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In England, 1 in 5 children and young people (CYP; aged 8-25 years) has a probable mental disorder with higher rates among those living in poverty, and among white children compared with other ethnic groups. However, in the UK, research shows that the prevalence of mental health conditions and associated service use differs among some ethnic minority groups (e.g., Asians) suggesting potential unmet mental health need. Early interventions have been shown to improve life outcomes, and UK government policies encourage the promotion of mental health and wellbeing in schools and colleges, but poor mental health continues to rise. Despite evidence showing that mental health problems occur as early as age 5 years, limited research focusses on primary schools (children aged 5-10 years). Northwest London (NWL), UK, is a diverse region in London, is in the top 20% most deprived, and has a high demand for CYP mental health services. The aim of our study was to explore teachers' perspectives of promoting positive mental health in NWL primary schools. We created a semi-structured interview based on policy guidance. Nine teachers were recruited and interviewed during June and July 2024. Thematic analysis identified six overarching themes: (1) mental health needs; (2) responsibility; (3). factors contributing to poor mental health; (4). barriers and (5) facilitators to providing support; and (6) collaboration. Subthemes included lack of skills to address the broad spectrum of mental health needs, funding, resources, and lack of support systems to ensure all children receive the right support at the right time. Our study highlights implementation gaps for promoting mental health policy in diverse real-world settings, and suggests that whilst schools play an important role for early mental health intervention, wider complexities limit sufficient support provision. Our findings have potential implications for mental health promotion policies in school settings.

There is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales. Data were analysed from 140 830 participants (4-24 years, stratified into 4-12, 13-15, 16-24 years) in 36 national surveys in England, Scotland and Wales, 1995-2014. Regression models were used to examine time trends in seven parent/self-reported variables: general health, any long-standing health condition, long-standing mental health condition; Warwick-Edinburgh Mental Wellbeing Score (WEMWBS), above-threshold Strengths and Difficulties Questionnaire Total (SDQT) score, SDQ Emotion (SDQE) score, General Health Questionnaire (GHQ) score. Across all participants aged 4-24, long-standing mental health conditions increased in England (0.8-4.8% over 19 years), Scotland (2.3-6.0%, 11 years) and Wales (2.6-4.1%, 7 years) (all p < 0.001). Among young children (4-12 years), the proportion reporting high SDQT and SDQE scores decreased significantly among both boys and girls in England [SDQE: odds ratio (OR) 0.97 (0.96-0.98), p < 0.001] and girls in Scotland [SDQE: OR 0.96 (0.93-0.99), p = 0.005]. The proportion with high SDQE scores (13-15 years) decreased in England [OR 0.98 (0.96-0.99), p = 0.006] but increased in Wales [OR 1.07 (1.03-1.10), p < 0.001]. The proportion with high GHQ scores decreased among English women (16-24 years) [OR 0.98 (0.98-0.99), p = 0.002]. Despite a striking increase in the reported prevalence of long-standing mental health conditions among UK CYP, there was relatively little change in questionnaire scores reflecting psychological distress and emotional well-being.

