This site is intended for health professionals only

Future beginnings

Cheryll Adams D(Nurs) MSc BSc(Hons) RN RHV Dip Man
Independent Adviser, Nursing, Health Visiting and Community Health Policy and Practice
Honorary Senior Visiting Lecturer
City University

The government is working hard to reduce the impact of negative experiences on the infant, and showing greater understanding of how early interventions can affect the fiscal spend in later life

It is really only in recent years that we have started to invest more in securing positive outcomes for our pre-school children, and even in the early days of Sure Start the professional view among colleagues was that, as far as the government was concerned, childhood started at the age of three. Now we know better and the government is supporting earlier and earlier interventions.

What concerns the professionals working with the very early years population, though, is should we not be doing more in pregnancy? And how well does the public understand the impact of a negative emotional environment on the developing infant?

There is now a substantial body of evidence demonstrating the impact of stress during pregnancy on the developing infant. Negative outcomes such as low birth weight, prematurity and a link to attention deficit hyperactivity disorder - and even depression along with its attendant pathology in the infant - are now well documented. Equally important are the effects of smoking, alcohol and narcotics on the infant in utero, causing, as we know they do, miscarriage, still births, low birth weight and abnormalities of the infant. Many experts believe that foetal alcohol syndrome is under-diagnosed, but there is no doubt that it has a profound effect on developmental delays and may cause emotional, educational and behavioural problems in the child.

Smoking, we know, is responsible for low birth weight and prematurity. This is uncomfortable territory for parents who know they were drinking or smoking too much before they realised they were pregnant, or who have been subject to all sorts of stressors during pregnancy. But as a health professional, I feel it's an area to which more resources must be directed, and not just those of NHS staff. This needs to be backed by public health approaches so that protecting the infant is understood by the population as being essential to society's outcomes.

Encouragingly, the Office for National Statistics has just announced the results of a public consultation (with over 30,000 responses) on how to measure wellbeing in the UK. A common theme, apart from good health and economic security, was the importance of good relationships with friends and family. The expectation is that this consultation will lead to the publication of a set of national wellbeing indicators and there may also be a national child wellbeing indicator. This could be an essential tool, when the route to future unhappiness so often begins in the first years of life.

But what does all this mean for community nurses? It is essential that their services are designed to make more time for educating children, young people and new parents about the positive effect of good relationships, and a toxin-free environment, for the developing foetus and infant. Innovative approaches, such as ‘Roots of Empathy' programmes in schools, where children are taught about the emotional needs of the infant, are beginning to become popular. But these must be mainstreamed and with more school nurses, these professionals could provide the lead in ensuring that such programmes are delivered.

This year, for the first time in many years, the numbers of trained school nurses has dropped. This decline must be urgently reversed if they are to be able to have any significant impact on health promotion during the school years. The signs are that by autumn 2012 we will see the start of a significant increase in health visitor numbers and, hopefully, this profession will once again start to be able to focus on preventive activities such as supporting relationships in families and reducing stress during pregnancy. Midwives too are stretched, but what is clear is that there is a need for them in particular to be able to focus more on correcting the antecedents of long-term ill health and disability during pregnancy.

One way forward may be a care pathway approach, engaging school nurses, GPs, practice nurses, midwives and health visitors. Indeed, it should engage all those professions working with the so-called ‘healthy population' to help future parents embrace every necessary measure to ensure that their infant has the best start in life. I remain convinced that this is the smartest way to address NHS expenditure down the line, and it
would seem that policy is beginning to support these approaches.