The School-Age Years

Why the School-Age Years are important

The Chief Medical Officer and Professor Michael Marmot have highlighted the importance of giving every child the best start and reducing health inequalities throughout life. They recognise the importance of building on the support in the early years and sustaining this across the life course for school-aged children and young people to improve outcomes and reduce inequalities through universal provision and targeted support. There will be challenges within a child’s or a young person’s life and times when they need additional support. Universal and targeted public health services provided by health visiting and school nursing teams are crucial to improving the health and wellbeing of all children and young people.

Over the past 10 years, there has been significant research emerging around young people’s brain development. Puberty is a time of a major ‘second wave’ of brain activity, where the brain is developing its skills to make decisions, empathise and reason.^[1] At the same time, the body is developing its potential for fitness, physical strength and reproductive capacity.^[2]

The local picture

The most recently compiled and published data is compared with other local authorities of similar deprivation, unless stated otherwise, as of April 2023.

Table 1:  The school-aged years in Bedford Borough

School-Aged Indicator	Previous period [Comparator IMD 2019] (Date)	Most recent available period [Comparator IMD 2019] (Date)
Reception children age 4-5 overweight and obese* (%)
	21.5% [22.3%, England] (2021/22)	19.2% [21.3%, England] (2022/23)
Year 6 children overweight and obese** (%)
	39.1 [36.3*] (2021/22)	35.8 [36.6, England] (2022/23)
Smoking prevalence at age 15 – current smokers (%)
	9.3 [8.2, England] (2014/15)	9.3 [8.2, England] (2014/15)
School pupils (with SEN***) with social, emotional and mental health needs (%)
	2.35 [2.58] (2020)	2.4 [2.9] (2021)
Hospital admissions: mental health conditions, under 18 years (Rate per 100,000)
	61.4 [93.8] (2019/20)	120.5 [N/A] (2021/22)
Rate of hospital admissions caused by injuries in children (0-14 years) (Rate per 10,000)
	77.0 [84.6] (2019/20)	81.9 [79.5] (2021/22)
Hospital admissions as a result of self-harm in children aged 10-24 (Rate per 100,000)
	405.1 [581.6] (2019/20)	383.9 [N/A] (2021/22)
Hospital admissions: alcohol-specific conditions, under 18 (Rate per 100,000)
	25.0 [33.6] (2017/18-19/20)	24.6 [32.7] (2018/9-20/21)
Hospital admissions: substance misuse aged 15-24 (Rate per 100,000)
	96.9 [95.9] (2017/18-19/20)	86.8 [N/A] 2018/9-20/21)
MMR vaccination coverage for two doses (5 years old) (%) Benchmarked against national target (<90% is red)
	89.5% [85.7%] (2021/22)	90.4% [84.5%, England] (2022/23)
Hospital admissions for asthma (under 19 years)             (Rate per 100,000)
	128.9 [138.3] (2019/20)	149.2 [131.5, England] (2021-22)
First-time entrants to the youth justice system aged 10-17 (Rate per 100,000)
	178.5 [150.3, England] (2021)	119.7 [148.9, England] (2022)
Pupil absence (Persons 5-15 years): percentage of half-days missed (%)
	4.41% [4.74%] (2018/19)	4.2% [4.6%] (2020/21)
GCSE: average attainment 8 score (mean score)
	48.4 [50.9] (2020/21)	46.7 [48.5] (2021/22)
Not in Education Employment or Training (NEET): 16-17 year olds (%)
	4.6% [4.7%] (2021/22)	3.7%  [5.2%, England) (2022/23)
Chlamydia detection rate aged 15-24  (Rate per 100,000)** Benchmarked against UK has recommendations <1900
	1,768 [1,348] (2021)	1,386 [1,680, England] (2022)
Under 18 conception (Rate per 1,000)
	14.6 [N/A] (2019)	11.1 [12.7] (2021)
Children with one or more decayed, missing or filled teeth (5 years, number of DMFT) Note the measure has changed 2021/22 to % 5 year olds with experience of visually obvious dentinal decay so is not comparable previous measure.
	1.03% [0.80%, England] (2018/19)	22.5% (23.7%, England) 2021/22)
Year 9 Diptheria/Tetanus/Polio booster (%)
	78.4% (2019/20) Recovery over into academic year 2020/21	N/A
Year 9 Meningitis ACWY (%)
	78.4% (2019/20) Recovery over into academic year 2020/21	75.1% [79.6% England] (2021/22 academic year) 14-15 yr olds

