NICE is today (24 October) publishing new guidance on the social and emotional wellbeing of vulnerable childrenⁱ under 5. The recommendations cover home visits, early education and childcare for vulnerable children.

The guidance recognises that disadvantage before birth and in a child's early years can have life-long, negative effects on health and wellbeing. It aims to ensure that both universal and more targeted services provide the additional support all vulnerable children need to ensure their mental and physical health and wellbeing. Children living in disadvantaged circumstances are more likely to experience social, emotional and behavioural difficulties, and as a result, poor health, education and employment outcomes. For example, measures of ‘school readiness'ⁱⁱ show that the poorest 20% of children are more likely to display conduct problems at age 5, compared to children from more affluent backgroundsⁱⁱⁱ. Local early interventions that support and protect vulnerable children's social and emotional wellbeing are crucial to ensure their healthy development, capacity to learn and achieve at school.

Recommendations include:

· Each health and wellbeing board^iv should ensure that the social and emotional wellbeing of vulnerable children features in its ‘Health and wellbeing strategy', as one of the most effective ways of addressing health inequalities.

The resulting plan should include outcomes for ensuring healthy child development and ‘readiness for school' and for preventing mental health and behavioural problems.

• Health professionals in antenatal and postnatal services should identify factors that may pose a risk to a child's social and emotional wellbeing. These include factors that could affect the parents' capacity to provide a loving and nurturing environment. For example, they should discuss with the parents any problems they may have in relation to the father or mother's mental health, substance or alcohol misuse, family relationships or circumstances and networks of support.
• Health visitors or midwives should offer a series of intensive home visits by an appropriately trained nurse to parents assessed to be in need of additional support. The trained nurse should visit families in need a set number of times over a sustained period of time (sufficient to establish trust and help make positive changes).
• Health visitors or midwives should consider evidence-based interventions such as baby massage^v and video interaction guidance^vi to improve maternal sensitivity^vii and mother-infant attachment. (For example, this might be necessary when the mother has depression or the infant shows signs of behavioural difficulties.)
• Local authority children's services should ensure all vulnerable children can benefit from high quality childcare outside the home on a part- or full-time basis, and can take up their entitlement to early childhood education where appropriate. Attendance times should be flexible so that parents or carers have the opportunity to take up education, training or employment opportunities. Such services should also address any barriers that may hinder participation by vulnerable children such as geographical access, the cost of transport or a sense of discrimination and stigma.

Professor Mike Kelly, NICE Director of Public Health, said: “We know that there are a complex range of factors that impact upon the social and emotional development of children. While most parents offer love and stability to their children, regardless of their personal circumstances, in some cases, children living in challenging environments can experience emotional and behavioural problems. These can have a life-long, negative effect on their future health and wellbeing. NICE is pleased to publish this guidance which will help all those involved in delivering excellent services to the children and their parents who need them most.”

Catherine Law, Professor of Public Health and Epidemiology, University College London Institute of Child Health, and Chair of the Public Health Interventions Advisory Committee at NICE, said: “This new guidance includes a number of important recommendations that put the social and emotional wellbeing of vulnerable children at the very heart of early intervention services to ensure all children have a fair chance to be healthy and to succeed. The recommendations are based on the best available evidence, and will particularly help to strengthen home visiting and early education services.”

Bren McInerney, Community member of the Public Health Interventions Advisory Committee at NICE, said: "This guidance is a fantastic opportunity to look at how we achieve the very best social and emotional wellbeing of all children and families, particularly those in vulnerable and disadvantaged circumstances. The recommendations set out how health and social care professionals, as well as parents and families, can work together to secure the very best care and services for those under 5 years old. By implementing the guidance at all levels, and including children and families in a meaningful way, we can give all children a fair and equal start in life.”

Simon Antrobus, Chief Executive at Addaction said: “Addaction fully supports this new guidance. We know that timing is hugely important when helping vulnerable children - and we know that any support on offer must take into account the whole family, and not just the child. We recently published a report looking at this very issue. It proved that well timed, family-based interventions were the most effective way of tackling an 'intergenerational cycle of addiction', where children whose parents use drugs go on to develop their own problems later in life.

“We need to ensure that decision makers understand the importance of this kind of high quality, specialist support. Not only does it work - it is the best way of preventing other problems and giving children the best possible start in life.”

Ends

Notes to Editors

References and explanation of terms

i. The term ‘vulnerable' is used to describe children who are at risk of, or who are already experiencing, social and emotional problems and who need additional support.

