18 CHEMIST+DRUGGIST 28.09.2013

CPD Zone Update CPD Zone Update

This module covers:

● Key areas of health promotion for children

● Impact of obesity, nutrition, physical activity, passive smoking, dental health, accident prevention and immunisation on the health and wellbeing of children

● Numbers of children affected by issues that put them at risk of ill health

● Advice pharmacists can give to help improve the health of children

UPDATEModule 1673

SEPTEMBER» Special patient groups

● Immunosuppression Sept 7

● Incontinence Sept 14

● Dexterity di�culties Sept 21*

● Children’s wellbeing Sept 28

*Online-only module for Update and Update Plus subscribers. October is endocrine disorders month, starting with type 1 diabetes in the October 5 issue of C+D.

chemistanddruggist.co.uk/update

Sara Mudhar

Children’s wellbeing in their early years can a ect their health and opportunities later in life. Promoting safe and healthy lifestyles from a young age will lead to improved health outcomes later on. Community pharmacists and their sta are in an ideal position to provide advice and support on the wellbeing of children.

A child’s long-term prospects are related to their parents’ circumstances, particularly the disadvantages the parents face when compared with the rest of the population. These include one or both parents being unemployed, having mental health problems or a disability, as well as situations where the family has a low income, poor quality housing or is unable to a ord basic food and clothing items.

It is important to be aware of the disadvantages that a child’s parents may face, as these can be significant barriers to families adopting healthier lifestyles and behaviours.

Children’s behaviours and attitudes are formed early in life, and even very young children can be influenced by what they observe other people doing. Portraying unhealthy behaviours such as smoking, drinking excessively and drug use as undesirable can help to make children more resistant to peer pressure later in life.

Childhood obesityIn England, 30 per cent of children aged between two and 15 years are overweight or obese. If no action is taken, it is estimated that by 2050 25 per cent of children will be obese and 30 per cent will be overweight. Children who are obese in childhood are likely to remain obese into adulthood.

Being overweight or obese increases the risk of developing type 2 diabetes, heart disease and some types of cancer. It can also a ect mental health and self-esteem as well as the ability to ▶

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Children’s attitudes are formed early in life and even the very youngest can be influenced by what they observe

Promoting children’s wellbeing

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find employment. Addressing weight gain and obesity is a massive public health challenge – the NHS spends more than £5 billion each year managing health problems associated with being overweight or obese.

Only 3 per cent of overweight or obese children have parents who are not overweight or obese, so a whole-family approach is essential, rather than just focusing on changing an individual child’s behaviour. Some families may require skilled professional guidance and support. The following can help prevent obesity in children:● providing information and advice to expectant women, including about healthy weight gain during pregnancy● encouraging breast-feeding – there is evidence that the risk of excess weight gain later in life can be reduced by breast-feeding● delaying weaning until six months of age, introducing healthy foods, encouraging mealtime routines and controlling portion size from the outset● identifying children and families who are most at risk, for example, where one or both parents are overweight or obese or where a child is seen to gain weight rapidly● providing advice on nutrition and encouraging an active lifestyle.

NutritionEating a healthy and nutritious diet is important for children because it:● promotes physical growth and development● helps to improve concentration and behaviour● provides energy, builds strength and helps develop resistance to infection● reduces future health risks such as iron-deficiency anaemia, obesity, type 2 diabetes, heart disease, stroke, cancer and dental decay● helps establish healthy eating habits for life.

Getting children to eat a healthy diet is not easy, but a healthy diet for young children should ideally include:● regular healthy meals that o er choice, variety and balance● lots of fruit and vegetables● starchy foods such as bread, rice, potatoes and pasta● calcium- and iron-rich foods, including milk and dairy products as well as other sources of protein such as meat, fish, eggs and beans● meals that are low in salt and added sugar.

While healthy eating habits can be formed from a young age, it is important that older children are encouraged to continue to eat healthily. Studies looking at older children in the UK have shown that almost 40 per cent of 11- to 15-year-olds drink sugary soft drinks daily, less than 40 per cent eat fresh fruit daily and just over 60 per cent eat breakfast regularly. Eating breakfast has been shown to have a positive impact on young people’s memory and concentration.

