SH CP 160
Healthy Weight Guideline
0 – 19 Years
Version: 3
Summary:
This document defines the guidance to support the
prevention, early intervention and management of
obesity in babies, children and young people
Keywords (minimum of 5):
Weight, healthy eating, physical activity, overweight,
obesity, child, young person, school, college
(To assist policy search engine)
Target Audience:
Health Visiting, Family Nurse Partnership Team,
School Nursing Teams. Specialist Nurses for Children
in Care.
Next Review Date:
January 2018
Approved & Ratified by:
Children’s Division
Governance Committee
Date issued:
December 2015
Author:
Jane Levers, Lizzie Christie, Barbara Hollis, Members
of the Healthy Weight Action Group and Members of
the HV /SN Policy Group
Nicky Adamson-Young, Divisional Director Children’s
Division
Sponsor:
Date of meeting:
17.12.15
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Version Control
Change Record
Date
06/11/13
19/08/14
19/08/14
20/01/15
14/04/15
5/5/15
16/11/15
Author
Kath Clark
Jane Levers
Gillian Vince
Version
V1
V1
V1
V2
V2
Jane Levers
Karen Wilkins
Barbara Hollis
Jane Levers
Lizzie Christie
Amanda Whelan
Page
V3
16
Reason for Change
Introduction of new guideline
Addition of information relating to school age children
Addition of information relating to school age children
Addition of care plans
Policy review
Updated flowchart
Updated in view of new School Nursing service specification
Combination of Management of Babies at Risk of Obesity
Guideline and Management of Children and Young People
who are Overweight or Obese Guideline. Change of title.
Reviewers/contributors
Name
Kath Clark
Dr Jo Walker
Jane Levers
Gillian Vince
HV Policy Group
Fiona Butt
Liz Taylor
Senior Management team
School Nurse Team Leaders
Locality Clinical Managers
Senior Management team
Position
Locality Clinical Manager
Consultant Paediatrician
Professional Lead for School Nursing
School Nurse Practice Teacher
FNP Supervisor
Associate director for Nursing AHP
Version Reviewed &
Date
V1 07/01/14
V1 05/05/14
V1
V1
V1 11/09/14
V1 19.01.15
V1 20/1/15
June 2015
June 2015
June 2015
November 2015
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CONTENTS
Section
Title
Page
1.
Introduction
4
2.
Scope
5
3.
Definitions
5
4.
Duties/Responsibilities
9
5.
Main policy content
10
5.1
5.2
10
11
5.3
5.4
5.5
5.6
5.7
5.8
General principles
Prevention and Early Intervention, Universal Health Visiting
and School Nursing Services
Antenatal women
Infants aged 0 to 12 months
For Children 12 months to 5 years and 5 to 19 years
Physical Activity Guidance by age
Management of babies, children and young people identified
as overweight or obese. Universal plus/ Universal partnership
plus interventions by HV or SN teams
Referral to Specialist Services
11
12
12
13
14
15
6.
Training requirements
15
7.
Monitoring compliance
15
8.
Policy review
15
9.
Associated Documents
16
10.
Supporting references
16
APPENDICIES
A1
Training Needs Analysis (TNA)
17
A2
Healthy Weight Care Plan 0-19 years
18
A3
Healthy Weight Pathway 0-5 and 5-19 years
20
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Healthy Weight 0-19 Years Guideline
1.
Introduction
These guidelines for Healthy Weight, 0-19 Years are provided to enable Southern
Health Foundation Staff, Health Visitors, Family Nurses, School Nurses, Community
Staff Nurses, Community Nursery Nurses, Specialist Nurses for Children in Care to
work in partnership with children, young people, parents and carers to promote
behaviours that support healthy weights. Including the prevention, early intervention
and management of obesity.
Aims
 To work in partnership with the midwifery service during the ante-natal period to
identify any obesity risk factors.
 To work in partnership with the child, young person, family and other relevant
agencies to support lifestyle behaviour change.
 To monitor a baby’s weight from birth and offer early advice and support.
 To provide the delivery of key health promotion messages for all children, young
people and their families with regard to maintaining a healthy weight
 To encourage long term healthy eating and an active lifestyle
Obesity is a priority area for Government. The Government’s ‘Call to Action’ on
obesity (DH, 2011) included national ambitions relating to excess weight in children.
Healthy weight maintenance can be improved through encouraging breastfeeding,
introduction to solids and healthy family nutrition in line with guidelines.
The value that Health Visiting can add to this agenda has been articulated for Local
Authority commissioning in The Early Years High Impact Area, Healthy Weight,
Healthy Nutrition ( to include physical activity) emphasising the role of Universal
services as essential for primary prevention, early identification of need and early
intervention.
Children who are overweight are at increased risk of poor health outcomes such as
type 2 diabetes and poor mental health. Childhood obesity is a significant health
inequality with higher rates amongst children in disadvantaged areas and some
ethnic groups.
Overweight and obesity in childhood is associated with overweight and obesity in
adulthood, with subsequent increased risk of cardiovascular disease and some
cancers in adulthood (Foresight, 2007). This in turn leads to increased health and
social care costs.
