment services.

Smoking

No further needs assessment required at this stage.

Diet and nutrition

Needs analysis for universal provision for healthy start vitamins is required.

Obesity

Tier 3 maternal obesity needs assessment is required.

Illness and death

Injuries

Detailed analysis of the reasons for admissions to hospital for injuries is required (particularly for those in the young age range and those admissions under 24 hours).

Mental health

A needs analysis of the emotional health and wellbeing of children and young people is required.

Last updated: 17/01/17

Key contact: Rebecca Laidler

Job title: Health Improvement Commissioning Lead

e-mail: Rebecca.laidler@redcar-cleveland.gov.uk

Phone number: 01642 771604