Children & young people with potentially acute health conditions – advice for practitioners & carers

Asthma is a long-term condition that affects the airways carrying air in and out of the lungs.  Asthma tends to run in families, especially when there is also a history of allergies and/or smoking.

When a person with asthma comes into contact with one of their asthma triggers it causes their airways to react in three ways:

• the muscles around the walls of the airways tighten so that the airways become narrower
• the lining of the airways becomes inflamed and starts to swell
• sticky mucus or phlegm sometimes builds up, which can narrow the airways even more.

These reactions in the airways make it difficult to breathe and lead to asthma symptoms, such as chest tightness, wheezing, or coughing.

In the UK, around 5.4 million people are currently receiving treatment for asthma. That’s one in every 12 adults and one in every 11 children.

Asthma affects more boys than girls. Asthma in adults is more common in women than men.

If a child’s asthma is managed well, it is likely they will be able to get on with all the things they enjoy doing without asthma symptoms getting in the way.

A child’s GP or asthma nurse plays their part by prescribing medicines, updating the child’s written asthma action plan at regular reviews, helping work out the child’s triggers and keeping a record of the child’s asthma over time. A parent or carer and the way they look after their child’s asthma in between appointments is crucial too.

In between visits to the child’s GP or asthma nurse, there are lots of things a parent, carer and the child can do so they can stay well and cut the risk of an asthma attack.

Colleagues across Manchester have been working together to standardise asthma plans – read more about this work on the ‘wheezy kid‘ page on the MHCC website at  www.mhcc.nhs.uk/wheezykid

Paediatric asthma/wheeze management plans
MHCC Children’s Community Asthma Service have launched a team page, with an important update for colleagues across the city. They have produced a suite of documents to be used across the system to support the management of children with asthma:

1. Asthma UK – My Asthma Plan – this is a personalised asthma action plan to be used by healthcare professionals for children and parents/carers
2. A guide to manage your wheezy child (age 2 and over) – this is to be used WITH the My Asthma Plan NOT instead of – parents/ carers MUST be considered competent to follow the additional steps that are not included in the guide, through an asthma educational session delivered by a healthcare professional
3. Step Down Plan – to be used as a guide for reduction in salbutamol following an acute exacerbation.

These documents will now be used across the system and will be recognised in primary, community and secondary care.  They are available to download from the ‘our documents’ box on the team page at oneteam.healthiermanchester.org/People/Our-teams/Childrens-Community-Asthma-Service

The intention is that they will be adopted across Greater Manchester in due course.

Other sources of information:

• NHS provide information about the symptoms, causes, diagnosis and treatment of asthma; what it is like living with asthma and how to deal with attacks on their website at www.nhs.uk/conditions/asthma
• Asthma UK have advice about managing a child’s asthma on their website at www.asthma.org.uk/advice/child/manage/well
• British Lung Foundation website at www.blf.org.uk/support-for-you/asthma-in-children
• Allergy UK – for information about asthma and other respiratory conditions; also about domestic pet avoidance, house dust mite allergy, mould allergy and sulphites and airway symptoms
  • downloadable fact-sheets and more from the website at www.allergyuk.org/information-and-advice/conditions-and-symptoms/12-asthma
• NARA – The Breathing Charity can provide information about asthma and associated conditions, including severe and brittle asthma, on their website at naratbc.org.uk/asthma-and-some-associated-conditions/
• find support  for those who want to quit smoking  from the NHS Smokefree website at www.nhs.uk/smokefree
• our Smoking & related issues – safeguarding advice for all resource.

Childhood obesity video for health professionals
A new video by Public Health England demonstrates the role of health and care professionals in tackling childhood obesity. The video, part of the ‘All Our Health’ campaign, outlines the role health and care professionals have in supporting children, young people and families in maintaining a healthy lifestyle through exercise and a balanced diet.

• Find the video at www.youtube.com/644087_Childhood+Obesity

The video highlights the importance of balanced nutrition and an active lifestyle before and during pregnancy, and explains the positive effects of breastfeeding and recommended weaning practices on children’s health. You’ll also hear about how much time children of different ages should spend being physically active each day, and tips on appropriate portion sizes for children’s meals.

• The All Our Health resource is constantly evolving and can be found at www.gov.uk/all-our-health-personalised-care-and-population-health

Other sources of information:

• NHS website at www.nhs.uk/Livewell/childhealth
• WeightWise website at www.teenweightwise.com
• More Life website at www.more-life.co.uk

Childhood obesity: a plan for action
Statistics show that nearly a third of children aged 2 to 15 are overweight or obese; and younger generations are becoming obese at earlier ages and staying obese for longer. Obese adults are seven times more likely to become a type 2 diabetic than adults of a healthy weight, which may cause blindness or limb amputation.

Not only are obese people more likely to get physical health conditions like heart disease, they are also more likely to be living with conditions like depression.

Obesity rates are highest for children from the most deprived areas and this is getting worse. Children aged 5 and from the poorest income groups are twice as likely to be obese compared to their most well off counterparts and by age 11 they are three times as likely.

Obesity is a complex problem with many drivers, including behaviour, environment, genetics and culture.

The government aims to significantly reduce England’s rate of childhood obesity within ten years – read Childhood obesity: a plan for action on their website www.gov.uk/childhood-obesity-a-plan-for-action

Tackling childhood obesity requires support from all levels of influence
During the primary school period, from the age of 4 to 11 years, the proportion of children who are very overweight doubles (from 10% to 20%) – this increasing trend continues to adulthood.

