TOP MEDIC ON THE HEALTH OF OUR CHILDREN
Here, one of the country’s leading doctors, Dr David Tuthill – the Royal College of Paediatrics and Child Health’s (RCPCH) new officer for Wales – outlines the biggest health challenges facing children in Wales...
THE NHS turns 70 this summer, and since its conception in 1948 it has delivered many great things.
It can create, prolong, enhance and sustain life. It has also introduced child health screening and universal vaccination which has dramatically reduced the devastating burden of infectious disease.
We have a health service which supports us in our greatest time of need, any time, day or night, and is free at the point of delivery. It is a service that is the envy of many nations.
However, new challenges have arisen as children’s lifestyles have become more sedentary, more families live fragmented lives and many individuals are pressurised by digital media.
Thus, despite the advancements in care, it faces several challenges that must be overcome if it is to be “the envy of the world” as its creators hoped.
OBESITY...
Obesity is the greatest public health threat facing this country and nationally costs the NHS more than £6bn a year to treat.
In Wales, 27% of children are classified as being overweight or obese, putting them at increased risk of developing type 2 diabetes, asthma and sleep problems – conditions that are now taking hold much earlier in life. Unless something is done to reverse this trend, these children are likely to become overweight or obese adults, putting further strain on their health and the NHS.
We know that many factors fuel the obesity crisis, including a lack of physical exercise, families and healthcare workers not recognising or acting on overweight children and the hidden sugar and fat content in food.
In the wider environment we are surrounded by junk food and drink advertising, while the infrastructure of our towns and cities is often not conducive to children walking or cycling to school.
The UK government published Chapter Two of its long-awaited childhood obesity plan this month and as Welsh Government plans to publish its own bespoke plan for Wales, it provides an opportunity to build on some of the strong policies that Westminster champions.
Westminster is to consult on the advertising of junk food before 9pm, mandatory calorie labelling in restaurants and cafes, price promotions on unhealthy foods and supermarket product placement such as confectionery at check-outs.
I would be particularly pleased about the potential for better planning support for local authorities, helping them consider the health and wellbeing of the community in all new developments.
DENTAL HEALTH...
Poor-quality food and sugary drinks don’t just affect the waistline, they have a terrible impact on children’s teeth too.
Excess refined sugar leads to obesity, but it is also one of the leading causes of tooth decay.
Having poor dental health can cause toothache, dental infections, and affect a child’s ability to sleep, speak and eat. In Wales, one in three five-year-olds have tooth decay, and while this rate has reduced over recent years it is still the biggest reason why children under five go to hospital for a general anaesthetic.
Welsh Government’s Designed to Smile programme has been making a real difference by giving dental advice, providing toothbrushes and toothpaste, and encouraging families to see a dentist before their child’s first birthday.
It also delivers nursery and school-based toothbrushing and fluoride varnish programmes.
Let’s continue to build on this good work and urge councils to prioritise children’s oral health in their Health and Wellbeing Strategies.
Families can help improve children’s oral health by: Swapping fizzy drinks for water; brushing their child’s teeth twice daily for two minutes with fluoride toothpaste;
spitting out excess froth, don’t rinse your mouth out after brushing your teeth;
ensuring their child visits the dentist by their first birthday;
not using baby bottles after your baby’s first birthday.
MENTAL HEALTH AND WELLBEING...
The internet and digital media offer fantastic opportunities, and although they have the power to bring people together, build friendships and educate, they can pose a danger too.
Across the UK, one in four chil-
Obesity is the greatest health threat facing this country and costs the NHS more than £6bn a year
dren have experienced something upsetting and around one in eight young people have been bullied on social networking sites.
Speak to your child about being aware of people they meet on the internet. Ask them to tell you if they get unwanted messages or bullying.
You may not know everything about technology but you will be able to guide them away from these dangers. Too much screen time is also associated with increased weight, sleep deprivation and depressive symptoms – not conducive to a healthy lifestyle.
As a paediatrician, I would advise parents to stop screen time at least an hour before bed, giving them time to wind down and have a better night’s sleep.
As with many health conditions, including obesity and oral health complaints, the most effective way of addressing them is through early intervention and prevention.
This is also true of mental health, where huge numbers of children do not need Child and Adolescent Mental Health Service support, but instead require help to prevent problems starting.
Ensuring emotional and mental health is fully embedded in the new curriculum will go some way towards this and so too will training for anyone who works with children and young people in emotional and mental health awareness.
From a parental perspective, encouraging children to join a supportive social group such as Scouting can give them a resilience and a new sense of purpose.
In response to the mental health challenge, Welsh Government has recently declared the issue a national priority, agrees that emotional and mental health should be fully embedded in the new curriculum and supports mental health training for professionals who encounter children and young people.
We want government to work quickly to deliver on these promises to avoid repeating the conversation in five years’ time.
ALLERGIES...
Nearly one in three families will have been affected by an allergic disease, and the number of young children with food allergies and eczema plus adolescents with hay fever continues to rise.
This puts huge pressure on both the NHS staff and budget.
Around one or two per 100 children are affected by peanut or nut allergy, something that’s going to stay with them for life. They need dietary advice and school care plans to ensure they have optimal health.
My allergy team in Cardiff deal with all sorts of problems but provision of services across Wales is patchy and where there is access to help, children can be faced with a long wait. Research has begun to unlock why allergy is increasing. Two great UK research projects (LEAP) suggest that exposing babies to small regular amounts of foods such as peanut butter and egg from as early as four months old can prevent allergies developing.
It is something I support and encourage my patients to do but I would advise anyone with, or who suspects an allergy, to consult their doctor before doing this.
WORKFORCE...
Unsurprisingly, my fifth and final challenge for the NHS relates to its staff.
We know that on average an estimated 16% of rota posts are vacant in Wales across all rota tiers.
On the junior grade rotas an average of 21% posts are vacant, and on the middle grade – staffed by junior doctors with more than two years’ experience – an average of 17% are vacant. This is particularly challenging for units in rural areas which find it difficult to recruit and retain staff.
Earlier this month, central government pledged to invest an additional £384m per week in the NHS following Brexit.
What this means for Wales is still unclear but with any additional funding that crosses the border, we need to ensure it is ploughed into early intervention, preventing our children from becoming overweight or obese and stopping mental health conditions worsening.
Investing in our community, social care and schools will produce both short- and long-term dividends.
An investment in those who look after children – the workforce – will help them develop into healthy fit adults, reducing the burden on the NHS for life.
I’ve joined the RCPCH at an exciting but critical time. If I do anything during my term as officer for Wales, I want to ensure Welsh Government understand that an investment in child health is an investment for the future.
It will not only benefit the young, but has the potential to be gamechanging for adult health in the long term and that is something that cannot be ignored.
I would advise parents to stop screen time at least an hour before bed, giving them time to wind down