ObjectivesAsthma is the most common non-communicable disease in children,1 and the UK has among the highest childhood asthma death rates in Europe.2 Integrated paediatric asthma care in the North West London ICS aims to improve clinical care for these children through MDT case-based discussions and Group Consultations. These bring hospital specialists to GP practices to review individual cases and share knowledge.It is important to evaluate whether integrated models of care are reaching patient groups most in need.3 We compared patient demographics for the GP practices that had taken part in these integrated care interventions with the related local authority. We used three measures as a proxy for need: the Indices of Multiple Deprivation (IMD) score, the hospital admission rate for asthma in patients <19 years old, and the proportion of patients <18 years old living in highly polluted areas.MethodsAsthma interventions taking place between November 2021 and July 2023 were analysed. 40 GP practices were involved in these interventions. Data relating to these practices and local authorities were obtained from fingertips.phe and the ICS’s linked datasets.For each of the three markers (deprivation, hospital admissions, and air pollution), we used t-tests in Excel to compare the GP practice data with data for the surrounding area.ResultsThe mean IMD score for the patients at the GP practices was 24.7 compared with 21.4 for the surrounding local authority, showing they are significantly more deprived than the surrounding area (p=0.003).Hospital admission data for asthma was available for 19 out of 40 GP practices. There was no statistically significant difference between admission rates for intervention GP practices and the Local Authority as a whole (227 versus 168 admissions per 100,000, p=0.118).Air pollution data was available for 38 out of the 40 practices. There was no significant difference between the proportion of patients living in high pollution areas at the intervention GP practices compared with the Local Authority as whole (1.71% vs 2.76% respectively, p=0.131).ConclusionOur study shows that an integrated model of paediatric asthma care can reach the more deprived patients in the areas they are targeted. These patients have levels of hospital admissions for asthma and live in areas with air pollution comparable to the average for the overall area.ReferencesH Zar, T Ferkol, The Global Burden of Respiratory Disease- Impact on Child Health, 2014R Shah, et al. International comparisons of health and wellbeing in adolescence and early adulthood, 2019.S Baxter, et al. The effects of integrated care: a systematic review of UK and international evidence, 2018.

Adolescence is a pivotal point in the life course, characterised by transformative physical, cognitive, and emotional growth, an openness to change, and a drive to reshape the social environment. It offers unique opportunities to adopt changes in diet and physical activity that can persist into later life. Yet pre-existing nutritional problems, including micronutrient deficiencies, food insecurity, and poor-quality diets, persist at the same time as adolescents face the rapid emergence of an obesity epidemic. Adolescent growth and nutrition has been largely overlooked in intervention and policy research. Most intervention studies have emphasised micronutrient supplementation, with few taking into account the multiple drivers of adolescent diets. This Series paper highlights that effective interventions and policies will need to cut across sectors; be supported by multifaceted and multilevel policy; and extend across education, health, food systems, social protection, and digital media. Better data standardisation and systems will be essential in coordinating and monitoring these responses. In a context of shifts in planetary ecosystems and commercial drivers, resilient food systems will need to both ensure access to healthy and affordable foods and provide the infrastructure and incentives for continuing physical activity. Intergenerational partnerships with young people will be essential in bringing about transformative change and ensuring that food policies reflect their needs and aspirations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. The predominant SARS-CoV-2 variants were wild-type and Alpha. Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019—the clinical disease associated with SARS-CoV-2 infection—and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. These results are important for guiding decisions on shielding and vaccinating children. New variants might have different mortality risks and should be evaluated in a similar way. A clinical review of all pediatric deaths in England from March 2020 to February 2021 attributes 25 deaths to SARS-CoV-2 infection and identifies risk factors to guide interventions.

ObjectivesChildren born during the Covid-19 pandemic had reduced exposure to early-life respiratory infections compared to pre-pandemic cohorts. This study investigated whether varying level of infection exposure was associated with differing patterns of salbutamol prescription.MethodsA retrospective cohort study using the Northwest London Discover dataset (94% NWL population coverage) including prescription data from General Practice systems. Four birth cohorts were tracked for three years to investigate the impact of Covid-19 on salbutamol prescriptions. Logistic regression assessed cohorts and patient’s characteristics on salbutamol prescriptions.ResultsThere was a significant drop in salbutamol prescriptions during the Covid-19 lockdown followed by a return to pre-pandemic levels as restrictions were lifted (table 1). After adjusting for deprivation, gender and ethnicity, Cohort 2 had 28% lower odds (OR 0.72, 95% CI 0.68–0.77, p<0.001) and Cohort 3 had 18% lower odds (OR 0.82, 95% CI 0.78–0.88, p<0.001) of receiving a salbutamol prescription compared to Cohort 1. Children in Cohort 4, born during the 1st pandemic year, showed salbutamol prescription patterns similar to those in Cohort 1, suggesting a return to pre-pandemic levels.Abstract 6710 Table 1Number and proportion of children receiving salbutamol prescriptions by age for each cohortOverall, males had 43% higher odds of salbutamol prescription compared to females (OR 1.43,95% CI 1.37–1.50, p<0.001). Asian children had 7% lower odds (OR 0.93, 95% CI 0.88–0.98, p<0.05) and Black children had 9% higher odds (OR 1.09, 95% CI 1.00–1.18, p<0.05) compared to White children. Children from most deprived quintile had 16% higher odds (OR 1.16, 95% CI 1.07–1.24, p<0.001) compared to the middle quintile.ConclusionThe Covid-19 pandemic had a major impact on children’s exposure to respiratory infections, significantly affecting salbutamol prescriptions. Ongoing monitoring of these ‘Covid’ cohorts offers a unique opportunity to study the long-term impact of respiratory infections at different stages of childhood.

