13th December 2024
In a new report published yesterday, the National Child Mortality Database (NCMD) shows in detail the impact that asthma and anaphylaxis are having on child mortality across England. In this Voices blog, NCMD Deputy Director Sylvia Stoianova pulls out some key findings for health visitors.
Sylvia Stoianova, Deputy Director of the NCMD
Our latest thematic report, published yesterday morning, has some stark findings. In the period for which we have data (between 1 April 2019 and 31 March 2023), we found 54 deaths due to asthma and 19 deaths due to anaphylaxis. That’s one death from asthma every month, and 5 deaths per year from anaphylaxis, through the whole period.
Behind every statistic is a real person and family who have experienced the tragic loss of a loved one. This report explores the data and characteristics of the children who were affected, the factors that led to their deaths, and recommendations to ensure that we improve and save children’s lives in future. But in this blog, I’m going to focus in particular on what health visitors can do to affect change in this area.
Image shared with kind permission from National Child Mortality Database (NCMD)
The first thing to say is that we have made some strong recommendations in this report to support health visitors and school nurses in their practice, because these professional groups have a vital role to play in improving health outcomes for babies and children through their preventative public health work. In the report, we have also called for school nursing provision in every school, in recognition of the important role that school nurses play in supporting children at school with asthma and/or allergies in line with the School and Public Health Nurses Association (SAPHNA) vision document. But training is also essential. We recommend that all school nurses and health visitors should complete relevant speciality tier training as per the National Capabilities Framework for Professionals who care for Children and Young People with Asthma. School nurses can raise awareness of asthma triggers for school staff, and support children and young people with asthma and allergies and their families. Health visitors can also help raise awareness of the triggers for asthma with parents through their universal reach. The uptake of training should be promoted by the relevant professional bodies such as the Institute of Health Visiting and the School and Public Health Nurses Association. National government also has a role to play as they set the context in which health visiting services operate. Through their leadership roles, the Office for Health Improvement and Disparities and NHS England can ensure that all health visitors have access to high quality continuous professional development as part of their ambition to give all children the “best start in life”, regardless of where they live.
Image shared with kind permission from National Child Mortality Database (NCMD)
One advantage that health visitors have over other practitioners supporting child health is their universal reach into every child’s home environment through home visiting. When the Child Death Overview Panels (CDOPs) reviewed the asthma deaths that were reported to us, they found that in 32 (48%) cases, smoking by family members was present, with 29 (43%) reviews reporting parental smoking. This is significantly higher than the proportion of adults who smoke cigarettes in the UK (13%). Cannabis smoking in the child’s house by the child’s carers (parents and grandparents looking after the child) was also recorded in 5 reviews. Raising awareness of the risks of smoking, as well as quickly identifying abuse and neglect, could play a huge role in safeguarding child health.
And there’s more. In seven reviews, CDOPs recorded contributory factors in relation to poor home conditions, including instances of excessive mould and dust, and dirty, overcrowded and tobacco smoke-filled houses. Factors related to poverty and deprivation were also present including living environment deprivation, homelessness, property in poor repair, and cold houses.
This is important for children with asthma because indoor air quality can have a significant impact on their health; mould, damp or parental smoking can all be potential triggers for asthma. The National Bundle of Care for Children and Young People with Asthma sets national standards of care for professionals and integrated care systems to follow, to minimise the risks associated with indoor air pollution. These include understanding and discussing the risks with children, young people and their families as part of the personalised asthma action plan, and to discuss these risks with housing providers to encourage timely repairs or for rehousing to be considered as per government guidance and legislation.
But the same factors can be relevant in cases of anaphylaxis as well, and in particular health visitors may have the keenest insight into the presence of pets in the household. There were 15 (22%) reviews where there were pets in the household and in 6 (9%) reviews CDOPs recorded this as a contributory factor. Allergens found in the animal’s skin flakes (dander), saliva, or urine can all trigger asthma symptoms, and animal allergies can develop at any stage of life. Asthma and Lung UK provide further information on how pets can trigger asthma symptoms and advice on how to lower the risks for babies and children.
Health visitors know that health starts at home – and this report shows just how important this principle is when it comes to tackling asthma and anaphylaxis.