Compared to other local authorities in the same deprivation decile, Bedford Borough has similar outcomes across most measures. 2.4% of school pupils in Bedford are identified with SEN and as having social, emotional and mental health as the primary type of need. This compares to 2.9% for the deprivation decile. However, Bedford has worse rates for year 6 overweight and obesity for and GCSE average attainment 8 score. Data for vaccinations is rated as red due to not meeting national recommendations and this is related to Covid-19 pandemic catch up and recovery.

Excess weight

Obesity has a profound effect on children’s physical and mental health. It can frame children’s life chances – not just their health, but also their employment, opportunities and lifetime earnings.

Once established, obesity is notoriously difficult to treat. Children with obesity are five times more likely have obesity as an adult and are more likely to develop cardio-metabolic disease, some cancers and musculoskeletal conditions in adult life.[3]

The causes of obesity are complex and multi-faceted driven by biological factors such as genetics, social factors such as the built environment and transport systems; values, culture and norms around eating; leisure centres and green space; education and schools; and poverty. Finally, obesity is influenced by commercial factors such as the production, supply, marketing and sale of high calorie sugar and fat foods. The combination of all these factors can lead to obesity.

There is also a link between obesity and poor mental health in teenagers, with weight stigma increasing vulnerability to depression, low self-esteem, poor body image and maladaptive eating behaviours. Nationally, by age 11, almost a third of children are overweight or obese, and this proportion is predicted to rise if concerted action is not taken.[4]

As well as helping children and young people maintain a healthy weight, there is increasing evidence of the mental health benefits of exercise in children and young people. Regular activity helps children and young people to feel good about themselves and concentrate better, as well as bringing physical health benefits.

National Child Measurement Programme (NCMP)

The NCMP weighs and measures children in their first year at school (Reception year) at aged 4-5 years and again in Year 6, aged 10-11 years. The NCMP is used to identify children who are underweight, overweight and obese so that they can be offered support, as well as being used to monitor trends.[5]

In Bedford Borough in 2022/23, the rates of excess weight (overweight and obesity) in reception year children were similar to the England average and showing no significant change in trend. However, the rate of year six pupils being overweight and obese is increasing, with Bedford showing an increase on previous years^[6].

• In year R: 19.2% of children were overweight or obese, which is similar to the England average of 21.3%
• In year 6: 35.8% of children were overweight or obese, which is an increase similar to the England average of 36.6%.

Aims and targets

Nationally, the Government have committed to halving childhood obesity and reducing obesity inequalities by 2030.^[7] With the recent spotlight on obesity due to the Covid-19 pandemic, key actions include work on sugar reduction, food labelling, calorie and sugar reduction, restrictions on advertising and food promotions as well as the ‘Better Health’ campaign to help people lose weight, get active and eat better after the Covid-19 pandemic ‘wake-up call’.^[8]

Tackling excess weight requires a whole systems approach to change the environment in which we are born, live, learn, play, work and age. Working with multiple partners including health colleagues, local planning teams and education the council has already begun to follow a whole system approach to identify ways we can change the local obesogenic environment.

The approach should be complemented by local weight management services. We need to maximise attendance at these services to effectively support those who are overweight or obese including families, pregnant women and school pupils.

Health inequalities

There is a strong association of deprivation with childhood obesity and overweight. Families living in deprived communities experience multiple interacting exposures to material, psychosocial and behavioural risks for childhood obesity across the life-course. Obesity prevalence is highest amongst some of the most deprived wards in Bedford Borough.^[9] This is consistent with the national pattern where children in the most deprived parts of the country are more than twice as likely to be obese as their peers living in the richest areas are.^[10] This is sowing the seeds of adult diseases and health inequalities in early childhood.