Vulnerable children include those who are exposed to:

• parental drug and alcohol problems
• parental mental health problems
• family relationship problems, including domestic violence
• criminality.

Vulnerable children may also include those who are in a single parent family or who were born to mothers:

• aged under 18
• with a low educational attainment
• who are (or were as children) looked after (that is, they have been in the care system.)

ii. In the context of this guidance, ‘readiness for school' refers to a child's cognitive, social and emotional development. Development during the child's early years may be achieved through interaction with their parents or through the processes of play and learning.

iii. Waldfogel J, Washbrook F (2008), Early years policy. London: Sutton Trust

iv. Following the Health and Social Care Act (2012), health and wellbeing boards will be put in place at each local authority. Directors of public health will act as strategic public health leaders for their local population. They will lead discussions about how ring-fenced money should be spent to improve outcomes for people's health and well-being locally. They should be in a position to ensure public health is always considered when local authorities, GP consortia and the NHS make decisions.

v. The benefits of baby massage are reported to include improvements in parent and/or child sleep patterns, their interactions and relationships.

vi. Video interaction guidance refers to interactions between a parent / carer and a child that are recorded using audio visual equipment. This is later viewed and discussed, typically with a health or social care professional. Parents and carers are given a chance to reflect on their behaviour, with the focus on elements that are successful. The aim is to improve their communications and relationship with their child.

vii. Maternal sensitivity defines the mother's availability and alertness in well-timed responses to the child's signals, consistently and appropriately, which increase the child's comfort and attentiveness and reduces his/her distress.

About the guidance

1. The Department of Health (DH) asked the National Institute for Health and Care Excellence (NICE) to produce this guidance.

2. NICE public health guidance is not statutory, but the NHS, local authorities and the wider public, private, voluntary and community sectors are expected to follow it.

3. NICE public health guidance applies to England only.

4. Most parents living in poor social circumstances provide a loving and nurturing environment, despite many difficulties. However, children living in a disadvantaged family are more likely to be exposed to adverse factors such as parental substance misuse and mental illness, or neglect, abuse and domestic violence. Consequently, they are more likely to experience emotional and behavioural problems that can impact on their development and opportunities in life (Farrington et al. 2006; Shonkoff and Phillips 2000). For example, measures of ‘school readiness' show that the poorest 20% of children are more likely to display conduct problems at age 5, compared to children from more affluent backgrounds (Aldfogel and Washbrook 2008).

5. For the purposes of this guidance, the following definitions are used:

• social wellbeing - child has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.
• emotional wellbeing - this includes being happy and confident and not being anxious or depressed.
• psychological wellbeing - this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive.

6. The guidance is aimed at all those responsible for ensuring the social and emotional wellbeing of children aged under 5 years. This includes those planning and commissioning children's services in local authorities (including education), the NHS, and the community, voluntary and private sectors. It also includes GPs, health visitors, midwives, psychologists and other health practitioners, social workers, teachers, and those working in all early years settings (including child minders and those working in children's centres and nurseries). The guidance may also be of interest to parents, other family members and the general public.

7. Addaction is one of the UK's largest specialist drug and alcohol treatment charities. Report: A better future for families: the importance of family-based interventions in tackling substance misuse

Related NICE guidance

Published

Autism in children and young people. NICE clinical guideline 128 (2011)

Looked-after children and young people. NICE public health guidance 28 (2010)

Pregnancy and complex social factors. NICE clinical guideline 110 (2010)

Social and emotional wellbeing in secondary education. NICE public health guidance 20 (2009)

When to suspect child maltreatment. NICE clinical guideline 89 (2009)

Social and emotional wellbeing in primary education. NICE public health guidance 12 (2008)

Attention deficit hyperactivity disorder (ADHD). NICE clinical guideline 72 (2008)

Antenatal care. NICE clinical guideline 62 (2008)

Antenatal and postnatal mental health. NICE clinical guideline 45 (2007)

School-based interventions on alcohol. NICE public health guidance 7 (2007)

Interventions to reduce substance misuse among vulnerable young people. NICE public health guidance 4 (2007)

Conduct disorder in children - parent-training/education programmes. NICE technology appraisal 102 (2006)

Bipolar disorder. NICE clinical guideline 38 (2006)

Postnatal care. NICE clinical guideline 37 (2006)

Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD). NICE clinical guideline 31 (2005)

Depression in children and young people. NICE clinical guideline 28 (2005)

Under development

Preventing and reducing domestic violence. NICE public health guidance (publication expected February 2014)

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICEprovides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.