Children and teens have faced so much disruption over the past year. How can pharmacy teams help get their health back on track to create a firm foundation for the future?
Children are our future, so the song goes, and it’s important that their futures are built on healthy habits learned early on in life. The pandemic has certainly been a disrupting force in many ways, but it’s important now for pharmacy teams to teach them well and ensure that children and teens are eating right, keeping active, getting enough sleep and protecting their mental health.
Fuelling good habits
Eating a well-balanced diet is essential to support the growth of children and teens and ensure they have enough energy to focus in school and participate in physical activity. “Research shows that the eating habits that we acquire early in life tend to track through to when we become teenagers and eventually adults, and so encouraging children to develop a liking for a diverse range of foods can help to set the foundation for healthier eating habits that can support good health throughout life,” says Simon Steenson, nutrition scientist at the British Nutrition Foundation (BNF). “This is important, as one in three children in England are overweight or obese by the time they leave primary school, and we are seeing an increase in cases of high blood pressure and type 2 diabetes among children. Obesity can also have an impact on children’s mental health and, if obesity tracks into adulthood, then this can increase the risk of heart disease, cancer and respiratory disease.”
On average, children and teenagers in the UK are eating over twice the recommended amount of free sugars, according to the latest National Diet and Nutrition Survey from Public Health England (PHE), although this has improved over time. The term ‘free sugars’ is applied to food and drinks that have added sugar in them, such as fizzy drinks, chocolate and biscuits. Sugar found naturally in foods such as fruit are not considered to be free sugars. The current Government guidelines recommend that free sugars make up no more than five per cent of daily energy intake, as an over consumption of sugar can lead to tooth decay and weight gain. “Parents can cut down on their children’s free sugar intake by offering alternatives to sugar-containing fizzy drinks, such as low-fat milk or plain water. Fruit juices and smoothies should be limited to a small glass per day (150ml), as the acid in these can be bad for teeth,” explains Simon.
When supporting parents with their children’s diets, the NHS’ Eatwell Guide is a great place to start. It is a useful visual aid and can be followed by parents for their own nutrition too. “[Diets] should include plenty of fruit and vegetables – about a third of what we eat each day – as well as wholegrain and higher fibre starchy foods like brown rice, wholemeal bread and pasta,” says Simon. “Protein foods are also important and can provide essential vitamins and minerals, but it’s a good idea to have a variety of types, including plenty of plant-based ones like beans, peas, chickpeas or lentils, alongside some meat and fish. At least two portions of fish a week is recommended, with one portion an oily fish like salmon or mackerel.”
Dairy foods should also be included in a balanced diet as these are a good source of protein and calcium, helping to establish strong bones. “If choosing dairy alternatives, check these are fortified with nutrients such as vitamin B12, calcium and iodine,” Simon advises. Fatty foods, or ones that are high in salt and sugar, should be limited as these can lead to weight gain and are usually high in calories.
When it comes to quantity, Simon says that young children are usually fairly good at regulating their own appetite, but this can vary day to day, depending on their mood or how active they have been. “Parents who are concerned about how much their child is eating can try using child-sized plates and bowls, putting out smaller portions, waiting for the child to ask for more if they are still hungry and not making children eat everything on their plates,” he explains.
A healthy diet in combination with daily physical activity is a winning combination and a great way for pharmacy teams to help encourage healthy growth and development in children and teens. Throughout the Covid-19 pandemic, the reduction in physical activity time for children and teens when schools and extracurricular activities were closed is thought to have been detrimental, leading to a variety of problems. “The three key things, all of which interrelate, are obesity, sleep and behaviour. All are worse when the child is sedentary, as we saw during the pandemic,” says Dr Max Davie, officer for health improvement at the Royal College of Paediatrics and Child Health (RCPCH).
The number of children and young people who were active during mid-May to late-July 2020 fell by 2.3 per cent, with just over 100,000 fewer children meeting the recommended level of activity compared to the same period 12 months earlier. This is according to Sport England’s ‘Active Lives Children and Young People Survey Coronavirus (Covid-19) Report’ published in January 2021.
Now, as lockdown restrictions continue to lift, pharmacy teams should encourage young people to focus on getting active again, not only to help manage weight gain, but to boost mood and improve sleep too. The current Government guidelines for physical activity for children and teens aged five to 18 is an average of 60 minutes of moderate intensity physical activity per day. A varying level of intensity is recommended to help with the development of bones, muscles and movement skills. Activity should ideally be spread out across a day to avoid long periods of inactivity. Getting children and teens active doesn’t mean they necessarily have to join a sports team, which can be both timely and costly for parents. Briskly walking to school or walking the dog, playing outdoors, cycling and dancing are all regarded as moderate intensity activities, according to the NHS.
And, similar to establishing healthy eating habits, getting children to be physically active at a young age should encourage them to be more active in later life, rather than adopting more sedentary lifestyles. “Bad habits are hard to break and the downstream consequences on weight, sleep and mental health can be very significant,” adds Dr Davie.
Pharmacy teams can provide examples for people to get active in their communities using resources from the NHS Change 4 Life campaign, which has a variety of ideas for indoor and outdoor activities, including games, sports and activity ideas for children with disabilities.
