The pandemic has had far reaching effects on the health of children and a return to ‘normality’ brings the impact of these into sharp focus
The national lockdowns meant children were unable to go to school, socialise or participate in sports and clubs, having lasting effects on their mental health, fitness levels, weight and sleep.
Focus on mental health
Rates of children’s mental health problems increased during the pandemic, with 39 per cent of six- to 16-year-olds experiencing worsening mental health in 2021 compared to 2017, according to the Mental Health of Children and Young People in England 2021 report by NHS Digital. From this age group, it is thought one in six were affected by mental health problems, up from one in nine in 2017. In 17-19-year-olds, mental disorders were thought to have increased to one in six from one in 10.
“Children are still feeling the effects of the pandemic and over the past year they have told our counsellors that the lockdowns impacted their motivation, friendships and how isolated they felt,” says Alex Gray, service head of Childline. “Children have also shared that they feel reluctant to speak out because they are concerned people will not understand and instead, they may bottle things up.”
Conditions to watch out for
Encouraging children to talk
Alex Gray, service head of Childline, has this advice to pass onto parents:
- Remind children that they’re there to listen and support them no matter what they are worried about or how they’re feeling
- Let them know they can talk to you any time and whenever they feel ready
- Remind them of the other trusted adults in their life they can turn to. This could be a teacher, older sibling, doctor or a Childline counsellor. Sometimes a child may prefer to talk to another trusted adult first before speaking with their parent or carer.
Safeguarding children in the pharmacy
Pharmacists have a legal duty to protect children and young people from abuse and neglect. They also have a duty to work with other organisations to safeguard children and young people. The wider pharmacy team also needs to understand and recognise possible signs of abuse, neglect or exploitation and know how to act.
If abuse/neglect is suspected, pharmacy teams should follow the local safeguarding procedures, e.g., from their employer, NHS trust or local council. If the nature of abuse is considered an emergency, the police should be contacted. Otherwise, decide on next steps, such as taking advice or referring to social services. Pharmacy teams should keep a record of concerns and suspicions, decisions taken, and reasons and any action taken.
They should not investigate suspicions or allegations of abuse directly or discuss concerns with an alleged perpetrator.
Diet and nutrition for a healthy weight
The pandemic has led to further increases in childhood obesity. Latest figures from the National Child Measurement Programme (NCMP) England 2020-21 found obesity prevalence in reception year up from 9.9 per cent in 2019-2020 to 14.4 per cent in 2020-21. In year six, it rose from 21 per cent to 25.5 per cent. This is the largest increase recorded since the NCMP began in 2006. “Obesity in childhood is more likely to lead to an adult that is overweight or obese,” says Hannah Whittaker, British Dietetic Association (BDA) spokesperson and registered dietician. “With this comes increased risk of cardiovascular disease, type 2 diabetes, osteoporosis, respiratory problems and sleep apnoea. Children who are obese are also at a higher risk of poor mental health.”
Over consumption of sugar is also an issue. A new study by University College London (UCL), presented to the European Congress on Obesity, found that British toddlers and children consume too much sugar. Analysis of the UK’s largest contemporary dietary dataset of toddlers found only 16 per cent of those aged 21 months and two per cent of seven-year-olds met the recommend intake of free sugars.
The World Health Organization (WHO) recommends that free sugars should not make up more than 10 per cent of daily calories, with five per cent or less the ideal target. This is 50g as the maximum, 25g as the target. “Parents can read the back of packaging to help identify a food high in sugar. This is one that contains more than 22.5g sugar per 100g. A low sugar food has 5g or less per 100g,” says Hannah.
Portion control is another important factor. “Young children tend to need smaller portions than older children and teenagers,” says Helena Gibson-Moore, nutrition scientist at the British Nutrition Foundation (BNF). “Larger plates can lead to larger portions being served, so parents should use smaller plates, especially for younger children. It’s best not to pile too much food on a child’s plate, if they are still hungry, they can be offered second helpings. Children learn by example, so one way to establish good eating habits is for parents to be a positive role model and eating healthy meals together can help children learn to like healthier foods.”
In addition, Helena recommends all children aged six months to five years have a daily supplement containing vitamins A, C and D. “All school aged children should consider taking a vitamin D supplement of 10mcg a day between October and March,” she adds. “For children following a vegan diet this should be balanced, and vitamin B12 should be obtained from fortified foods or a supplement.”
Exercise and physical activity
According to Sport England’s latest Children and Young People Active Lives report 2020-21, 44.6 per cent of children meet the recommended guidelines of 60 minutes per day of sport and physical activity, but 32.4 per cent do less than 30 minutes a day. The proportion who are active is down by 2.2 per cent on pre-pandemic levels.
“One of the most concerning pieces of evidence from our report was children and young people reported fewer positive attitudes towards sport and physical activity. Enjoyment and confidence in taking part saw significant drops, which are two of the five components in defining physical literacy,” says a Sport England spokesperson. “If positive attitudes and physical literacy levels don’t increase, there’s a likelihood the next generation will be less active, leading to poorer health and wellbeing.” For more information visit: sportengland.org. NHS Better Health also has accessible activity options.
Last year, problems with sleep on three or more nights a week affected 28.7 per cent of six- to 10-year-olds, 38.4 per cent of 11–16-year-olds and 57 per cent of 17–23-year-olds, according to NHS Digital. Across all age groups, figures were higher for those with a probable mental health disorder.
Lisa Artis, deputy CEO of the Sleep Charity, says the main causes of sleep problems in children include:
- Being overtired
- Self-settling – some children can’t settle themselves to sleep
- Being hungry or too full
- Being thirsty
- Being uncomfortable – a comfortable mattress is important for a growing child
- Having nightmares or night terrors
- Being overstimulated before bedtime
- Illness, changes or stress in the family.
“A good bedtime routine really helps support children’s body clocks and aids relaxation. Establishing and sticking to a bedtime routine right from the start until early teens can go a long way to minimising later problems,” says Lisa.
How much sleep?
12-16, including naps
11-14, including naps
10-13, including naps
Nine to 12
Eight to 10
Here are the Sleep Charity’s top tips to pass onto parents:
- Take time to plan a bedtime routine and write it down
- Do the same thing each day, with set a wake up time each morning
- Turn off all screens at the start of the routine
- Dim lights in the hour before bed
- A bath 30 minutes before bed helps promote sleep
- A bedtime story is a great way to end the routine.
Visit the National Sleep helpline: 03303 530541 or the Sleep Charity website to find out more.