Physical activityBeing physically active is important for the healthy growth and development of children, and the amount of activity recommended varies depending on the age of the child.Children of pre-school age should be physically active for at least 180 minutes spread throughout each day. This can include a mix of less energetic activities (walking) and more energetic activities (skipping or jumping). However, active play such as climbing, riding a bike or playing games is the best way for younger children to be active.

The benefits of physical activity in young children include: maintaining a healthy weight; improved cardiovascular health, bone strength and movement; and co-ordination development. Engaging in physical activity with other children also supports the learning of social skills.

Children aged five years and over should engage in moderate to vigorous physical activity for at least 60 minutes and up to several hours each day. They should engage in vigorous-intensity activities on at least three days each week to strengthen bone and muscle. For children of all ages, the amount of time spent sedentary for long periods should be kept to a minimum.

Physical activity is also associated with improved concentration levels in children, more positive social behaviour and lower levels of anxiety and depression. Active children are happier with their appearance and report higher levels of self-esteem, happiness and satisfaction.

Just over 20 per cent of children aged five years and over in the UK engage in more than an hour of moderate to vigorous intensity physical activity each day. Boys are more likely than girls to meet the recommendations for physical activity.

Passive smokingPassive smoking can increase the risk of developing cancer and other health problems and is especially harmful to children. Children who are regularly exposed to second-hand smoke have an increased risk of:● developing asthma and other respiratory conditions such as bronchitis and pneumonia – second-hand smoke can trigger asthma attacks in children who already have the condition and younger children are more likely to be admitted to hospital for a serious respiratory infection● recurrent coughs and colds● developing meningitis● middle-ear infections such as otitis media, which can lead to loss of hearing● sudden infant death syndrome – this is twice as likely in babies whose mothers smoke.

Children who grow up in a household where a parent or another family member smokes are three times more likely to start smoking in later life. ▶

22 CHEMIST+DRUGGIST 28.09.2013

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If a parent or other family member is trying to stop smoking, they are more likely to be successful if other smokers in the household also try to quit.

If parents are not interested in stopping smoking, they should be encouraged to think about planning smoke-free areas for children within the home, as well as avoiding smoking in cars with children.

Dental healthTooth decay is one of the most widespread health problems in the UK. It is estimated that more than 30 per cent of children starting school and about a third of 12-year-old children have signs of visible tooth decay. Good dental hygiene is essential from a very young age to minimise the risk of tooth decay. Parents should be advised that:● sugar should not be added to baby foods when weaning● teeth should be brushed twice a day as soon as they start to appear● only a smear of an age-appropriate toothpaste should be used ● babies should be introduced to a drinking cup from six months of age – bottle feeding should be discouraged after the age of one year● the frequency and quantity of sugary foods and drinks should be kept to a minimum● if sugary foods and drinks are consumed, they should be limited to mealtimes● where possible, all medicines given to children should be sugar-free.

AccidentsAccidents are the most common cause of death in children between the ages of one and 14 years and approximately 1,000 children in the UK die each year as a result of accidents. About 500,000 children under five years of age attend hospitals each year as a result of accidents in the home. Many accidents can be avoided and advice on the prevention of accidents is an important element of health promotion in children. Advice about minimising the risk is shown in Box 1, right.

ImmunisationsImmunisation is one of the most e ective public health interventions and has saved more lives worldwide than any other medical product or procedure. In the UK, a set programme of vaccinations known as the childhood immunisation programme is o ered to all children free of charge from two months of age. Despite this, there is still widespread variation in the number of children and young people who have been immunised against some of these diseases. To ensure uptake of childhood immunisations, it is important that parents are given evidence-based information and advice, including benefits and potential side e ects of immunisation. ▶

References● Child health surveillance: www.patient.co.uk/doctor/child-health-surveillance ● How healthy behaviour supports children’s wellbeing:www.gov.uk/government/uploads/system/uploads/attachment_data/file/232978/Smart_Restart_280813_web.pdf ● Giving all children a healthy start in life:www.gov.uk/government/policies/giving-all-children-a-healthy-start-in-life ● Tackling obesity:www.nice.org.uk/newsroom/news/TackleObesityCommunityWideApproach.jsp● Child health:www.nhs.uk/livewell/childhealth6-15/Pages/Childhealth615home.aspx● Reducing obesity and improving diet:www.gov.uk/government/policies/reducing-obesity-and-improving-diet ● Tooth decay:www.nhs.uk/conditions/Dental-decay/Pages/Introduction.aspx ● Physical activity guidelines for children and young people:www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-children.aspx ● Immunisations:www.chemistanddruggist.co.uk/main-content/-/article_display_list/15282072/vaccination-programmes (Update Module 1644)

