Consultation with Parents Re National Child Measurement Programme â€“ Pilot Feedback to parents
Report of Findings
Bolton Community Network Bolton Community & Voluntary Services 1
Weighing in Schools Results of Consultation with Parents Introduction: In Bolton 22.1% of children in Reception are overweight or obese. By Year 6 this has increased to 31.5%. (NCMP - National Child Measurement Programme 08/09). It is predicted nationally if the current trend continues that this will increase to 40% by 2025 and 60% by 2050. Child Obesity is linked to adult obesity and can lead to a range of serious health problems (Foresight, 2007) Bolton NHS commissioned Bolton Community and Voluntary Services to consult with parents regarding their children being weighed in primary school. All children in reception and Year 6 are currently weighed by the childhood surveillance team which is part of Bolton NHS. At the moment parents can request the weight of their child but they are not informed what weight category their child falls into. Previously the Childhood Surveillance Team monitored trends in childhood obesity. This is now changing to a screening programme where parents will be routinely informed of the results of weighing. The Community Network consulted with parents on how they would like to be informed of their child’s weight and what would encourage them to take action if necessary to help their child to achieve a healthy weight. Bolton NHS will undertake a pilot in certain schools. As part of this pilot, letters will be sent to all parents of Year 6 children informing them of their child's weight and explaining whether their child is: underweight, a healthy weight, overweight or very overweight. Parents with overweight children will be given information on the MEND programme, which consists of 18 sessions designed for the whole family encouraging physical activity and healthy eating.
Target group: White and Asian parents in Farnworth, Rumworth and Sharples.
Aims: • • • • • •
Raise awareness of weighing in schools Raise awareness of National Child Measurement Programme (NCMP) pilot Understand how parents would like to receive feedback Identify how feedback can be given sensitively Raise awareness and uptake of services, particularly in at risk groups Identify the type of support that parents would like to receive
Methodology: 10 schools in the target areas were contacted with a view to consulting with their parents. Due to the short time scale and other commitments only Sunninghill Primary school in Rumworth decided to take part in the consultation. 2
Several community groups were contacted with four agreeing to participate. Bolton Community Network designed the consultation in partnership with Bolton NHS. Different consultation methods were used with different groups depending on the size and nature of the group. These included a quiz, group discussion with flip chart, group work, case studies and individual exercises with post it notes. Key questions were discussed with all groups and all groups were given a copy of the sample letters to comment on. All parents were given the opportunity to discuss issues in private on a one to one basis if they preferred. Parents were informed that a report of the results and recommendations of the consultation will be given to the public health department of Bolton NHS and that all views will remain confidential. Parent’s views will inform how the pilot scheme is delivered. All participants will have access to a copy of the report from the consultation.
Demographic of Parents consulted: In total 5 groups were consulted: Sunninghill Primary School Parents,(‘Rumworth Parents’) Parent Forums at Lord Street and Grosvenor and Orchard Children Centres, Farnworth After Schools Parents Group at New Bury Learning Centre (‘Farnworth Parents’) and a group of individual parents from the Sharples area.(‘Sharples Parents’) Geographical Areas Covered: Area
No. of Parents
Total number of parents
Ethnic Origin: Asian
Results of consultation: Who Plays A Part in Helping to Keep Your Child Healthy? Parents discussed a range of both positive and negative influences on their child's health.
Influences on a childâ€™s health:
Who is responsible for your child's health? All parents felt that they were the person most responsible for their childâ€™s health. They would only consider involving their GP if they were unwell. Other people play a part but the parents ultimately make decisions about the food they eat and the activities they undertake.
What support do you need to help keep your child healthy? Parents felt that there were many influences that made it difficult to keep their child healthy, including game consoles, a lack of facilities in certain areas, particularly Farnworth, cost and pressure from advertising, and what other children were eating. â€˘
There appeared to be a lack of consistency with after schools activities, with some schools providing a range of physical activity and others offering very limited options. Cost was a barrier to participating in these activities. Parents suggested that short taster sessions should be provided without having to pay for several sessions when children may not want to continue to attend. 4
Parents in Rumworth where particularly concerned about the large number of take aways in the area and the extensive advertising of these. Parents wanted a ban of junk food advertising around the school area.
Parents in Rumworth were unaware that they had a school nurse and felt having someone to discuss general concerns with, including weight, would be beneficial.
A school in Farnworth had a weekly drop in the 'comfy room' for parents, where they could call in and raise any concerns or questions. This would be an ideal opportunity to discuss weighing in schools.
The majority of parents felt that school meals had improved and were providing a range of healthier options.
Groups in Farnworth and Rumworth suggested that cook and taste sessions with children and parents would be a very positive and practical way of encouraging healthier lifestyles. There seems to be a great deal of activities for under fives, particularly through the children’s centres, but fewer activities available for primary school children.
Parents wanted more information on activities available in the area and at the school so that they were able to make an informed choice about taking part.
The Sharples group of parents felt children learn by example and that it was important that children saw their parents being active and eating healthily. Inviting a friend to the park, family bike rides or walking to school can all be important in helping make sure a child does lots of physical activity.
Parents felt that more physical education could be offered at school and that sports day should be longer, in certain areas parents wanted these to take place at local parks.
All parents wanted activities to be local, many feeling that activities organised through schools would have a better uptake.
Parents in Farnworth felt that toast should be offered every morning at school as some children do not have a breakfast and that milk should be provided to all children until the end of primary school.
Weighing of Children: •
The majority of parents were extremely concerned about how their children would be weighed and wanted this to be handled sensitively so that children did not worry about it.
