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This publication is available at https://www.gov.uk/government/publications/early-adolescence-applying-all-our-health/early-adolescence-applying-all-our-health
Children progress through a number of transition stages in their lives as part of the journey to adulthood. Early adolescence is widely recognised as a crucial period that will have an impact and influence on the child or young person’s life. Between the ages of 10 and 14 years, children and young people experience many changes which may impact on their wellbeing positively or negatively.
The transition from primary to secondary school is a crucial transition stage that offers an opportunity to provide support and advice. There is good evidence that the outcomes for both children and adults are strongly influenced by factors that operate during these years, particularly as they take more control of their own health and wellbeing including making diagnosis and choices about their health.
School nurses are the lead professionals in co-ordinating and delivering the Healthy Child Programme 5 to 19. They have a crucial role in supporting children, young people and families with healthy choices and promoting activities. School nursing teams work with important partners including schools, youth workers and wider community services. They promote health and wellbeing during this period to ensure children and young people are equipped to address challenges and to become more involved in healthy choices.
Facts about early adolescence
Social and emotional wellbeing
Mental health problems affect around 1 in 10 children and young people. The most common problems are:
- conduct disorders
- attention deficit hyperactivity disorder
- anxiety and depression
- autism spectrum disorders
Mental health problems in children and young people cause distress and can have wide ranging effects, including impacts on educational attainment and social relationships, as well as affecting life chances and physical health.
Mental health problems in children and young people (chapter 10) reports that 70% of children and young people who experience a mental health problem have not had appropriate interventions at a sufficiently early age. The number of young carers is increasing within England and Wales. The impact of caring can be detrimental on health and wellbeing as well as educational attainment.
The Health Survey For England shows that 28% of children aged 2 to 15 were classed as either overweight or obese. National Child Measurement Programme data tell us that obesity is strongly related to socioeconomic status and the most deprived children are more than twice as likely to be overweight or obese than the least deprived children. Evidence also shows that once obesity is established, it tends to track into later life, impacting physical and emotional health.
Read childhood obesity for more information.
Oral health is part of general health and wellbeing and contributes to the development of a healthy child and to school readiness. Poor oral health impacts on children and families wellbeing and is costly to treat. It is a sentinel marker of wider health and social care issues such as poor nutrition, obesity, the need for parenting support, and in some instances safeguarding and neglect.
Children who have toothache or who need treatment may have to be absent from school. Parents may also have to take time off work to take their children to the dentist.
Pupil absence in schools in England: autumn 2014 and spring 2015 (PDF, 610KB, 10 pages] reported that:
- the overall absence rate for pupils who are known to be eligible for and claiming free school meals (FSM) was 6.8%, compared to 4.1% for non FSM pupils
- the percentage of FSM eligible pupils that were persistent absentees was 9.3%, compared to 2.9% of pupils that were not eligible for FSM
- pupils with a statement of special educational needs (SEN) and pupils with an education healthcare plan (EHC) had an overall absence rate of 6.9%, compared to 4.2% for those with no identified SEN
- the overall absence rate for pupil referral units in autumn or spring 2014 to 2015 was 31.1%
The Teenage Pregnancy Independent Advisory Group (PDF, 217KB, 2 pages) reported that:
- half of all under 18 conceptions occur in the 20% most deprived wards
- over one third of teenage mothers have no qualifications and 70% are not in education, training or employment
- babies of teenage mothers have worse health outcomes than older mothers; they are 60% more likely to die in the first year of life than babies of mothers aged 20 to 39 and twice as likely to be admitted to hospital as a result of an accident or gastroenteritis
- teenage mothers are
- 3 times more likely to get postnatal depression than older mothers
- more at risk of poor mental health for 3 years after the birth
- 3 times more likely to smoke during pregnancy than mothers over 35
- less likely to breastfeed
- likely to struggle to complete their education and gain employment
Not in education, employment or training (NEET)
A report on young people not in education, employment or training reported that they are likely to be:
- eligible for free school meals
- those who have been excluded or suspended from school
- those with their own child
- those who have a disability
In October to December 2015, 11.8% of all young people aged 16 to 24 were NEET.
