The start of a new term is an opportunity for community pharmacy to put children’s health categories centre stage.

According to the most recent State of Child Health report by the Royal College of Paediatrics and Child Health (RCPCH), the health of babies, children and young people in the UK has improved considerably over the past 30 years, but there is still an alarming gap between rich and poor.

“Children living in the most deprived areas are much more likely to be in poor health, be overweight or obese, suffer from asthma, have poorly managed diabetes, experience mental health problems and die early,” says Professor Neena Modi, president of the RCPCH.

As children get ready for the next school year, or start school or nursery for the first time, parents worry about uniforms, school bags and stationery supplies. Yet this is also an ideal time to put children’s health on the agenda and focus on both short-term problems such as cold and head lice and long-term issues, such as exercise and obesity.

Long-term health

Pharmacists can remind parents to get their children’s hearing, teeth and sight checked before the start of a new school year. “Earache and ear wax build-up are common problems, particularly in children,” says Miriam Luff, Earex brand manager. “From excessive ear wax production and overactive wax-producing glands, there can be a number of causes of ear health issues in children. As parents and carers prepare for the back-to-school season, it’s important to ensure that children’s ears are in optimum health. Loud environments can aggravate ear pain and untreated ear problems can have an adverse effect on concentration levels and learning.”

According to the Health Conditions in Schools Alliance – a coalition of more than 30 leading charities and health organisations, including Diabetes UK, Asthma UK and Crohn’s & Colitis UK – thousands of children with long-term medical conditions are being put at risk in schools across England. Nine in ten schools in England that were asked couldn’t present an adequate medical conditions policy, the Alliance revealed.

“The law states all schools should have a medical conditions policy outlining how to care for any children with medical conditions, the procedures for getting the right care and training, and who is responsible for making sure the policy is carried out,” says Sharon Roberts of Diabetes UK. “Without this document in place, staff may not know how to properly care for a child with a medical condition, which can lead to dangerous consequences and, in a worst-case scenario, death.”

Pharmacists are ideally placed to remind parents to report any new health problems to the school. “If children have been diagnosed with any conditions between school years or terms, parents must make sure the school is aware,” says Sid Dajani, independent community pharmacist and member of the RPS English Pharmacy Board. “Parents must make sure their child has the right number of inhalers, creams etc, and that the school knows how to help the child manage their symptoms.”

From October, school staff will be able to keep and administer emergency adrenaline auto-injectors. One in five fatal food-allergic reactions in children happen in schools, said a working group of organisations including Anaphlyaxis Campaign and Allergy UK which lobbied for the change.

Lifestyle issues

Junk-food diets in all age groups are contributing to obesity and poor oral health. In teenagers, for example, overindulgence may contribute to a variety of other problems, such as difficulties with concentration and learning, poor immunity and even teenage moodiness.

This can be partly blamed on the sugar, refined carbohydrates, unhealthy fats and additives in junk food, but also on a lack of natural vitamins and minerals that are vital for healthy skin, brain, energy and immunity, says nutritionist Cassandra Barns. “It’s not always necessary – and can be counterproductive – to ban all junk food for a child or teenager. But making sure they have a good foundation of healthy meals at home can go a long way towards ensuring they stay healthy.”

Nearly one in five of the UK population has low vitamin D levels, which increases their risk of deficiency. The best source of vitamin D is sunlight on the skin, but this can be difficult to come by when the children go back to school in September and spend less time outdoors. Advise parents that children over five years old would benefit from taking a daily supplement containing 10mcg of vitamin D during the autumn and winter months.

A lack of outdoor play can have other negative effects on children’s health as well. New research from Sudocrem revealed that while children recognise they should spend more time outdoors, many aren’t acting on this, with 61 per cent claiming they don’t have enough time to play outside. On average, British children are outside for five hours each week and spend 45.5 hours in front of the TV.

Mr Dajani visits one primary and two secondary schools each year to discuss healthy lifestyles, including alcohol, smoking, drugs, diet and exercise. “Unhealthy habits often develop in the early teens,” he says. “I talk about distinguishing between sweets and medicines, as it’s not always easy to do so, and about health prevention and management at a young age. I also discuss the role of a pharmacist to encourage a lifelong relationship with local pharmacies rather than always going to a GP.”

Common ailments

According to Neil Stewart, pharmacist at Well, it’s not unusual for children to have eight or more colds a year. “Pharmacists can advise parents to ensure the whole family wash their hands regularly to prevent the spread of germs, and ensure that the children have a healthy, varied diet with plenty of fluids to boost their immune system,” he says. “Parents can also ensure they have a supply of children’s ibuprofen and paracetamol available to ease the symptoms if their child does become ill. Pharmacists can recommend saline nose drops to relieve the blocked nose.”

Head lice are a common problem, especially in school children aged four to 11. They are spread by direct head-to-head contact, which is why cases rise in the back-to-school season. More traditional treatments are no longer working as lice are developing a resistance to insecticides.

“There is strong evidence that the head lice population already has, and continues to, develop resistance to pesticide products in the UK [permethrin and malathion],” says Ian Burgess, director of the Medical Entomology Centre. “However, these products aren’t used much now and account for less than 10 per cent of the market. Pharmacists should recommend non-pesticide treatments to parents such as 4 per cent dimeticone, an odourless silicone that coats lice, effectively smothering them. Silicones aren’t absorbed by the skin, so are suitable for asthmatics and young children. Lice eradication using dimeticone is up to 100 per cent effective, making it the ingredient of choice for pharmacists.”

The pharmacy team can help ensure parents are using the treatments properly. “Failing to follow the instructions will make the treatment less effective. For example, many parents forget to check the child’s hair for lice after they have used a treatment to ensure it has worked. Alternatively, they can fail to complete a second treatment where required,” says Mr Burgess.