RCPCH Insight
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RCPCH Insight

State of Child Health: One year on — in conversation with Dr David Tuthill

Dr David Tuthill is a consultant paediatrician and the RCPCH Officer for Wales. This article is part of a series to mark one year on from the publication of State of Child Health 2020 by the Royal College of Paediatrics and Child Health.

Talk to me a bit about the sort of experience that children and young people have had in Wales this last year?

In Wales, Covid has affected loads of children’s things: it’s stopped their schooling, it’s stopped their out of school clubs, and it’s created a lot more anxiety. There’s been a huge amount of angst among the adult community and that’s been forced upon children. They’ve suffered a situation that’s been unheard of in our generation and felt the indirect effects of Covid quite severely. We’ve seen some children not being able to access care. We’ve had concerns about child protection issues- referral rates fell during the early pandemic. Did more of it go unrecognised because the safety net of school or nursery was missing?

We had several pre-existing concerns before Covid reared its ugly head which have all probably been exacerbated by Covid.

There was quite an increase of children presenting with mental health issues and eating disorders. We’ve got good routine childhood immunisation rates in Britain, but we’ve got children that are getting unhappier and increasingly worries and affected by issues like obesity. Dental health is improving but it’s still not good and despite the Senedd’s best efforts we lag behind the other nation in this. So, in summary we had several pre-existing concerns before Covid reared its ugly head which have all probably been exacerbated by Covid. I think we’ll see that more clearly in a year or two.

Do you think Wales doesn’t do well on child health?

If you compare the nations directly you may be starting with an unfair comparison as many health outcomes are linked to social issues such as family incomes. So a better comparison is of Wales to North East England, where you’ve a similar post-industrial heritage, lower wages and closer unemployment rates. When you do this we have similar rates of oral health for instance. I don’t think its necessarily worse than England or Scotland or Ireland. There are some bits where we’re a bit better, some bits where we’re a bit worse.

Why are there such big gaps regionally on things like child mortality and even oral health? How do we improve on those areas?

Whatever problem you look at in child health you can link it to socioeconomic determinants: poverty, poor education, unemployment, adverse childhood experiences (ACE), family breakdown to name a few. Such issues don’t give a child an optimal start to life. Oral health is strongly linked with poverty. Some areas of England have fluorinated drinking water; we haven’t got any here in Wales. So, we should support the fluoridation of water to level up dental health for all. In Wales we have ‘Design to Smile’ which is having a positive effect on oral health but we still need to go further and ideally faster on this.

It’s more effective to put money into the community and prevent it happening, rather than into new tertiary obesity clinics when the damage has already been done.

I think most places in the UK have seen obesity rise. Just before lockdown, the Welsh government had been looking at getting a joined-up strategy to link up several excellent threads; healthy eating schools, mile-a-day club at school, active transport (cycle & walking) to school. It’s more effective to put money into the community and prevent it happening, rather than into new tertiary obesity clinics when the damage has already been done. The same would be true of mental health. It would be much better to my mind, to be running children’s youth clubs and school counselling for example. This allows children in the community to experience a positive environment to prevent things happening. I think that wider picture of how we join up health, social care and education is key. That was being looked at in Wales by the Welsh government but then Covid blew everything else apart for a while.

What do you think is going well in child health in Wales?

Having a joined-up strategy for things like Healthy Weight Healthy Wales is good. I think there was a genuine desire among the politicians, the Welsh government and the Health Minister, to do that and recognition that there were some problems there. Also, we have recognised the problem with dental health and are trying to improving it. With mental health, I don’t think we’re right yet. A recognition of the problems we have with overloaded CAMHs services, requires a joined-up strategic approach to improve things.

Thinking broadly about child health what’s the thing that worries you most as a paediatrician?

That children will be forgotten in the post-Covid recovery. There is also the big challenge of global warming. We need to ensure a sustainable ‘green’ environment with less pollution and adverse impact on children’s health. How we join up healthcare in an environmentally sustainable way is vital.

We get lifelong health benefits from investing in children.

Then it’s making sure we are getting those preventative things right. I do a lot of allergy work and in terms of that, how we can stop children being allergic in the first place? There is some work now that we can do now– by giving a baby peanut butter and egg in the first year of their life you can stop them developing these allergies. With pollution- if we don’t ‘poison children’ early on, they’ll be healthier with bigger lung capacity as adults. If you breastfeed a child, when they grow up, they are less likely to have heart attacks, stroke, diabetes when they’re older. Putting a penny in now saves a pound later. We get lifelong health benefits from investing in children.

If you got your hands on government policy what’s the thing you’d focus on first?

Currently, I would focus on primary mental health care and supporting children’s mental health and wellbeing in the community. They need support at home to enable them to recover from the anxiety, the loss of school and other issues from Covid. So, with government policy I’d focus on mental health and wellbeing. How we improve that, both to aid children to recover and giving them resilience in the long-term. After that I’d want to enhance research into child health. There is some good research into child health here, but it strikes me as less than it was. We need good scientists, good researchers, good clinical workers; by finding answers to important clinical questions we will improve children’s health.

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Insight from the Royal College of Paediatrics and Child Health.