Who is involved in promoting healthy weight in pre-school children?
Children’s centres in Blackburn with Darwen provide a wide range of universal groups and services that any professional can refer/signpost families to. Are you aware of the Children’s Centres in your area?
Find your nearest children’s centre.
Below is a list of the types of services and activities your local children’s centre may offer:
Health visitor drop-in: health visitors hold regular drop-ins at Children’s Centres where families can come in to talk to health visitors and have their child weighed. The geographical team have also been trained to support the health visitors to deliver the child health clinics and are able to offer universal support and advice in relation to weighing and measuring children. If any concerns around the child’s weight arises during these weigh-ins parents are able to discuss any concerns with a health visitor.
HENRY (Health, Exercise and Nutrition for the Really Young) parenting courses: Children’s Centres run universal 8-week HENRY courses for parents or carers of children aged 0-5 years. These are free for parents to attend. Parents are able to self-refer onto these courses or can be referred by a health professional. HENRY courses aim to support parents and equip them with the skills to give their child a healthy start in life. For more information on what HENRY courses offer go to the HENRY Website.
Other children’s centre services include:
- Active play
- Routine family meet and greets
- Classes on healthy eating and portion sizes
Health Visiting Team
Health visitors aim to promote the health and well-being of families with children ages 0-5. They encourage healthy lifestyles, addressing concerns about physical and mental wellbeing, as well as addressing health inequalities.
All health visitors are registered nurses or midwives with an additional qualification, such as a specialist community public health nurse. They aim to work in partnership with families and with other local providers of services for children and families, leading on the National Healthy Child Programme (birth to five years) and universally they offer health reviews and support to families at home or in a community venue. Following robust assessment processes targeted support is also offered to families with identified needs to improve outcomes for all children.
Health visitors are committed to enabling health and wellbeing and improving outcomes for under-fives with a commitment to promoting healthy eating messages which in turn contributes to their wider health and wellbeing outcomes. Health visitors work in partnership with local communities, GPs, pediatricians, dieticians and Children’s Centre’s to monitor the weight of pre-school children, offering advice and support with targeted therapeutic interventions as needed. Health visitors hold regular child health clinics where families can come to have their child weighed and discuss any concerns.
Community nursery nurse
Nursey nurses regularly see children from birth to 5 years, either at weekly clinics or routine health development reviews. Development reviews are completed at a number of stages. For pre-school age children these take place between 2, and 2 and a half years of age. During these contacts nursery nurses have the opportunity to discuss and promote healthy lifestyles. They talk about the types of food the family eat, the child’s milk intake, physical activity and the child and family’s meal time routines. If the nurse has any concerns, they may refer the family to a ‘HENRY’ course (see above for further details), or for targeted support with mealtime management and eating routines at home. The child’s measurements are taken during these health reviews and plotted on the centile charts to review the measurements. Where concerns are identified with obesity or underweight, referrals are completed as appropriate to other professionals.
For more information on the role of the Health Visiting Team see the links to the Lancashire Care NHS Foundation Trust website for both Health Visiting Services and School Nursing with whom they work closely.
General Practitioner (GP)
GPs are the first point of contact in the community if a family has a non-emergency health issue. GPs may come across pre-school children who are under- or over-weight, either because parents are directly seeking support for children’s weight or because parents have brought children to the GP for a non-weight related medical issue. If they are in a consultation with a family and for example they come in about a child’s asthma and the child visually looks overweight (which is something that may contribute to their health problems), the GP might plot the child on the centile chart and use this to help explain to the family about the weight status of their child. They would then spend a few minutes talking to the family about their child’s eating and activity, and offer advice on this. They would give parents the opportunity to go away with this information and come back to see them or the practice nurse about how things are going. If the parents feel they need extra support the GP might signpost them to the health visiting team or a local children’s centre.
Practice nurses work within GP practices where their primary roles involve screening, providing health education and supporting GPs in delivering health care. There may be some variations in a practice nurse’s role depending on the needs of the practice, and due to different local demands. Most practice nurses will be involved in setting up and running clinics for people living with long term conditions (e.g. diabetes) or promoting lifestyle behaviour change (e.g. stop smoking). They are also likely to be involved in childhood immunisation where they may come across pre-school children who are over or under weight. Whilst they may not have time to address this in a clinic setting they might ask the parent to come back and see them again. When time allows they could weigh the child and use a growth chart to talk through the child's weight with the parents. The nurse could then discuss the child's eating and physical activity with the parents and offer advice and information to take away. They might invite the parents to come back and see them at a later date to review progress. If the parents need extra support the practice nurse might signpost them to the health visiting team or a local children's centre. If the practice nurse is particularly concerned about a child's over- or under-weight, they may refer to a GP for medical support.
Children may be referred into secondary care if, for example, the child has extreme obesity or other risk factors for underlying pathology (see the mosdule on identifying unhealthy weight for examples of these risk factors). If a child is referred to a paediatrician for obesity, they would take a history/examine the child with the view of diagnosing any comorbidities of obesity (mostly in older children, for example, high blood pressure, type II diabetes etc.) and/or look for any underlying pathologies pre-disposing the child to obesity. Pharmacological treatments are sometimes employed in older children, but would only be considered if multi-component interventions aiming at diet, exercise and other lifestyle changes had been unsuccessful. Paediatricians work with other health professionals including GPs, dieticians, community weight reduction services to help support the family with education around obesity and lifestyle changes. Extremely obese children and/or children with certain co-morbidities may be referred to tertiary care.
Are you aware of the leisure centre services in Blackburn with Darwen and what they offer? (e.g. parent and toddler swimming). Is this something you could direct the families you are working with to?
To find out more take a look at the website.