Early Years and Childhood

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Immunisation is essential for the protection of individual and community health. Vaccines enable an individual’s immune system to learn how to fight a disease and to create antibodies that protect people from diseases when they are exposed to them. Vaccinations work by imitating an infection or disease which then stimulates an immune response leading to the development of antibodies. These antibodies can then recognise the disease or infection if a person encounters it. The antibodies will fight and destroy the disease or infection, protecting an individual from the disease or infection. The antibodies decrease over time and hence repeat vaccinations called boosters are needed.

Vaccines help to prevent the spread of disease by attempting to achieve “herd immunity”. Herd immunity is where a large percentage of a population is vaccinated which creates an environment where diseases are not easily transmitted as there are far fewer people susceptible to infection. This is also important as it helps protect those within a population who may not be able to have the vaccine. High levels of vaccine coverage lead to greater herd immunity and greater protection for all. This is also known as the collective immunity of a community. Immunisation during childhood is vital, as it helps provide a child with the best start in life, and protects against serious illness.

The building blocks for lifelong emotional and physical health are laid down in the period from conception to the age of two. Prevention of ill health and early intervention in childhood can develop and maintain healthy behaviours throughout life, particularly immunisations, weight and oral health

• Children who suffer neglect and extreme lack of stimulation in infancy have decreased brain function and can inhibit their capacity to learn and thrive
• Child Development review – differences in child development will impact children by the time they enter school. If left unsupported, some children are more likely to fail to achieve their full potential
• School Readiness – Suffolk data shows 3 out of 10 local children (2,300 out of 7,900) were not ready for school. For boys in Suffolk, this gap is even bigger – 4 out of 10 were not ready for school compared with 2 out of 10 for girls. The picture has been improving since 2012/13 when just over half were not ready for school.

• Physical activity – The national average for physically active children and young people (2020/21) is 44.6%. For Suffolk it is 42% and Essex 42.4% – Tendring has a particularly low level of activity at 35%
• UK Chief Medical Officers recommends 5-18 year olds are physically active for an average of at least 60 minutes per day across the week.

• Healthy Weight – most of SNEE is similar to the national average. There is a strong association between deprivation and obesity in children

• Oral health – level of dental decay better in Suffolk than national, and similar to national in Essex – no small area data to compare deprivation

Asthma – the most common long term condition among children and young people

Epilepsy – most common significant long-term neurological condition of childhood

Diabetes – predominantly type 1 but type 2 increasing (UK level highest in Europe)

Accidents, unintentional and deliberate injuries – Ipswich higher hospital admissions, West Suffolk lower. Others similar to England. Hospital Episode Statistics data shows majority admissions for 0-9 yrs caused by falls

Vulnerable children are any children at greater risk of experiencing physical or emotional harm and/or poor outcomes because of one or more factors in their lives, and this may include adverse childhood experiences

• Poverty – both Tendring (23.3%) and Ipswich (17.9%) have higher proportions of children living in low income families than England ave. (17%)

• Free school meals – In 2020/21, 19.3% of primary school pupils in Suffolk (10,969 pupils) were eligible for free school meals. lower than England (21.6%)
• In 20/21 the rate of children in need episodes during the financial year, per 10,000 children was 280.8 for Essex and 467.7 for Suffolk
• ‘Toxic trio’ is where children are living in a household with Domestic abuse, mental ill-health and substance misuse

• Most people who experience mental ill health as adults had a first episode before the age of 24.
• Mental ill health in childhood can affect educational attainment and socialisation, further impacting adult life.
• Children and young people with a mental disorder are more likely to be bullied and to bully others
• Prevalence of emotional disorders increased with age and are more common in girls than boys
• Behavioural disorders are the most common reason for referral of children and young people to child and adolescent mental health services – behavioural disorders were more common in boys and young men

Public Health England’s report into school readiness in London highlights:

The report points out we can improve school readiness through:

• Good maternal mental health
• Learning activities including speaking to babies and reading to children
• Enhancing physical activity
• Parenting support programmes
• High quality early education

Early Diagnosis

Early diagnosis is crucial to parents obtaining the right information and support and enabling the child to develop to their maximum potential.

A child may be diagnosed during pregnancy eg amniocentesis for genetic conditions.

Post birth a child may be diagnosed by a GP or other doctor, health visitor, or specialist psychologist.

Mencap highlights the potential impacts of diagnosis on parents:

• Feelings of disbelief, disappointment, self-pity, shock, anger, numbness, guilt and denial.
• Sense of mourning, or unreality.
• Feeling frightened at the wild variety of emotions.

