What is child health promotion?

‘Health in childhood determines health throughout life and into the next generation… Ill health or harmful lifestyle choices in childhood can lead to ill health throughout life, which creates health, financial and social burdens for countries today and tomorrow’. (World Health Organization 2005: ix)

The above quote illustrates just how important the promotion of children’s health is. Child health promotion focuses upon the enhancement of children and young people’s overall health and well-being.

Do children’s nurses need to promote health?

The Nursing and Midwifery Council (NMC) (2010) standards for pre-registration nursing education clearly indicate that nurses should be able to recognize unhealthy activities and promote the health and well-being of the people they work with. In addition, the Department of Health (2012) launched an initiative entitled Making Every Contact Count (MECC). This programme advocates that every health professional supports patients to facilitate healthier choices; there is a clear emphasis placed upon the role of nurses and it is suggested that all nurses, in any context, can make every contact count in order to positively influence the health of their client group. In terms of children’s nursing, it may be advising a parent about areas such as children’s immunization, sleep requirements, diet or dental hygiene; alternatively, it may be referring an adolescent who smokes to a Stop Smoking Service.

Involving children

The ‘emergence of children’s voice’ (Prout and Hallett 2003: 1), and the need to involve children in a range of issues, has grown in acceptance and it is now widely established that the views and experiences of children should be taken into account wherever possible. Health promotion is no different and it is essential that children and young people be fully engaged in the promotion of their health from an early age.

Engaging with children requires tremendous skill and expertise and there are a range of factors that should be taken into account:

• Planning. The child and the nurse need to be clear about the aim of the health promotion initiative. Planning and organization are fundamental if success is to be achieved.
  
• Developmental stage. Taking the child or young person’s cognitive developmental stage into account is crucial. If someone does not understand the approach taken, or if the strategy is perceived to be too ‘babyish’, there will be a lack of engagement. Similarly, physical capability and ability needs to be assessed to ensure that appropriate strategies are utilized.
  
• Fun. We all enjoy having fun so being able to portray a serious health message in a fun and creative manner can be a good way to engage children (particularly those at the primary school age) and enable them to remember the key issues. For example, a strategy to enhance handwashing may involve educating children about ‘germs’ and how they are spread. Children could be asked to dip their hands into bright paint, representative of germs, and then be asked to use soap and water to remove it. The remains of the paint on the children’s hands after washing serves as a demonstration of how germs can then be spread to other areas, such as food.
  
• Rewards. Young children in particular enjoy a reward system (e.g. a certificate or sticker) if they, for example, successfully complete a game. However, the older age range are also responsive as long as the ‘prize’ is age appropriate – wrist bands and pens that reinforce the health message are frequently well received.
  
• Friends. It is widely recognized that children and young people of all ages enjoy spending time with their friends so health promotion activities that enable this are more likely to be engaging.
  
• Sensitivity. The time and context of any health promotion activity needs to be considered. For example, while a child is recovering from an acute illness and family members may well be experiencing increased stress levels, it may not be appropriate to discuss sensitive issues such as a child’s excess weight. Perhaps discussion or referral to other health professionals may be more appropriate.

Ethics

Health promotion also presents some ethical challenges. The aim of health promotion is to do good, but sometimes there can be negative outcomes – for example, a children’s nurse could advise a teenage girl to reduce her weight as she has a high body mass index, this would be perceived as being in the girl’s best interests. However, if the girl started smoking because she had heard that this is a good appetite suppressant, there could be negative consequences. This is one reason why the evaluation of any health promoting activity is so important.

Evaluation

Evaluation is a key aspect of health promotion, in other words, has it worked? Does anything need to be changed for the future? This can be difficult to assess, but it is still important that evaluation is objectively considered. It can include simple strategies such as:

• The children’s nurse’s reflection on the activity
  
• Feedback from whoever the activity was aimed at.

Where is health promoted to children?

In summary, everywhere. All health professionals have a responsibility to be involved in the promotion of children’s health, whether this is in an acute or primary care setting. Schools have been recognized as a key environment in which health can be promoted. However, emphasis has traditionally been placed upon the promotion of specific health needs such as diet, sexual health, drug and alcohol abuse, rather than fostering a more holistic and engaging health promotion approach. There is now a recognized need to develop strategies to redress this balance. One way could be the organization of a health promotion ‘market’, facilitated by health professionals, which exposes children and young people to a range of health promotion initiatives.