Rapid Responses to:

EDITORIALS: Peter Lachman and David Vickers The national service framework for children BMJ 2004; 329: 693-694 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

NSF/CHILDREN IGNORES THEIR GROWTH

Tam Fry   (24 September 2004)

A new vision of health, in life

Woody Caan   (30 September 2004)

NSF/CHILDREN IGNORES THEIR GROWTH 24 September 2004
Tam Fry, Honorary Chairman Child Growth Foundation Send response to journal: Re: NSF/CHILDREN IGNORES THEIR GROWTH	The Child Growth Foundation finds it unbelievable that the National Service Framework for Children ignores the need to check child's growth, either routinely or oportunistically, other than at school entry. The assessment of growth should be a basic paediatric measure throughout a child's growing years and HEALTH FOR ALL CHILDREN, for all its woes, agrees that it should be considered at every health contact. When the Framework fails to list any requirement to measure weight, length or OFC in the first four years of a child's life, one can be forgiven in thinking that no-one in the Department of Health has any knowledge of endocrinology. Recommending a single growth check at school entry is fairly useless, too, since it will tell you only how tall, short, thin or fat the child is on the day. It will not tell you whether or not it is growing normally which should be the object of any assessment. When the public health White Paper is published with, presumably, a call to identify the early signs of unhealthy weight gain in children and intervene to prevent them getting fatter what measure does the Department propose is taken? BMI has certainly to be a candidate - supported by a waist circumference measurement - but as far as the NSF is concerned, BMI doesn't exist! Competing interests: None declared
A new vision of health, in life 30 September 2004
Woody Caan, Professor of public health APU, Chelmsford, Essex CM1 1SQ. Send response to journal: Re: A new vision of health, in life	Lachman and Vickers [1] grasp both the context (children have been invisible in the NHS) and the opportunity (the vision of the national service framework is vast). Before the national service framework (NSF), the Children's Tsar saw the fundamental constraint on change: 'the English don't value childhood'. [2] But in terms of poor adult health, lifecourse research has consistently shown that the environment, experience and capacity for learning in childhood set the scene for future illness [3]. I found reading the section of the NSF on Child and Adolescent Mental Health unexpectedly moving. Upfront, its focus was on the 'well-being' and 'development' of our children and young people in England. In particular, the framework challenged professionals in every area of practice to build genuine 'partnerships with children, young people and families'. In other words, if things are to improve for our whole population, children must cease to be invisible - they must be seen, and heard, and listened to! Active participation, the sort of public involvement that makes a difference both to the services provided and to the self-efficacy of the young person, is pretty close to a new vision of 'health'. Many of us, whatever our professional discipline [4], come across young people struggling with difficult circumstances and with few obvious resources. For mental well-being that will last and last, we all need to learn new skills of working with children and families (even the most socially excluded ones) that enable them to become 'mentally and emotionally resilient'. [5] I have taken that quote from a recent strategy addressing 'stigma' as the 'biggest and most important challenge we face'. For child health, indifference is the biggest and most important challenge we face - and it will be transformed, when we start to value health across the lifespan. 1 Lachman P, Vickers D. The national service framework for children. BMJ 2004; 329: 693-694. 2 Aynsley-Green A. The English don't value childhood. THES 2004; 30 July: 18-19. 3 Graham H, Power C. Childhood disadvantage and adult health: a lifecourse framework. London: Health Development Agency, 2004. 4 Caan W. Paediatricians as child protectors? BMJ Career Focus 2004; 328: 208. 5 National Institute for Mental Health in England. From Here to Equality. Leeds: NIMHE, 2004. Competing interests: None declared