Identifying which children and young people (CYP) are most vulnerable to serious infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important to guide protective interventions. To address this question, we used data for all hospitalizations in England among 0–17 year olds from 1 February 2019 to 31 January 2021. We examined how sociodemographic factors and comorbidities might be risk factors for pediatric intensive care unit (PICU) admission among hospitalizations due to the following causes: Coronavirus Disease 2019 (COVID-19) and pediatric inflammatory multi-system syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the first pandemic year (2020–2021); hospitalizations due to all other non-traumatic causes in 2020–2021; hospitalizations due to all non-traumatic causes in 2019–2020; and hospitalizations due to influenza in 2019–2020. Risk of PICU admission and death from COVID-19 or PIMS-TS in CYP was very low. We identified 6,338 hospitalizations with COVID-19, of which 259 were admitted to a PICU and eight CYP died. We identified 712 hospitalizations with PIMS-TS, of which 312 were admitted to a PICU and fewer than five CYP died. Hospitalizations with COVID-19 and PIMS-TS were more common among males, older CYP, those from socioeconomically deprived neighborhoods and those who were of non-White ethnicity (Black, Asian, Mixed or Other). The odds of PICU admission were increased in CYP younger than 1 month old and decreased among 15–17 year olds compared to 1–4 year olds with COVID-19; increased in older CYP and females with PIMS-TS; and increased for Black compared to White ethnicity in patients with COVID-19 and PIMS-TS. Odds of PICU admission in COVID-19 were increased for CYP with comorbidities and highest for CYP with multiple medical problems. Increases in odds of PICU admission associated with different comorbidities in COVID-19 showed a similar pattern to other causes of hospitalization examined and, thus, likely reflect background vulnerabilities. These findings identify distinct risk factors associated with PICU admission among CYP with COVID-19 or PIMS-TS that might aid treatment and prevention strategies. The risk of intensive care unit admission among children with COVID-19 or its sequelae is affected by age, ethnicity and comorbidities. Understanding these modifiers might help identify at-risk children and guide interventions.