To tackle other health inequalities, the NHS CORE20plus5^[11] (Children and Young People) sets out five priorities, targeting the most deprived 20% of the national population and the ‘plus’ population groups (including minority ethnic communities, inclusion health groups, people with a learning disability and autistic people, people with multi-morbidities and protected characteristic groups amongst others).
The five priorities are:

• Asthma
• Diabetes
• Epilepsy
• Oral health
• Mental health

NHS figures show that hospital asthma admissions for children increased by 149% in England and Wales between 2021 and 2022. This rise could be fuelled by increased mixing after the relaxation of Covid-19 pandemic lockdown restrictions, resulting in more exposure to colds and flu viruses, which are common triggers for asthma attacks. Disruptions due to the pandemic may too have meant that children missed vital routine checks of their medication and care, as two thirds of all people with asthma did not receive an annual asthma review at the height of the pandemic. ^[12] It is of note that Bedford has higher hospital admissions for asthma across all age groupings (0-9yrs; 10-18 yrs and under 19) than national levels and most comparator LAs (2021-22)^[13].

Bedford also has much higher rates of admissions for epilepsy (2021-22) across all age categories (0-9; 10-18 and under 19)[14].

Admission levels for diabetes are lower than in comparator LAs (2021-22) although this is based on small numbers[15].

School age vaccination

The delivery of school-aged vaccinations by the Community and School Aged Immunisations team was severely affected by school closures due to the Covid-19 pandemic from March 2020. Social distancing, bubbles and school closures resulted in a more time consuming and complicated delivery of the programme. For 2021/22 the percentage of those having had the Meningitis ACWY (14-15 year olds) was 75.1% and for Diphtheria/Tetanus/Polio and IPV booster at 5 years old is 88.3%. The team continues to offer these vaccines both in school and in community clinics.

Flu was the most challenging programme to deliver and it has a time limited delivery model having to work around all the complexities of school closures, social distancing, bubbles, pupil absence and parental concern. Uptake in 4-10 year olds for 2020/21 was 57.4%, slightly above the East of England average.

Reducing health-related risk-taking behaviours

Adolescence is recognised as the most significant time for introducing behaviours that can have long-term health impacts, for example, smoking, and substance and alcohol misuse. Health during adolescence is strongly linked to educational outcomes, including attainment and employment.

Whilst the majority of research is showing that risk-taking behaviours amongst young people are on the decline, there seems to be an upward trend of children and young people experiencing poor emotional health. There is also evidence of a link between risk-taking behaviours and poor mental health.

In addition to support in the community through schools and specialist services, Bedford offers Parent Line and Chat Health (11-19) which are both confidential text services offering information and support across a wide range of issues.

Smoking and e-cigarettes/vapes

Smoking continues to be a major cause of ill health, particularly heart and lung disease. Many people start smoking as adolescents and some will continue to smoke into adulthood. However, across England, the number of young people aged 11-15 who reported trying smoking has fallen and is now at the lowest levels since 2003.[16]  In 2018, 16% of 11-15 year olds (23% in 2012) had smoked at least once, with 5% of 15 years olds smoking regularly[17].

Smoking initiation is associated with a wide range of risk factors including: parental and sibling smoking, the ease of obtaining cigarettes, smoking by friends and peer group members, socio-economic status, exposure to tobacco marketing, and depictions of smoking in films, television and other media. Children who live with parents or siblings who smoke are up to three times more likely to become smokers themselves than children of non-smoking households[18].

Tobacco remains the main cause of preventable morbidity and premature death in England.[19] Beyond the well-recognised effects on health, tobacco also plays a role in perpetuating poverty, deprivation and health inequalities.

We know that many young people are accessing e-cigarettes/vapes but there is no robust data on the scale of use among young people in Bedford. Nationally, the ASH survey (2023)[20] found that 20.5% of children (11-17) had tried vaping, up from 15.8% in 2022. There had been a 50% growth in experimentation (trying once or twice) from 7.7% in 2022 to 11.6% in 2023 but relatively stable rates of more regular use. The survey indicates that the prevalence of trying and ‘currently using’ vapes increases with age. Among 11-15 year olds, 15% have ever tried vaping, compared to 34% of 16-17 year olds. The figures for current use are 4.6% among those aged 11-15 and 15% for 16-17 year olds.

The health impact of vaping is not yet clear. NHS  information[21] for young people includes:

• Vaping exposes users to some toxins, but we do not yet know what the risks might be in the longer term.
• Some vapes contain nicotine, which is an addictive substance that can be hard to stop using once started.
• Nicotine may be more risky for young people than for adults, as evidence suggests the brain in adolescence is more sensitive to its effects.
• Some disposable vapes on sale are illegal and do not meet UK quality and safety regulations.

