National Institute for Health and Clinical Excellence (NICE)
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Help vulnerable children get the best start in life, says NICE

The social and emotional wellbeing of vulnerable children under 5 should be at the heart of early intervention programmes to ensure that they get the best start in life, says NICE.

This latest guidance will help to strengthen home visiting and early education services, and recommends that health professionals are alert to any factors that may pose a risk to a child's social and emotional wellbeing.

Children living in disadvantaged circumstances are more likely to experience social, emotional and behavioural difficulties, and as a result, poor health, education and employment outcomes.

The poorest 20 per cent of children are more likely to display conduct problems at age 5, compared to children from more affluent backgrounds, according to measures of school readiness.

NICE recommends that each health and wellbeing board should ensure that the social and emotional wellbeing of vulnerable children features in its ‘Health and wellbeing strategy', as one of the most effective ways of addressing health inequalities.

The resulting plan should include outcomes for ensuring healthy child development and ‘readiness for school' and for preventing mental health and behavioural problems.

Health professionals in antenatal and postnatal services should identify factors that may pose a risk to a child's social and emotional wellbeing, says NICE.

These include factors that could affect the parents' capacity to provide a loving and nurturing environment. For example, they should discuss with the parents any problems they may have in relation to the father or mother's mental health, substance or alcohol misuse, family relationships or circumstances and networks of support.

Health visitors or midwives should offer a series of intensive home visits by an appropriately trained nurse to parents assessed to be in need of additional support. The trained nurse should visit families in need a set number of times over a sustained period of time - sufficient to establish trust and help make positive changes.

Health visitors or midwives should consider evidence-based interventions such as baby massage and video interaction guidance to improve maternal sensitivity and mother-infant attachment.

Local authority children's services should ensure all vulnerable children can benefit from high quality childcare outside the home on a part- or full-time basis, and can take up their entitlement to early childhood education where appropriate.

Professor Mike Kelly, NICE Director of Public Health, said: “We know that there are a complex range of factors that impact upon the social and emotional development of children. While most parents offer love and stability to their children, regardless of their personal circumstances, in some cases, children living in challenging environments can experience emotional and behavioural problems.

“These can have a life-long, negative effect on their future health and wellbeing. NICE is pleased to publish this guidance which will help all those involved in delivering excellent services to the children and their parents who need them most.”

Catherine Law, Professor of Public Health and Epidemiology at University College London Institute of Child Health, and Chair of the Public Health Interventions Advisory Committee at NICE, said: “This new guidance includes a number of important recommendations that put the social and emotional wellbeing of vulnerable children at the very heart of early intervention services to ensure all children have a fair chance to be healthy and to succeed.

“The recommendations are based on the best available evidence, and will particularly help to strengthen home visiting and early education services.”

Simon Antrobus, Chief Executive of the charity Addaction added: “Addaction fully supports this new guidance. We know that timing is hugely important when helping vulnerable children - and we know that any support on offer must take into account the whole family, and not just the child.

“We recently published a report looking at this very issue. It proved that well timed, family-based interventions were the most effective way of tackling an 'intergenerational cycle of addiction', where children whose parents use drugs go on to develop their own problems later in life.

“We need to ensure that decision makers understand the importance of this kind of high quality, specialist support. Not only does it work - it is the best way of preventing other problems and giving children the best possible start in life.”

Educational slide sets, costing support, and information resources for schools and maternity settings are available to help put this guidance into practice.

Episode 13 | The Digital Divide