Children's health

Tackling ill health and life style issues in children can achieve much by way of preventing health problems throughout the rest of their lives. As Lord Darzi has observed, the breadth and scale of inequalities within England are striking.

The gap in life expectancy between the most deprived and least deprived areas has widened and the opportunity to access healthcare has worsened in areas of greater need. Attention must be given to wider determinants of health such as early child development, poverty and lifestyle.

The 'whole person' approach of physiotherapy is ideally suited to addressing the often complex and non-medical causes of ill health in children but also to instilling a responsible 'engaged' approach to health matters — vital if the NHS is to make the transition from a 'sickness' service to a 'well-being' service.

Case study (1) - Obesity and lifestyles programme

Childhood obesity is now a major problem. The age at which children are obese is falling and it has been documented that childhood obesity increases the risk of adult obesity. Many factors are thought to have led to this increase such as reduced exercise, changing food habits and changing lifestyle habits. Short-term consequences of obesity include asthma, Type II diabetes, joint pain, high blood pressure, early signs of cardiovascular disease, low self-esteem, and depression. Long-term consequences include a greater likelihood of being an obese adult, a greater risk of cancer and cardiovascular disease.

In response to this increasing problem this physiotherapy led multidisciplinary programme for overweight and obese children aims to maintain the children's weight as they grow and to promote a healthier lifestyle for the families involved. A healthy lifestyle is aided by improving diet, increasing physical activity, decreasing sedentary activity and addressing any psychological or emotional issues experienced by the children involved.

Secondary aims are to improve functional exercise capacity, reduce weight circumference and improve the children’s blood profile (levels of fat, glucose and insulin in the blood). The eight week programme incorporates education sessions for both parents and children covering the areas of physical activity, dietary management, goal setting, self-monitoring, and healthy eating.

Case study (2) - Back care for children programme

The service is for school children aged from 6 - 12 years, their families and school staff. Three Chartered Physiotherapists work as required to staff the service in two ways: delivering the programme to local secondary schools, working in partnership with teachers in the class- room, leading back care workshops to class sized groups; planning for and leading courses throughout the UK to train multi-disciplinary/ multi-agency colleagues on how to teach back care to children. Dynamic, fun, interactive workshops introduce 5 'core elements fundamental to the 'ABC' approach; anatomy and physiology; ergonomics; good practice; exercise; and philosophy. Back care lessons for Years 2, 5 and 7 have been designed by the physiotherapists to enhance the Personal and Social Health Education (PSHE) syllabus in Primary and Secondary schools.

The lessons are supported by educational resources, including a computer animated video. Schools are encouraged to complete follow-up work. The children are asked to take on a 'health ambassador' role and cascade back care information back home. In addition to visiting schools, the team hold training days for health and education personnel to learn the 'what, why and how' of the programme.

Case study (3) - Service for children with life limiting neurological conditions

A physiotherapy led multi-disciplinary service has significantly reduced readmission to hospital with respiratory infection in children with life limiting neurological conditions. Family members and carers of children with Duchenne Muscular Dystrophy underwent training in manual techniques and the effective use of cough assist devices to facilitate removal of lung secretions, thus avoiding repeated and prolonged hospital readmission.