Drug and alcohol misuse

Drug and alcohol misuse can have significantly harmful impacts on young people, beyond the immediate effects. This can affect educational outcomes, employment, housing, relationships, and increase the likelihood of criminal behaviour. There is also evidence to suggest that young people who use recreational drugs and alcohol are at risk of poor mental health outcomes, including depression, disruptive behaviour disorders and suicide. Cannabis and alcohol are the most common substances used by young people,^[22] although there is evidence that young people also use new psychoactive substances (NPS), also known as ‘legal highs’. Young people who misuse substances may be at a greater risk of both criminal and sexual exploitation and may be more likely to be involved in criminal and gang behaviour. There is a growing body of evidence suggesting that young people with ADHD, anxiety or depression are self-medicating with drugs and alcohol[23]. 

Nationally, the 2018 substance use survey^[24] reported that 24% of pupils aged 11-15 years had taken drugs at least once, ranging from 9% of 11 year olds, to 38% of 15 year olds. Nine percent of pupils surveyed reported taking drugs in the month prior to the survey. Of those who had taken drugs in the past year, 33% reported taking cannabis only; however, 35% reported taking two or more types of drug. Data for England also showed that there has been a downward trend in the number of young people who drink alcohol, however, 6% of children and young people reported drinking alcohol weekly, 11% reported drinking alcohol between fortnightly and monthly and 9% reported being drunk in the 4 week previous to completing the survey.

The Young people’s substance misuse treatment statistics 2020 to 2021 reported nationally^[25] that:

• There were 11,013 young people in contact with alcohol and drug services between April 2020 and March 2021. This is a 23% reduction from the previous year (14,291) and a 55% reduction in the number in treatment since 2008 to 2009 (24,494).
• Cannabis remains the most common substance (89%) that young people come to treatment for.
• Around 4 in 10 young people in treatment (41%) said they had problems with alcohol, 12% had problems with ecstasy and 9% reported powder cocaine problems.
• The most common vulnerability was early onset of substance use (73%), which means the young person started using substances before the age of 15; followed by mental health needs (43%); anti social behaviour (33%) being affected by domestic abuse (23%); being affected by others’ substance use (23%).
• Other vulnerabilities include being a looked after child (13%), Child in Need (14%) and not in education and employment (NEET).

Locally, hospital admissions in Bedford due to alcohol-specific conditions in under 18s or substance misuse in 15-24 year olds are relatively rare but are considered the ‘tip of the iceberg’, pointing to wider substance misuse and its impacts.

• For under 18s, the hospital admission rate due to alcohol-specific conditions is 24.6/100,000 (2018/19 – 20/21) and is similar to local authorities in the same deprivation decile (32.7/100,000).^[26]
• For 15-24 year olds, the rate of hospital admissions due to substance misuse is 86.9/100,000 (2018/19-20/21), which is similar to the UK value of 82.2/100,000 (2018/19 – 20/21). There is currently no comparator data for the LAs in the same deprivation decile.^[27]

Drug and alcohol services for young people

Aquarius Bedfordshire offers a range of confidential and accessible support, information and advice to young people aged between 5 and 19 who use drugs or alcohol and provides support for young people affected by someone else’s use, for instance, a parent or sibling. Interventions are structured and evidence-based (cognitive behavioural techniques).

An evaluation was carried out in 2018^[28] to identify areas of best practice, and development for drug and alcohol support for children and young people.

Aquarius also offers drug and alcohol training to schools, and provides parenting interventions, sharing evidence-based information to widen the support network available to children and young people. Children and young people are monitored through follow-up reviews after discharge, and those with complex needs receive treatment for longer to address these complexities in a ‘needs led’ approach.

Areas of development were identified, including working closely with schools to develop targeted PSHE lessons, and support drug and alcohol policy development. In addition, enhancing joint working protocols and improving use of technology in the service were identified as important development areas.

Mental Health

Children suffering from mental ill health are at risk of poor physical health outcomes, poor educational attainment, and are at greater risk of unhealthy behaviours such as taking up smoking.