Many parents were not aware that their children had been weighed despite letters being sent out to inform them of this. The majority of parents had not requested 5
information on their child's weight. •
Parents trust information coming from the school and many feel that the school should be involved in this process. Parents suggested providing sessions at schools to discuss how children will be weighed and answer any concerns particularly for hard to reach parents.
How would you like to be informed of your child's weight? •
The majority of parents wanted detailed information about their child's weight explained in clear non medical terms and as concisely as possible. Parents thought that a combination of both Letter A and B (see appendix) would be preferred.
Parents liked the table explaining their child's weight and height.
Parents did want to know what their child's BMI was but this needed to be explained more clearly.
Weight should be offered in metric and imperial measurements.
Many parents were confused by the use of the term percentile but did want to know how their child's weight compared to other children of the same age.
Parents felt that two pages are long enough for people to take the time to read and understand the letter.
The majority of parents preferred the explanations on letter B but felt that these could be shortened.
All parents felt that some sort of chart should depict their child's weight in relation to other children of the same age. A suggestion was made that the chart used for children under 5 in the red book could be used as parents were familiar with this.
A website could be set up for each category for parents to seek information if they wished to.
The Sharples parents felt that parents with children in a healthy weight range should be congratulated and given positive feedback.
Sharples parents felt the letters were both inadequate and need more thought and planning.
A tear off slip could be provided where parents can reply with comments and request more information if they want to.
Letter should be sent from the GP.
If the letter was sent by the Bolton NHS, there would need to be an explanation of who this is.
There should be a named person or team and a contact number in the letter if not sent by the GP
The GP should be informed of the child's weight and parents told that they can contact the GP for further information and advice.
Support for Children Overweight or Very Overweight/Underweight In both Farnworth and Rumworth two children had been identified as being underweight and parents were concerned that support was available for these children also. Parents would be much more likely to take the issue seriously and access further support if the letter was sent by the GP. One parent expressed concern that a letter from the GP may scaremonger and lead to parents being worried unnecessarily. The majority of parents felt there should be an opportunity to discuss different options available to reduce a child's weight and not to only be offered The Mend Programme. Gym passes, or tokens toward cutting the cost of joining a club could be provided as an incentive. The Mend programme should take into account the specific needs of each family and tailor the course according to these needs. If parents were treated on an individual basis then more parents would be inclined to get involved.
Parental Concerns: Discussing children's weight is a very sensitive issue for many parents who can feel that they are being judged or that it is their sole responsible to maintain their child's weight. Reassurance is needed to ensure that parents see weighing in schools as a positive step. Some parents are concerned that their child will be bullied if they are overweight and this reiterates the need for private weighing and a sensitive approach. Parents feel it is not always helpful to be concerned about children's weight. Parents know if their child is healthy or not regardless of their weight. Parents do not necessarily look at the long term effects of being overweight for their children. Parents do not want their children to be concerned about their weight in case this leads to unhealthy dieting. The Sharples group of parents discussed our perceptions of what is a healthy weight. Do we compare a child to an adult, are we in control of portion sizes and do we all 7
understand the needs in terms of nutrition for a child? It is important that parents are aware of how to approach reducing a childâ€™s weight so that they handle it sensitively and through a healthy approach. Parents did not like the name of the childhood surveillance team; this makes it seem like something to do with the police.
Comments from Parents:
'What is a healthy weight?' 'Children are all different shapes and sizes' 'It's puppy fat' 'Children's weight is affected by puberty' 'My child is very thin and was told she needed to be active all the time to keep healthy, I don't think that this is right' ‘There should be a blanket ban on advertising junk food near schools.’ ‘All parents should receive the information by default without having to opt in’ ‘I don’t understand what BMI means’ ‘The comfy room at school is a really good idea where parents can call in with anything they are worried about’ ‘It doesn’t help when the ice cream van is parked right near the school’ ‘There are no parks for the kids that we can walk to’ ‘If you want to find out what 's on offer you can, but you need to make the effort’ 'Some people just won’t want to know'
Recommendations: The recommendations need to be addressed by a range of agencies working with children and families and not solely by Bolton NHS in order to be realistic and achievable.
Raise awareness within schools of the reasons for weighing children and reassure parents that this will be handled sensitively. This could be achieved through educating and involving teachers in the process and promotional material sent out to parents. The production of one leaflet for each area of activities for children, to include park facilities, leisure facilities and after schools activities. Identifying gaps in provision of healthy activities during and after school across all primary schools in Bolton. Weighing in schools to link with healthy school initiative Where possible a range of activities should be offered to parents to encourage healthy lifestyles in addition to the Mend programme Provide activities at a local level which include parents, for example, cook and taste sessions that are not necessarily targeted only at children who are overweight. Provide a clear letter to parents with detailed information provided in non medical terms with a chart to back up this information. Mend programme to be tailored to specific needs of each family with pre assessment included. Letter to parents to be sent from their GP Provide a named contact in the letter for parents to find out further information. Send out information with the letter on maintaining a healthy diet and lifestyle. Re name the childhood surveillance team.
Summary Children's weight is clearly an emotive issue for many parents. Parents feel very protective of their children and are faced by many different influences when trying to encourage and support their children to adopt a healthy lifestyle. Weighing children in schools needs to be part of a much wider approach to encouraging families to have healthy lifestyles. Services need to be tailored around the needs of each area and provided locally wherever possible. Parents want to be informed but care needs to be taken around this sensitive issue and clear and concise information provided. We appreciate all of the feedback contributed by the parents consulted. Parents were very keen to ensure that their views would influence decisions and that they would be kept informed about what has happened to the information that they have provided.