The impact of black mould on families and how health visitors can help

16th February 2024

To help raise awareness of the impact of black mould on families and winter illnesses, we are delighted to share this Voices blog by Wendy Thorogood, Head of Clinical Services at Barnardo’s, and Carly Green, Continuing Professional Development Lead at iHV.

Wendy Thorogood, Head of Clinical Services at Barnardo’s

Carly Green, Continuing Professional Development Lead at iHV

The tragic death of Awaab Ishak in 2020, just eight days after his second birthday, was the first case to be directly attributed to prolonged exposure to mould in the home environment. This exposure resulted in severe respiratory complications that ended Awaab’s life.

The safety and quality of housing stock will be an uncomfortably familiar issue to the many health visitors and other early years professionals visiting families in their homes every day. But what learning can be taken from this to help health visitors to support children and families in light of this event?

Damp is the build-up of moisture in a property and can result in the growth of mould (a type of fungus) and other microorganisms¹. Mould predominantly affects the respiratory system as a result of the allergens, irritants and toxins that it can produce². Symptoms may include, but are not limited to, cough, shortness of breath, wheezing, exacerbation of asthma and other respiratory conditions, skin rashes and eczema – and with young children being recognised as a high-risk group, this is a particularly pertinent topic for health visiting services.

Awaab Ishak’s parents had reported the mould to Rochdale Boroughwide Housing (RBH) on multiple occasions. RBH has since faced criticism due to their lack of proactive approach, instead advising the family to paint over the mould. Such issues with mould in the home are sadly becoming increasingly widespread, given the current cost-of-living crisis and many families consequently attempting to save money by reducing energy consumption on heating. It is estimated that around 904,000 homes in England have a problem with mould and condensation³. However changes in legislation following Awaab’s death (Awaab’s Law), will require landlords to investigate and remedy such issues within a strict timeframe.

Whilst the coroner found that both health visitors and community midwives had attempted to escalate the mould issue in Awaab’s case, the report highlighted an “evident gap” in the information being shared amongst professionals. The report’s findings align with the findings from a multitude of other investigations into child deaths and serious incidents which highlight the importance of effective communication and information sharing between agencies when working with babies, young children and families. Health visitors can play a crucial role in identifying and advocating for families living in unsuitable housing. In addition to the sharing of relevant concerns with other professionals and escalation with landlords and housing departments, health visitors and their colleagues can access agencies such as Barnardo’s and Shelter for additional support in advocating for families experiencing mould in the home. Barnardo’s found that over 204,000 families had seen damp or mould on their child’s bed or bedding as result of not being able to afford heating. Barnardo’s has been supporting families through providing new bedding and helping families to access further financial support⁴.

Although it can be an emotive topic, it is essential for health visitors to raise the issue with families if they notice mould in the living environment. Families can often feel shame around having mould in their homes. However, health visitors can sensitively open the conversation with families, reassuring them that this is not a reflection of their hygiene, but is a common, national problem. Supporting families to look at mould-prone areas that their baby or children may be exposed to is important for health visitors; these can include bedding and clothes where spores may exist. If possible, keeping beds and bedding away from external walls can help to reduce mould. Health visitors can advise families to take the following steps to help reduce condensation and mould:

open windows regularly (to increase ventilation, particularly in moist rooms such as bathrooms and kitchens)
cover pans when you cook
dry clothes outdoors or in a dryer
close internal doors when you cook or shower
use extractor fans in the kitchen and bathroom
leave a gap between furniture and external walls
wipe condensation from window sills each morning (and dry wet surfaces such as shower screens after use).

(Recommendations based on advice available on the Shelter website).

Although Awaab’s Law is still to be finalised and implemented, professionals working with families can make positive steps to minimise the harm caused by mould and damp in homes, to prevent any more children dying in the same tragic circumstances.

For more information, watch the iHV Winter Illness webinar in which Wendy Thorogood, Head of Clinical Services at Barnardo’s, discusses the effects of mould on physical health.

Professionals can search the Barnardo’s Other Resources for Early Years Settings, this links them to published reports which offer a varied guide to documents that are useful when working with children and families. This includes the No crib for a bed: the impact of the cost-of-living crisis on bed poverty report that focuses on bed poverty, which is one aspect of child poverty, to explain the longer term challenges that are caused by families not having enough money to afford the essentials needed to raise happy and healthy children.

If you are working in an area that Barnardo’s are contracted in, then you can link directly with the key worker who is working with the family as they have access to additional grants, or you can contact the centre to ask for their advice.