Box 1. Minimising the risk of accidents

Burns and scalds ● Do not carry hot drinks at the same time as holding a baby● Use fireguards● Cordless kettles and saucepan handles should not be left to overhang the front of the cooker● Keep hot drinks, teapots, matches, irons and hair straighteners out of reach● Put cold water in the bath before hot water and carefully check temperature ● Install smoke alarms and test them regularly.

Choking● Avoid giving babies and young children toys with small parts● Cut food small enough for a child’s mouth● Do not leave small children to eat unsupervised.

Falls● Do not put babies on beds or tables● Use a stair gate until a child is at least two years of age● Avoid using baby walkers – playpens are better.

Su�ocation● Avoid pillows for babies and small children● Dummies should not be used on a cord around the neck● Keep plastic bags away from children.

Poisoning● Medicines, cleaning products and the like must be stored out of children’s reach.Where possible, use child-resistant caps.

Cuts● Keep knives, scissors and other sharp objects out of the reach of children● Safety glass should be used in doors.

Drowning● Babies and children should be supervised when bathing or close to water.

Vehicles● Ensure children are properly restrained.

This article is based on material from C+D’s Well Being course. Well Being is a training course for sta� who work in pharmacies that are, or plan to be, engaged in the healthy living pharmacy programme. Well Being comprises four modules that will enable sta� to become healthy living champions with a Royal Society for Public Health qualification. Details at chemistanddruggist.co.uk/well-being

24 CHEMIST+DRUGGIST 28.09.2013

CPD Zone Update

Reflect What is the estimated level of obesity in children in the UK? How much physical activity should children aged five years and over take part in per day? What advice can be given to help prevent tooth decay in children?

Plan This article discusses how pharmacists can provide advice and support to parents about the wellbeing of their children. It includes information about obesity, nutrition, physical activity, passive smoking, dental health, accident prevention and immunisation.

Act Read the Update article and the suggested reading (below), then take the 5 Minute Test (above). Update and Update Plus subscribers can then access their answers and a pre-filled CPD logsheet at www.chemistanddruggist.co.uk/mycpd

Read the information about healthy eating on the Change4Life website tinyurl.com/wellbeing11

Find out more about the amount of physical activity that children need and some advice for encouraging them to exercise on the NHS Choices website tinyurl.com/wellbeing12 tinyurl.com/wellbeing13

ASK THE EXPERTSeptember is special patient groups month and our expert is on hand to answer your queries. From immunosuppression to incontinence, submit your questions by email: steve.titmarsh@ubm.com

For advice and resources to recommend to parents about smoking cessation, look at the information on the NHS Smokefree website tinyurl.com/wellbeing14

Find out about advice that you could give to parents on improving dental health in children on the NHS Choices website tinyurl.com/wellbeing15

Revise your knowledge of the childhood vaccination programme from C+D Update module 1644, Vaccination programmes (C+D, February 16, p18) or from the NHS Choices website tinyurl.com/wellbeing16 tinyurl.com/wellbeing17

Evaluate Could you now confidently give advice to parents about the steps that they could take to improve the wellbeing of their children?

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1. In the UK, 40 per cent of children aged between two and 15 years are overweight or obese. True or false?2. Only 3 per cent of overweight or obese children have parents who are not overweight or obese. True or false?3. Breast-feeding can help reduce the risk of excess weight gain in later life. True or false?4. Studies of children aged 11 to 15 years found two thirds of them drink sugary soft drinks every day. True or false?5. Eating breakfast has a positive impact on young people’s memory and concentration. True or false?6. Pre-school age children should be physically active for at least 60 minutes each day. True or false? 7. Children aged five years and over should

engage in bone and muscle strengthening activities on at least three days a week. True or false?8. Children who grow up in a household where another family member smokes are five times more likely to start smoking in later life. True or false?9. In the UK, half of 12 year olds have signs of visible tooth decay. True or false?10. The childhood immunisation programme is o ered to all children from the age of two months. True or false?

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