There is relatively little data about prevalence rates for mental health disorders in pre-school age children but by the time they reach school age, 1 in 10 children need support or treatment for mental health problems. This means that in a class of 30 schoolchildren, three are likely to suffer from a mental health disorder such as depression, conduct disorders, anxiety, and hyperkinetic disorders (e.g. Attention Deficient Hyperactivity Disorder).

Young people have been uniquely impacted by the Covid-19 pandemic and lockdown, with NHS research suggesting 1 in 6 may now have a mental health problem, up from 1 in 9 in 2017.^[29]

Since the pandemic there has been increasing numbers and increasing acuity of children and young people suffering crisis, whether it is due to mental ill health, or related to learning difficulties and/or autism. GPs are also seeing an increased number of children and young people with mental health difficulties and have less capacity to support these young people. This has included an unprecedented surge in the numbers of children and young people presenting with eating disorders. Schools are similarly challenged with stretched capacity across teaching and support staff.

There are three different teams within East London Foundation Trust CAMHS (Child Adolescent Mental Health Service) which provide emotional wellbeing support to education settings. These are:

• Two Mental Health Support Teams (MHST) in the Bedford Borough Area offering support within 36 Schools (8 Secondary and 28 Primary Schools) in the more deprived areas as part of addressing health inequalities. These teams offer evidence based support to children and young people with mild to moderate need; provide support to schools to develop their while school approach; timely advice to schools and liaison with other agencies to ensure children get the right help to stay in education.
• CAMHS – Schools Mental Health Team (SMHT) – The schools mental health team is an early intervention service with the aim of improving access to psychological therapies from year 7 to young people aged 18. Most referrals come directly from schools following consultation with a CAMHS practitioner at regular face to face consultation meetings.
• Behavioural Improvement Team (BIT) works with young people who have been excluded from school. They are in Alternative Provisions, often because of behavioural issues in Mainstream schools.

In Bedford, mental health referrals are received into a single point of entry (SPOE) which is made up of CAMHS, CHUMS and Early Help colleagues. Young people and families can also self-refer into CAMHS. Each referral is triaged by the SPOE team which includes a risk assessment being undertaken.

CHUMS mental health and wellbeing service offers a range of services to children and young people with mild to moderate mental health concerns. When a case is accepted from the SPOE panel into CHUMS, it is transferred to CHUMS and they allocate onto their wait list for the specific intervention the panel has agreed.  As part of their waiting time initiative, CHUMS will make contact with those families either by phone or email to review risk and need, in a timely manner according to wait times.

If a young person’s risk or presentation has deteriorated, then the CHUMS practitioner will update a risk assessment and safety plan and decide if the case needs to come back to the SPOE panel for further multi-agency discussion around need or allocate within CHUMS internal processes to include a review of the self-guided information and strategies given to all young people, families and carers at the time of original triage assessment with CAMHS triage clinician.

For those children and young people experiencing moderate to severe mental health issues, CAMHS offers a range of support. A multi discipline discussion takes place and agrees which pathway is most appropriate to the meet the individual needs.  All young people, families and carers are provided with self-guided information and strategies are provided at the initial triage assessment and can contact the clinic if they have any additional concerns whilst they are waiting for a follow up appointment. 

There has been increasing pressure on CAMHS (Child and Adolescent Mental Health Service) Tier 4 beds, local hospital paediatric beds and the CAMHS crisis and eating disorder teams.

ELFT has recently opened a local Tier 4, 8 bedded adolescent in-patient unit, based in Luton, to support BLMK young people who require in patient stays to be closer to home. This allows families and carers to visit the young person easier which can reduce the length of stay. This is also helping reduce local young people being admitted to inappropriate adult mental health beds and remaining on a paediatric ward for long periods of time. The majority of young people admitted to a paediatric ward for a longer period of time are eating disorder cases awaiting specialist in-patient provision or in the event of a social crisis, family or placement breakdown.

The CAMHS Crisis team and Eating Disorder team now have an element of dedicated Home Treatment roles which are part of the avoidance admission approach and to support early discharge from units.

The rate of hospital admissions for mental health conditions for under 18s in Bedford was 120.5 per 100,000 in 2021-22, which was similar to England (99.8 per 100,000). Bedford is ranked in the middle (9/15) in relation to comparator LAs. The rate of self-harm (10 to 24 years) at 383.9 per 100,000 is also similar to England[30].