While uptake of infant and childhood immunisations is generally good in England, a proportion of children and young people will have missed opportunities to receive routine vaccines and remain vulnerable to preventable infectious diseases.
Early adolescence is an ideal opportunity to determine immunisation status, particularly as young people are becoming more aware of their own health and wellbeing. No opportunity to check immunisation history and offer missing immunisations should be missed.
This is particularly important for children born from the late 1990s to late 2000s who may not have been immunised against measles, mumps and rubella. As a result, cases and clusters of measles are still being seen in this birth cohort. These can be prevented through them receiving 2 doses of MMR vaccine. This will also provide protection against rubella which is important for females of childbearing age.
Core principles for healthcare professionals
Healthcare professionals should:
- know the needs of individuals, communities and population and the services available for children and young people
- think about the resources to support healthy lifestyles available in the health and wellbeing system
- understand specific activities which can prevent, protect, and promote healthy lifestyles
Healthcare professionals should be aware of the interventions at population level, which include:
- using national and local data to identify public health priorities for children and young people, focussing on important challenges they may experience between 10 and 14 years, including the transition between primary and secondary school, and progression towards self-determination and decision-making
- promoting emotional wellbeing and health messages both in and out of school settings; seeing children and young people as community based assets who can support population health and wellbeing
- working collaboratively with partners including schools and local authorities to stimulate awareness of need and to develop collective solutions
Community health professionals and providers of specialist services can have an impact by:
- developing integrated services between health, education providers, community and third sector organisations to ensure they are responsive to national and local needs and demonstrate improved public health outcomes
- providing services to meet local need, at times when children and young people can access and in locations that are convenient; in and out of school and during holidays
- providing improved access to information and local support for children, young people and families, including digital and online services
Family and individual level
Healthcare professionals can have an impact on an individual level by:
- ensuring children, young people and families are aware of the service and how to access it in a timely manner
- improving service access through technology and safe social media approaches which complement face to face delivery
- providing early help and access local services for children, young people and families who may need additional support, at times when they need it most
- ensuring services are young people friendly and meet, or are working towards, You’re welcome quality criteria
- using supervision as a supportive tool to address emotive issues from practice
- keeping updated on policies and procedures for working in safeguarding or child protection
Public Health Outcomes Framework (PHOF)
There are 3 indicators linked to children aged 10 to 14:
- excess weight in 4 to 5 and 10 to 11 year olds (2.06ii)
- hospital admissions caused by unintentional and deliberate injuries in children aged 0 to 14 years (2.07i)
- emotional wellbeing of looked after children (2.08)
There are 2 further indicators linked to children under 16:
- under 18 conceptions: conceptions in those aged under 16 (2.04)
- population vaccination coverage HPV in girls aged 12 to 13 years (3.03xii)
A recent study of children waiting for dental extractions in hospital found that 26% of school age children had missed an average of 3 days at school while waiting for admission, with some children missing up to 15 days. In addition, when they attend hospital for treatment a further 2 days of school absence are incurred.
School absence statistics
Statistics are available on overall authorised and unauthorised pupil absences by school type, including persistent absentees and pupil characteristics on GOV.UK.
Health and Social Care Information Centre (HSCIC)
The school-age children profiles for local areas include key current local data about children and young people’s health and wellbeing. This information provides a context to help schools prioritise action.
Statistics on NEET and participation
The Department of Education provide statistics on young people’s participation in education, employment and training and those not in education, employment or training.
Examples of good practice
Quality criteria for young people friendly health services sets out principles to help commissioners and service providers to improve the suitability of NHS and non-NHS health services for young people.