The NHS Information Centre data on childhood obesity is stark. In 2011 around 3 out
of 10 boys and girls aged 2 to 15 years were either overweight or obese. Childhood
obesity has risen by 1% every 2 years since the mid-1990s.
In the 2011/12 school year, around 13.5% of children in reception and 15% in year 6
were either overweight or obese. Around 9.5% and 19% respectively were obese.
Up to 79% of children who are obese in their early teens are likely to remain obese as
adults (Chief Medical Officer, 2008).
Documents such as The 1001 Critical Days: The importance of the conception to age
two period (Wave Trust, 2013) has demonstrated the significance of the antenatal
period. The opportunity to promote healthy weight for women and recognition of the
impact of maternal health and wellbeing on the developing infant have had an impact
on shaping early intervention services.
The emotional and psychological effects of being overweight are often seen as the
most immediate and most serious by children themselves. They include teasing and
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discrimination by peers; low self-esteem; anxiety and depression. Obese children
may also suffer disturbed sleep and fatigue.
Some obesity-related conditions can develop during childhood e.g. Type 2 Diabetes,
previously considered an adult disease, has increased dramatically in overweight
children. Other health risks include early puberty, eating disorders such as anorexia
and bulimia, skin infections, asthma and other respiratory problems. Some
musculoskeletal disorders are also more common, including slipped capital femoral
epiphysis and tibia vara (Blount disease).
Core elements of delivery of the Healthy Child Programme, 0-5 and 5-19 (DH, 2009
amended August 2010) include effective promotion of health and behaviour change.
This includes delivery of population, individual and community level interventions
based on NICE Public Health guidance. (NICE, PH6,PH49) Practice which
encourages identification of the strengths within families and how to make every
contact with a family, child and young person a health promoting contact.
2.
Scope
 For all staff within the Children’s Division
 To include antenatal women, children aged 0 – 19 years and their parents/ carers
living in Hampshire (excluding Portsmouth and Southampton) where care is
delivered by Southern Health Foundation Trust, Health Visitors, Family Nurses,
School Nurses Community Staff Nurses, Community Nursery Nurses and
Specialist Children in Care Nurses.
 To enable a baseline assessment on children, young people and their parents/
carers using an appropriate assessment tool.
 To ensure appropriate monitoring of children and young people who are
overweight or obese and referral to specialist services when necessary
 To enable appropriate and timely information sharing to safeguard children.in
accordance with Working Together to Safeguard Children ( HM Government,
2015)
 To ensure clear and consistent evidence-based practice resulting in quality and
equity of delivery of the Healthy Child Programme (DH, 2009-ammended August
2010)
 To support timely referral to education groups, weight management services or
specialist practitioners
3.
Definitions
3.1
Health Visiting Team
A team of practitioners who work with a defined population to deliver services that
promote the health and well-being of children, young people and their families.
Team members will include all or some of the following practitioners:
 Health Visitors [HV]
 Community Staff Nurse [CSN]
 Community Nursery Nurse [CNN]
 Health Care Support Worker [HCSW]
 Clerical Support Worker/ Administrator
 Student Health Visitor
 Pre-registration nursing Students
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3.2
School Nursing Team
A team of practitioners who work with a defined population to deliver services that
promote the health and wellbeing of children, young people and their families.
Team members will include all or some of the following practitioners:
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3.3
School Nurse [SN]
Special School Nurse [SSN]
Community Staff Nurse [CSN]
Community Nursery Nurse [CNN]
Health Care Support Worker/ School Nurse Assistant [HCSW/ SNA]
Clerical Support Worker/ Admin Assistant
Student School Nurse
Pre-registration nursing students
Children in Care Team
A specialist team of practitioners who work with those children and young people (019) who are in the care of the local authority (looked after children), their carers and
families. The service promotes the health and wellbeing of these children and young
people. The team identifies individual health needs of this vulnerable group by
undertaking statutory health assessments and supports all aspects of health
interventions required.
The team members include:
 Children in Care Team Leader
 Specialist Nurses for Children in Care
 Secretary to the team
 Secretary to the Team Leader
3.4
Family Nurse Partnership:
The Family Nurse Partnership (FNP) is a national, evidence based programme. The
aim of the programme is to improve the antenatal health, child health and
development and parents’ economic self - sufficiency in disadvantaged young
families.
The FNP team comprises a supervisor and a team of family nurses and a Quality
Support Officer.
Supervisors and Family Nurses are responsible for delivering the FNP intensive,
preventative home visiting programme to vulnerable, hard to reach young women
under the age of 20 who are expecting their first baby in a defined geographical area.
3.5
The Safeguarding Team
The team will provide professional advice and training on safeguarding
and child protection matters to all clinical staff. The team will ensure
support and supervision is available for practitioners to discuss concerns
around vulnerability. This will promote good professional practice and
decision-making in order to safeguard the health and wellbeing of children
and families.