Why did you do this work?The Providing Assessment and Treatment for Children at Home (PATCH) programme is a Hospital-at-Home programme available at five sites in Northwest London (NWL) which serves children and young people (CYP) across all eight NWL Health Boroughs. PATCH is nurse-led, providing treatment and review of mild to moderately unwell children in their home via telephone/video consultations and home visits. PATCH is highly acceptable to the parents of CYP receiving the service1 and has been shown to reduce both hospital admissions and length of stay. However, less is known about equity of access to the PATCH service. This project aimed to evaluate the accessibility of the PATCH programme for CYP across each health borough and socioeconomic group.What did you do?We used electronic healthcare records for all children across NWL available through the Whole System Integrated Care (WSIC) database linked to the data collected from the PATCH teams from October 2023 to July 2024. We examined the characteristics of CYP across all NWL Health Boroughs by sociodemographic group (using IMD quintile), age, ethnicity and gender. Counts of PATCH use were age-standardised through direct standardisation. We then conducted chi-squared analyses to establish whether there were any differences in the observed and expected counts of PATCH use across Health Borough and IMD quintile. The chi-squared adjusted residuals were analysed to identify any significant differences present between observed and expected counts of use across each Health Borough and IMD group.What did you find?During this study, 1,892 children used PATCH. Of these, 228 were from outside NWL. The distribution of age and ethnicity was significantly different across Health Boroughs. Further, PATCH use was significantly lower than expected in two health boroughs, Brent (p<0.001) and Ealing (p<0.05). There was a decrease of 26.7% and 13.4% in observed PATCH use when compared to the expected use, respectively. Whereas observed PATCH use was significantly (p<0.001) increased by 57.1% in Hammersmith and Fulham and by 53.9% in West London compared to the expected counts. Conversely, observed counts of PATCH use showed no significant differences from the expected counts across IMD quintiles. This is evident within the most deprived quintile; wherein a statistically insignificant difference of 1.2% between observed and expected counts of use was seen.What does it mean?This evaluation suggests that children accessing PATCH services may reflect the NWL population based on IMD quintile. Yet, there are likely discrepancies in the accessibility of PATCH across the Health Boroughs of NWL. Further work is needed to explore the reasons for these differences as they could be related to specific health needs of the population. Therefore, whilst PATCH shows definite promise as an intervention to tackle inequities in child health within NWL, further research is required to establish any potential barriers to access at the Health Borough level.ReferenceRajeev Y, Patel A, Manuel A. 877 Evaluation of ‘providing assessment and treatment for children at home (PATCH)’ service at hillingdon hospital for VIW and asthma. Archives of Disease in Childhood 2023;108:A331-A332.

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

ObjectivesTo develop a working definition of successful transition from paediatric to adult services for young people with epilepsy (YPE).To describe transition success rates over time within a large paediatric epilepsy service.To identify baseline characteristics which predicted successful transition.To investigate whether successful transition predicted better clinical outcomes in early adulthood than at transfer.Methods Population: Clinical records were accessed for all patients aged 20–24 with epilepsy in the service database from 2009–2023 who transitioned from paediatric to adult services. Exposure variables: Date of birth, gender, ethnicity, date and age first seen in paediatric service, epilepsy diagnosis, co-morbidities, daily anti-epileptic drug (AED) usage and seizure frequency were analysed. Successful transition measure: Following a literature review encapsulating NICE guidance analysis, alongside consultation with clinicians, four measures of success were selected. To qualify as a successful transition, the following would be met: initiated at a developmentally appropriate age, preparation topics covered, joint clinic occurrence and adult follow-up within six months. Outcome measures: Diagnosis, co-morbidities, AED usage and seizure frequency were recorded at ages 17 and 20 to derive a comparison of clinical outcomes. Statistical analyses: Logistic regression models firstly explored associations between exposure variables and successful transition; then between successful transition and health outcomes. Multivariable regression analyses investigated attenuations from socio-demographic and clinical confounders.ResultsOf the total population of 20–24-year-olds (n=147), only 72 had accessible data.72.2% (52/72) of patients underwent a successful transition: initiated transition appropriately (88.9%), preparation topics covered (88.9%), joint clinic occurrence (80.6%) and adult follow-up within six months (84.7%).The more recent transitions (for patients currently aged 20) had a higher success rate (68.0%) than those currently aged 24 (35.7%).The odds of successful transition were higher for females than males (OR 4.77 [0.93, 24.37], p=0.061), although statistically non-significant within our limited sample size. No other exposures showed significant associations with successful transition.Importantly, unadjusted models showed that successful transition improved the odds or reduced yearly seizure frequency in early adulthood (OR 5.02 [1.23, 20.49], p=0.025), further confirmed by a Fisher’s Exact Test significant result (p=0.034).Successful transition was not associated with changes in other recorded outcome measures such as epilepsy diagnosis.ConclusionThis study showed the feasibility and benefits of defining, monitoring and investigating the impact of successful transition among YPE. Further multi-centre studies should be performed with a greater sample size to increase statistical power.