The Marmot Review proposed the most effective evidence-based strategies for reducing health inequalities in England from 2010. It includes 2 specific policy areas for children:
- give every child the best start in life
- enable all children, young people and adults to maximise their capabilities and have control over their lives
Getting it right for children, young people and families - maximising the contribution of the school nursing team: vision and Call to Action provides best practice guidance for school nurses.
School nursing: public health services includes advice on promoting emotional wellbeing and positive mental health of children and young people.
Supporting children, young people and families and communities to be safer, healthier and to reduce youth crime (PDF, 127KB, 4 pages) is guidance to support school nurses and youth justice professionals working with young people who are in the youth justice system or at risk of being involved.
Maximising the school nursing team contribution to the public health of school aged children is guidance for putting in place public health services for children and young people from 5 to 19 years.
Supporting the health and wellbeing of young carers sets out the key messages for services and professionals to meet the needs of young carers. It is of interest to all professionals providing on-going care where a child or young person may be involved in caring duties.
Supporting the health and wellbeing of military families supports health visitors and school nurses to deliver improved outcomes, and outlines aspirations for service delivery.
Measles: the green book, chapter 21 provides measles immunisation information, including updates, for public health professionals.
Showcase badge missions from Makewaves, includes:
- my oral health
- healthy eating
- active lifestyles
- clash concluder
- safer internet day
Behaviour change: general approaches (PH6) provides the principles for effective interventions and is aimed at those responsible for helping people to change their behaviour to improve their health.
Behaviour change: individual approaches (PH49) also makes recommendations on individual-level interventions, aimed at health-damaging behaviour in over 16s.
Obesity prevention (CG43) guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children is the first national guidance on the prevention of overweight and obesity in adults and children in England and Wales.
Physical activity for children and young people (PH17) also provides guidance for all those who are involved in promoting physical activity among children and young people, including parents and carers.
Preventing unintentional injuries
Unintentional injuries: prevention strategies for under 15s (PH29) gives advice and guidance on preventing unintentional injuries in the home, on the road and during outdoor play and leisure.
Unintentional injuries on the road: interventions for under 15s (PH31) gives advice on how healthcare professionals and local highways authorities can make the roads safer.
In addition, unintentional injuries in the home: interventions for under 15s (PH30) aims to prevent unintentional injuries among all children and young people but, in particular, those living in disadvantaged circumstances as they are at increased risk compared to the general population.
Social and emotional wellbeing
Depression in children and young people: identification and management (CG28), in primary, community and secondary care, covers the care children and young people can expect from their doctor, nurse or counsellor.
Social and emotional wellbeing in primary education (PH12) is guidance is for teachers and school governors, and for staff in local authority children’s services, primary care and child and adolescent mental health services.
Social and emotional wellbeing in secondary education (PH20) focuses on interventions to support all young people aged 11 to 19 who attend any education establishment.
Substance misuse among vulnerable children and young people (PH4) outlines the paths for reducing substance misuse.
Smoking: preventing uptake in children and young people (PH14) is guidance for those responsible for the health and wellbeing of children and young people under 18.
Alcohol: school-based interventions (PH7) is aimed at teachers, school governors and practitioners with health and wellbeing as part of their remit.
In order to support oral health improvement at an individual and population level Public Health England and NICE have published Delivering better oral health. This is an evidence-based guide to prevention in dental practice which describes the preventive advice and actions required to improve oral health.
Oral health promotion: general dental practice (NG30) describes how dental teams can best convey such advice.
Improving oral health: an evidence-informed toolkit for local authorities aims to support local authorities (LAs) to commission oral health improvement programmes for children and young people aged up to 19 years.
Oral health improvement: local authorities and partners (PH55) recommends that oral health is promoted and protected by: improving diet; reducing consumption of sugary food and drinks, alcohol and tobacco; improving oral hygiene; increasing the availability of fluoride; encouraging regular dental attendance; increasing access to dental services.
Looked-after children and young people (PH28) focuses on how organisations, professionals and carers can work to help looked-after children and young people reach their full potential.