A lack of sleep can be detrimental to both physical and mental health for children and teens, especially impacting their ability to focus in school. Cognitive development, mental health and growth and weight management are also better with more sleep, according to Dr Davie.
The NHS recommends that children aged six to 12 years get between nine and 12 hours sleep per night, and teenagers aged 13-18 get a minimum of eight to 10 hours. Yet 32 per cent of primary and 70 per cent of secondary school children reported sleeping less than nine hours a night in a 2019 survey conducted by the BNF.
Equally, the pandemic has had a significant impact on sleep, with as many as 70 per cent of children under 16 going to bed later, according to a survey conducted by The Sleep Charity, The Sleep Council and Sleepstation. This survey also found that children are becoming more heavily reliant on technology, with nearly three quarters (74 per cent) of parents reporting that their children were using electronic devices including phones, TV, tablets and game consoles during lockdown. Distractions such as these, as well as toys and games, are thought to be detrimental to sleep as they keep children and teens up for longer.
As previously mentioned, diet can also have an impact on sleep. The BNF survey also found that almost one in 10 (nine per cent) secondary school students reported drinking a caffeinated drink before bed. What’s more, a lack of sleep can lead to poorer food choices and, if left unchecked, this can become an unhealthy cycle leading to weight gain.
Pharmacy teams can recommend three steps to help to improve children and teens’ sleep:
- Establish a good bedtime routine. This should include encouraging children and teens to take the time to wind down by doing relaxing activities, such as reading or taking a bath. In addition, eating large meals, or food and drinks high in sugar and caffeine should be avoided too close to bedtime
- Remove distractions. Toys, games and any electronic devices such as phones, TVs and game consoles should be removed from the bedroom. Switching off devices and avoiding screens for at least 30 minutes for bed is also recommended as the blue light that these emit can suppress the sleep hormone melatonin
- Create a good sleep environment. Dr Davie recommends a bedroom that is quiet, not too hot or cold, dark and has no screens. “If there’s a sleep problem, there’s usually one of these going wrong,” he adds. In addition, Dr Davie says a child that is experiencing stress or feels unsafe will struggle to sleep, but there are steps that can be taken to manage this.
Mind on the matter
The number of children with a diagnosable mental health condition has risen significantly throughout the Covid-19 pandemic from one in nine in 2017 to one in six in 2020. It is thought that this trend is going to continue for years to come, according to Dr Lou Enright, lead clinical psychologist at Action for Children’s Build Sound Minds project. The most common mental health concerns for children and teens include panic attacks, general anxiety disorder, separation anxiety, depression, low mood, eating disorders and obsessive-compulsive disorder (OCD).
Because of the worrying increase in mental health issues, it’s incredibly important for pharmacy teams to encourage parents and carers to pay attention to their children and teens to help spot the signs if something is wrong. “Parents need to become familiar with the patterns in their children’s behaviour,” says Dr Enright. “When younger or primary school-aged children are anxious, they may communicate this through becoming angry, tearful or clingy. Some might even have problems sleeping, including bad dreams or even bedwetting.” Teenagers can show their anxiety slightly differently, Dr Enright says, for example by having outbursts or meltdowns, problems sleeping or panic attacks. “Whether for toddlers or teenagers, stepping in to help early with preventative services can often stop problems developing further, not only reducing pain and anguish but the need for intensive support further down the line,” she adds.
As support networks such as schools were disrupted by the pandemic, stable support systems at home are likely to have become even more important. This can be achieved by parents and carers being mindful to how children and teens are behaving, listening to them and taking action if necessary. “If low mood or anxiety starts to impact on their access to everyday activities or their ability to take care of themselves, then they should seek help,” says Dr Enright. “A visit to their GP is a good place to start. If a child’s emotions are affecting their school life, it’s a good idea to talk to their school as well.
Pharmacy teams can signpost parents and carers to help and advice about children’s mental health, such as:
- Action for Children offers parents a one-to-one chat with a parenting coach via its Parent Talk service
- The Young Minds free parent helpline is available 9.30am to 4pm Monday to Friday by calling: 08088 025544.
Pharmacy teams can also play a vital role in safeguarding children, helping to identify and support those who are vulnerable. Information on safeguarding is available from the NSPCC.
In March 2021, the Government published its annual report from the Early Years Healthy Development Review, in which it laid out its plans improve the health of babies and children in England. This includes the digitalisation of the Personal Child Health Record (PCHR), commonly known as the ‘Red Book’, by April 2023.
The Red Book is used to record the health and development of babies and children from birth, including any immunisations received, height, weight and any other health issues that are, or were, present.
The digitalisation of this vital document aims to help improve the health outcomes for babies and children by protecting and storing their medical information from a young age. This will also make accessing a child’s medical history quick and easy, and make it more accessible for healthcare workers, as well as foster carers and adoptive parents, where applicable.
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health commented that this development “has an important role to play in ensuring children’s health and wellbeing needs are considered across services, optimising opportunities for early intervention”.
Viatris has created this short video based on a publication reviewing global research into the potential impact of the Covid-19 pandemic on mental health. It identifies six areas where psychiatrists can play a role in supporting people's mental health through these difficult times.