During this period inequalities emerge and by age 11, children from minority ethnic groups or from more deprived backgrounds are more likely to be overweight.

Excess weight in children is linked to multiple health, emotional and social problems.

Whilst the government’s childhood obesity plan puts much emphasis on activities that schools can do to tackle the problem, different approaches are needed that consider broader influences from the family, community, media and the food industry.

See our childhood obesity and neglect resource for local resources.

Diabetes is a serious condition where the blood glucose level is too high. There are two main types – Type 1 and Type 2 – which are different conditions and are both serious. There are some other rarer types of diabetes too.

• Find out more on the Diabetes UK website at www.diabetes.org.uk/diabetes-the-basics

Having a child with diabetes can be difficult; a child may have to take insulin to treat it and they will either use a pen or a pump and eventually be able to do this by themselves with adult help.

Diabetes UK can offer the support and information a family might need as a child grows up; they also run support groups.

• Call their helpline on 0345 123 2399 or visit their website at www.diabetes.org.uk/your-child-and-diabetes

The Manchester Diabetes Centre allows patients easy access to diabetes specialist nurses, dietitians, podiatrists and medical staff who offer help and support and promote self-management with the aim of reducing diabetes-related complications.

They provide extensive out-patient services and take referrals from other hospitals in the region and also support hospital-based patients and provide clinical and educational support for healthcare professionals.

• Contact the Diabetes Centre Reception on 0161 276 6700 or find out more on their website at mft.nhs.uk/mri/services/diabetes/

Other useful websites include:

• NHS – website at www.nhs.uk/Conditions/Diabetes
• DigiBete – a video platform and social enterprise, created in partnership with the Diabetes Team at Leeds Children’s Hospital, to help young people and families to manage Type 1 Diabetes. DigiBete is  constantly innovating and adding lots more resources to its website at www.digibete.org/

Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed – millions of children have eczema atopic dermatitis

There are several types of eczema which often appears in the first six months to 5 years of a child’s life; it is not contagious.

For most types of eczema, managing flares comes down to the basics:

• knowing a child’s or adult’s particular triggers to avoid exposure
• implementing a daily bathing and moisturizing routine to protect skin and lock in moisture
• using OTC and prescription medication consistently and as prescribed to curb symptoms.

There is no cure for eczema but there are treatments and more being developed.

Find out more from:

• Allergy UK website at www.allergyuk.org/eczema
• Kids Health website at kidshealth.org/en/parents/eczema-atopic-dermatitis
• National Eczema Society website at nationaleczema.org/eczema/children/
• National Eczema Society website at www.eczema.org/
• NHS website at www.nhs.uk/conditions/Eczema-(atopic)

Key learning includes:

• the importance of full multi-agency information sharing regarding the safeguarding concerns and clarity about the impact on the child’s health and medical needs.
• referrals for children with medical conditions need to capture:
  • the voice of the child; and
  • the impact on the child from their medical condition in addition to safeguarding concerns
• it should be clear what the professional making the referral wants to happen
• referrals from health services need to be of a good quality and clearly demonstrate what the risks are – and how serious the concerns are
  • for example if a parent smokes what is the risk to a child with brittle asthma and what does that child need to stay safe (i.e. a smoke free environment)
• the importance of multi-agency partners working with health colleagues, including paediatricians, specialists nurses, therapists and universal health practitioners (health visitor, school nurse and GP) to request clarification on how the safeguarding and health issues impact on the child’s well-being
  • to inform the level of need it is essential to have a clear understanding of a child’s medical needs and the impact of the safeguarding concerns on the child’s well-being given the specific medical concerns
  • it is essential that there are conversations with the child’s lead health professional to clarify the child’s health needs
  • the child’s lead health professional will depend on the nature and the severity of the child’s health/ medical needs
• the key worker for a child with a multi-agency plan should have a simple map of the range of health staff, contact numbers and email addresses so that all health staff are invited to child in need and child protection conferences/core groups
• young people should be supported to engage in managing their own condition
• agencies such as housing have a clear role in discussions about the home environment and the multi-agency group need to be explicit as to how this may impact on a child’s health needs.

QualityWatch is a major research programme providing independent scrutiny into how the quality of health and social care is changing. Developed in partnership by the Nuffield Trust and the Health Foundation, the programme provides in-depth analysis of key topics and tracks an extensive range of quality indicators. It aims to provide an independent picture of the quality of care, and is designed to help those working in health and social care to identify priority areas for improvement.

The QualityWatch website at www.qualitywatch.org.uk presents key indicators by area of quality and sector of care, together with analysis of the data. This free online resource also provides research reports, interactive charts and expert commentary.

QualityWatch Focus On reports are regular, in-depth analyses of key topics. These studies exploit new and innovative methodologies to provide a fresh view of quality in specific aspects of health and social care.

• Focus on: Emergency hospital care for children and young people can be accessed at www.qualitywatch.org.uk/cyp
• Children and Young People’s Health Services Statistics can be accessed atcontent.digital.nhs.uk/maternityandchildren/CYPHSmonthly

The Children and Young People’s Joint Strategic Needs Assessment (JSNA) for Manchester has been produced in recognition of the fact that improving the health outcomes of children and young people in Manchester requires a multi-agency approach to the collation, analysis, presentation and publication of data, research and intelligence relating to the health and wellbeing of children, young people and families across the city.

The Children and Young People’s JSNA is a ‘living’ resource that will be expanded and developed over time through consultation with key stakeholders and will incorporate the views of children and young people.

• The Manchester CYP JSNA can be found at www.manchester.gov.uk