A whole systems approach will be needed to address the challenge and provide care and support to local children and young people in the wake of the pandemic. Addressing the priorities therefore needs to be a collaborative programme across the commissioning and provider system, inclusive of local authorities, educational partners and the voluntary and community sector. ELFT are currently in the process of working towards a long-term vision/goal of an integrated schools offer. This offer would bring the MHST, Schools, BIT and CHUMs all in one to maximise resources, creating a consistent offer to equitably meet the needs within all education provisions in partnership with the wider system.

Improving emotional health and wellbeing and building resilience

Positive emotional health and wellbeing amongst children and young people promotes healthy behaviours, good attainment and helps prevent behavioural and mental health problems.^[31] Most children and young people are part of happy and healthy families, and their parents or carers are the providers of their emotional support. Sometimes children and young people need extra support.

Families, schools, local health, and social care organisations have a vital role in helping children and young people to build resilience and supporting them through life’s adversities. We are aiming for children and young people to have good levels of resilience to enable healthy relationships and life choices. School nurses are mobile health professionals, based in community settings like health centres who can support children and families at all maintained schools across Bedfordshire.

Bedford Borough’s Early Help service is able to offer support and advice regarding mild to moderate wellbeing and emotional health issues for children and young people. Staff are equipped with specialised training to administer a diverse range of interventions, alongside offering advice and guidance to families and professionals. The interventions available through the service include the following: Solution Focused Practice; Enhanced Evidenced Based Practice (EEBP)- an evidence-based treatment for young individuals grappling with mild to moderate anxiety and/or depression; Teen Brain Matters – tailor-made training sessions and workshops designed specifically for professionals, teachers, parents, and young individuals, with the aim of enhancing their understanding of the changes and development processes occurring within the teenage brain; Parent Led CBT, which  adopts a Cognitive Behavioural Therapy (CBT) informed approach to assist children and young individuals in managing their fears and anxieties.

Sexual Health

As young people become sexually active, it is important that they have easy access to contraception and sexual health services. Chlamydia is the most common, curable sexually transmitted infection in the UK. If left untreated it can cause infertility in both women and men. An effective screening programme for chlamydia aims to screen young people between the ages of 15 and 24 years, to achieve a detection rate of at least 2,300 per 100,000. This ensures that the programme is effectively targeting those young people at highest risk of infection.

Areas achieving this rate should aim to maintain or increase it. Such a level can only be achieved through the ongoing commissioning of high volume, good quality screening services across sexual health services and primary care. Bedford is working to build towards this rate due to disruptions caused by the Covid-19 pandemic (Bedford had a detection rate of 1768 in 2021, which is positive in comparison to other similar areas).

There is support for schools around contraception and sexual health in secondary schools in Bedford Borough. Targeted outreach work is delivered to young people identified as more vulnerable, this includes looked after children, young people from areas of high teenage pregnancy, and young people not in employment, education or training.

Teenage pregnancy

Teenage pregnancy is a complex issue, affected by personal, social, economic and environmental factors. Under 18 conception data includes all conceptions that result in either a live birth or abortion.

The national conception rate for women aged under 18 years more than halved between 2011 and 2021, reducing from 30.9 conceptions per 1,000 women to 13.2 per 1,000 women of the same age. Those aged under 16 years saw the biggest percentage change in conception rates over the last decade. The conception rate for those aged under 16 years is around a third of what it was ten years ago, with 2.1 conceptions per 1,000 women of the same age in 2021, compared with 6.1 conceptions per 1,000 women of the same age in 2011[32]. Bedford experiences similar rates to national and local comparators:

• Under 18 conception rate of 11.1 per 1000 (2021)[33]
• Under 16 conception rate of 2.4 conceptions per 1000 (2021)

The Integrated Contraception and Sexual Health service (iCaSH) provide an integrated contraceptive and sexual health service for all ages, including services specifically for young people.

To support young parents in Bedford, there is a local Support Pathway for Parents under 20. The pathway offers young parents a range of support to improve outcomes for themselves, their partner, and their child. The support pathway begins from the very first booking appointment with the midwife where young parents complete a consented referral form for further support. All young parents are contacted at point of referral into the children’s centre/family hub, whether it be antenatal or postnatal to offer universal or targeted support for example parenting. They are then invited to the weekly young parents’ group which is well attended.

