Paediatric fitter better sooner is coming!
The need to invest in our children’s health has been highlighted once again by the recent review by Lord Darzi. Only 5% of the NHS budget is allocated to children’s health, and the ‘gap’ needs to be closed between adult and children’s elective recovery and services to become more equitable. Children represent >20% of our population, and the report also highlights much health inequality, with children from the most deprived backgrounds twice as likely to be obese by age 5.
In England, 20% of 4-5 year olds and 33% of 10-11 year olds are now overweight or obese, and it is estimated that obesity in our children will cost the NHS up to 7 times that of a healthy child over their lifetime. We all know that prevention is key, but the covid pandemic brought with it even more sedentary behaviours fuelling the problem. Only 1 in 5 children reach the recommended amounts of physical activity that should be done- 3hours/day for our under 5’s, and 60 mins/day for above 5’s.
The PEACHY study showed 1 in 4 children presenting for anaesthesia and surgery were clinically overweight or obese and the national prevalence of dental decay is quoted as 29%! With approximately 500,000 paediatric operations performed each year in the UK…. that’s a lot of ‘teachable moments’ at pre-assessment to make a difference and ‘make every contact count’ to ‘wait well’ for surgery!
We need sufficient NHS resources and urgent changes if we want to ensure better health outcomes for our children, so they have healthy and productive adult life’s.
Public Health England has identified smoking, poor diet, physical inactivity, and high alcohol consumption as the four main behavioural risks to people’s health in England in their 2020-25 strategy document. This, in conjunction with the APAGBI Best Practice Guidance for Paediatric Pre-assessment 2022 and in 2023 GIRFT – Closing the gap document, brought health screening and behavioural change (self-care resources) whilst waiting for surgery into the domain of pre-assessment services. This document already recommends the RCoA, Beano and APAGBI collaboration ‘Dennis has an anaesthetic’ and ‘Dennis challenges’- a series of health promotion activities to help children and families take active steps to improve their lifestyle ahead of surgery. However, there is a gap for our older children and young people in terms of resources.
At the RCoA, we have a toolkit of resources called ‘fitter better sooner’…..to help adult patients take an active role in preparing both their body and mind for surgery, through universal lifestyle advice and health promotion. It has proven to be a very successful and one of the most downloaded resources from our patient information webpage.
The RCoA’s five-year commitment and vision combines strategic aims with core values, of which one core value is promoting healthier outcomes. It is time for an equitable toolkit for our children and young people, with a focus on:
- Eating
- Exercise, obesity
- Hydration
- Smoking/vaping/recreational drugs
- Keeping your teeth and gums healthy
- Sleeping well
- Optimising medical conditions
- Anxiety management strategies
At the RCoA we are currently working with the APAGBI … and will be collaborating with the RCPCH for engagement with their CYP networks- a group of young people to help design the suite of resources in a way that children are likely to respond to- watch this space!
The NHS Long-term Plan recognises that the NHS needs to give children the healthiest start in life. Messages regarding public health for children and families are an important opportunity within preassessment to “make every contact count”. As paediatric anaesthetists, or should we say ‘paediatric perioperative physician’s’, we need to think outside our anaesthetic silos, and integrate a more holistic approach. We have a public health responsibility as health care professionals to think about preventative medicine for our children and young people in our preassessment clinics.
Dr Samantha Black,
Consultant Paediatric and Perioperative Anaesthetist, Patient Information Lead RCoA and Paediatric fitter better sooner lead, APAGBI Perioperative committee
Dr Amy Norrington,
Consultant Paediatric Anaesthetist, APAGBI Perioperative committee, Regional clinical lead GIRFT NHSE