It is therefore crucial that parents have:

• The information they need at the pace and in the way that is best for them
• Support networks to talk to and rely on, and breaks from caring when they need them

‘What I Want’

The Council for Disabled Children has co-developed with the NHS a multi-agency Outcomes Data Dashboard to show progress over time towards strategic outcomes.

The Council has co-developed 7 ‘I-statements’:

• My voice is heard
• I am able to learn 
• I am healthy 
• I am happy 
• I feel supported
• I am safe

I am in control of my life

The Mental Health of Children and Young People survey 2021 shows that since 2017:

Rates of probable mental disorders have increased:

• 6-16 year olds: from one in nine to one in six – boys aged 6-10 are more likely to have a probably mental disorder than girls
• 17-19 year olds: from one in ten to one in six– notably rates for young women the rate increased from 13.4% to 24.8%
• More than half of children with SEND have a probable mental disorder

Some children and young people’s mental health had improved but for many it deteriorated:

• 6-16 year olds: one in four had experienced deterioration in mental health
• 17-23 year olds: just over half experienced deterioration.

Eating disorders are rising:

• 11-16 year olds: doubled from 6.7% to 13.0%
• 17-19 year olds: up from 44.6% to 58.2%

The All-Party Parliamentary Group On A Fit And Healthy Childhood in 2021, The Covid Generation: A Mental Health Pandemic In The Making, recommended:

“A radical overhaul of our national approach to wellbeing and mental health for children, young people, and families incorporating promotion of wellbeing and good mental health, and prevention and treatment of mental health problems”

• A multi-sector integrated approach, incorporating third sector and lived experience, taking broad approaches to promote wellbeing, access to early support, and accessible specialist services.
• A ‘root and branch’ revision of the role of CAMHS.
• A Named Pathway Coordinator for all children with mental health difficulties to direct them to appropriate services – 80% of children referred to CAMHS are declined with no alternative signposted.
• A trauma-informed approach.
• Expanded support in schools and Early Years Centres, including Education Wellbeing Practitioners, in-school counselling, mentors, chaplains and other pastoral support.
• Parents at the centre of all targeted provision.
• Co-produced guidelines for online mental health assessment and intervention.

Mental Health Inequalities

Royal College of Psychiatrists’ report in 2017 Good mental health services for young people highlights some young people are at a much higher risk of developing a mental disorder and should be prioritised when developing mental health services:

• Looked after children – fivefold increased risk of any childhood mental disorder and a four-to-fivefold increased risk of a suicide attempt as an adult.
• Young people with an intellectual disability – 6.5-fold increased risk of mental health problems.
• Young people with special educational needs – increased risk of conduct disorder.
• Young people with physical illness – increased risk of emotional and conduct disorder.
• Homeless young people – eight-fold increased risk of mental health problems in B&B or hostel.
• Young offenders – Males in custody aged 15–17 years have an 18-fold increased risk of suicide; Females in custody aged under 25 years have a 40-fold increased risk of suicide
• Young people who self-harm.
• Teenage parents.
• Young carers.
• Young people with a family history of psychosis or a major mood disorder, or prodromal symptoms.

Project 17’s Not Seen and Not Heard report found:

• Local authority assessments for section 17 [children in need] support are excessively focused on the credibility of parents at the expense of a focus on the child.
• Support under section 17 is increasingly hard to access and local authorities are employing various strategies to refuse families with no recourse to public funds support.
• Many children supported under section 17 are living in poor conditions, without enough space or privacy, often far away from their schools, friends, and support networks.
• Financial support provided to families under section 17 is often well below Asylum Support rates under section 4 of the Immigration and Asylum Act.
• The challenges of having no recourse to public funds and
  the interconnected barriers to accessing local authority
  support has a significant emotional impact on children
  and young people. Children experiencing these issues
  are left feeling socially isolated, distressed, ashamed,
  and unsafe.

No Recourse to Public Funds – Project 17 on impact on children https://www.youtube.com/watch?v=dySK_cuaLF8&t=16s

RCPCH – State of Child Health – Insight into the state of child health in the UK

https://www.leeds.ac.uk/news-health/news/article/4115/lack-of-sleep-damaging-for-children

https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/sleep-hygiene-children/

https://healthwatchsuffolk.co.uk/mhof/phasefive/

https://fingertips.phe.org.uk/profile/child-health-profiles

https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/07/cco-vulnerability-2019-infographic.pdf

Winstons Wish – giving hope to grieving children

Suffolk County Council – childrens and young people’s emotional wellbeing hub (East and West Suffolk) Information, advice and support for anyone concerned about the emotional wellbeing and mental health of a child or young person aged 0 to 25 years.

HCRG Care Group deliver a ‘Family Hub’ service in partnership with Barnardo’s across Essex. It is named locally as the Essex Child and Family Wellbeing Service (ECFWS)