LGBTQ+

As part of growing up, all young people will spend time exploring their identity and developing a sense of who they are. This will include thinking about who they are attracted to (their sexual orientation), how they feel about their gender (their gender identity), and the different ways they express their gender.^[34]

LGBT+ (lesbian, gay, bisexual, trans and those questioning their sexual or gender identity) children and young people realise they are lesbian, gay, bisexual or trans at different stages in their lives, but will often know at an early age.

Growing up, LGBT+ young people face specific challenges in addition to wider factors that lead young people in general to face additional difficulties. These include homophobic, biphobic and transphobic discrimination, and a lack of support and inclusion in education, training and work.^[35] In addition, nearly half of LGBT+ young people are still bullied at school simply for being who they are.^[36]

Being LGBT+ can feel like an extra pressure for young people, particularly at school, depending on the extent to which staff, peers and the wider school community are supportive. Creating an inclusive environment is a key part of making sure that LGBT+ young people feel welcome and valued in any environment.^[37] The principles around supporting LGBT+ young people are the same at any age. This includes helping young people to talk about how they feel, ensuring they are providing age-appropriate information to answer any questions they have.

Schools and services working with young people should ensure they are engaged with emerging guidance and best practice regarding supporting transgender pupils.

Personal, social, health education

Today’s children and young people are growing up in an increasingly complex world, living their lives seamlessly online, and offline. This presents many positive and exciting opportunities, but also challenges and risks. In this environment, children and young people need to know how to be safe and healthy, and how to manage their academic, personal and social lives in a positive way. This is why high quality and effective Relationships Education has been made compulsory in all primary schools in England and Relationships and Sex Education compulsory in all secondary schools, as well as making Health Education compulsory in all state-funded schools.

The Covid-19 pandemic has had a huge impact on children’s health, development and educational attainment all key stages – and deepened existing inequalities. Services are having to change the way they work to respond to the different needs and additional demands that are emerging post-pandemic, within limited resources. This will require commissioners and services to work more closely together to ensure effective early support is in place for school age children.

1. Education Settings must continue be supported to provide information and curriculum opportunities in regards to good health, wellbeing and resilience for all young people, including the most vulnerable. This should be delivered via a whole-setting approach that includes high quality and effective Personal Social & Health Education, Relationships & Sex Education, Health Education and Physical Education.
2. Ensure good access to services and provision that help to develop healthy behaviours in children and young people, in order that these behaviours will continue through adult life
3. Continue to strengthen the support regarding mental health, particularly at all transition points, be clear about what is available, and communicate clearly to all.
4. Ensure that the details of all services that support children and young people, parents, carers and families, are clear, accessible and effectively communicated to all.
5. Create communities that value and protect the environment.
6. Ensure excess weight is everybody’s business by working in partnership, and by developing a workforce, which is confident and competent in addressing excess weight.
7. Enable easy access and promotion of effective contraception and sexual health services, responding to the needs of young people.
8. Build services and pathways to ensure children, young people and their families are able to feel safe at home and in their community, enabling them to have safe and strong relationships, free from exploitation.
9. Ensure that all services are able to demonstrate that they listen and respond to the voice and lived experience of all young people, including early years.
10. Continue to develop a workforce that is able to effectively understand and respond accordingly to the impact of adverse experiences, trauma and contextual safeguarding.

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References

[1] UNICEF. 2017. The adolescent brain: a second window of opportunity. Available at: https://www.unicef-irc.org/publications/pdf/adolescent_brain_a_second_window_of_opportunity_a_compendium.pdf [Accessed 16 December 2020].

[2] Brown, K. A., Patel, D. R., & Darmawan, D. (2017). Participation in sports in relation to adolescent growth and development. Translational paediatrics. Available at: doi.org/10.21037/tp.2017.04.03 [Accessed 16 December 2020].

[3] Hayes M, Baxter H, Müller-Nordhorn J, Hohls JK, Muckelbauer R. The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review. Obes Rev. 2017; 18(12):1398-1411. doi:10.1111/obr.12595

[4] RCPCH. Available at: https://www.rcpch.ac.uk/key-topics/nutrition-obesity [Accessed 12 May 2021]

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