3.6
Healthy Child Programme (HCP)
A universal public health programme for all children and families delivered by Health
Visiting, Family Nurse Partnership Team and School Nursing Teams
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3.7
Personal Child Health Record (PCHR)
Individualised record of a child’s health from birth, held by parent/carer. Includes
centile charts for recording of child’s growth.
3.8
Promotional Guide (Centre for Parent and Child Support, 2012)
The Promotional Guide provides a structure for a guided conversation with parents.
The antenatal guide is underpinned by 5 core themes which research has identified
as impacting the long term outcomes for children:
 The health, wellbeing and development of the baby, mother and father
 Family and social support
 The couple relationship
 Parent-infant care and interaction
 The developmental tasks of early parenthood and infancy
The antenatal guide focuses on the experiences of pregnancy, preparation for labour
and birth, expectations of early infancy, parenthood and family life and the impact of
current and past life experiences and circumstances. It offers parents and
professionals the opportunity to identify strengths and concerns as well as prioritises
and effective plans for action.
3.9
Health Review
0-5 years – Scheduled as part of the HCP or as a targeted intervention at Universal
Plus or Universal Partnership Plus level. Health and Development Reviews are an
assessment of family strengths, needs and risks, providing parents with the
opportunity to discuss their concerns and aspirations, assess child growth and
development, communication and language, social and emotional development and
detect abnormalities. (2015 – 16 National Health Visiting Care Service Specification)
School entry - All children entering Reception/Foundation Year within state schools
are offered a School Entry Health Review. The review includes assessment of basic
screening of distance vision, hearing, height and weight. Additionally height and
weight is recorded as part of the National Child Measurement Programme [NCMP].
3.10
BMI (Body Mass Index).
Body Mass Index is defined as a person’s weight in kilograms divided by the square
of their height in metres and is reported in units of kg/m2. Specific cut-off points are
used to assess whether a person is a healthy weight, underweight, overweight or
obese. For children and young people these are related to age and gender.
From the age of two years BMI can be calculated and plotted on a paediatric BMI
identification chart
BMI =
Weight (kg)
Height (m) x Height (m)
Classification of obesity in adults:
For adults a BMI of 25 to 29.9 means you are considered overweight and BMI of 3039.9 means you are considered obese.
3.11
Interpreting BMI
A child whose weight is average for their height will have a BMI between the 25th and
75th centiles
BMI above the 91st centile suggests that a child is overweight
BMI above the 98th centile suggests that a child is very overweight (clinically obese)
BMI below the 2nd centile is unusual and may reflect under-nutrition
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3.12
Behaviour –Change Techniques
Behaviour-change techniques are techniques aimed at changing the way someone
acts (and so, logically, their thinking patterns). In this guideline, the changes relate to
dietary intake and eating behaviour, physical activity and sedentary behaviour.
Related NICE Guidance, PH6, Behaviour change at population, community and
individual level. PH49, Behaviour Change: individual approaches.
3.13
The National Childhood Measurement Programme
The National Childhood Measurement Programme (NCMP) measures the weight and
height of children in reception class (aged 4 to 5) and year 6 (aged 10 to 11). The aim
is to assess the prevalence of obesity and overweight among children of primary
school age, by local authority area. The data can be used at a local or national level
to support local public health initiatives and inform local services for children.
3.14
The National Childhood Measurement Programme has classified the definition
of Overweight as follows:
Children over the 85th centile and on or below the 95th centile are classified as being
overweight (NCMP & Health Survey for England HSE)
3.15
The NCMP has classified the definition of Obesity as follows:
Children over the 95th centile are classified as being obese (NCMP & Health Survey
for England HSE
3.16
Rapid Weight Gain
An upward crossing of two centile lines on a growth chart could be interpreted as
rapid weight gain depending on the individual circumstances of that child’s pre and
post natal history and wider consideration should be given to consider relevant
factors impacting on growth trends.
3.17
Change4Life (www.change4life.com)
This programme has promoted the following simple behavioural change messages
that families find acceptable
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Sugar swaps (swapping high sugar items for low sugar items)
Meal time
5 A Day
Cut back fat
Me size meals (serving children correct portion size – i.e. child size not adult)
Snack check (setting a limit on snacks and treats)
Up and about (moving more and setting a limit of 2 hours ‘screen time’)
60 active minutes (encouraging children to be active; minimum of 60 minutes per
day)
3.18
Start4Life (www.start4life.com)
This is a sister brand of Change4Life and is aimed at families under 2 years.
3.19
HENRY Programme
Health Exercise Nutrition for the Really Young is an evidence-based intervention that
enables a good start for babies and young children by bringing together information
about food and activity, parenting skills and behaviour change.
HENRY is a universal 8 week parent programme, offered to families through
Children’s Centres.
HENRY 1:1 is a programme offered to parents of babies and young children who are
at particular risk of becoming overweight or obese by trained staff from the HV team.
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3.20
MEND Programme
Mind Exercise Nutrition Do it! is a healthy lifestyle programme for children aged five
years and above who are above a healthy weight. It involves the whole family in
behaviour change and healthier eating. This can be accessed in Hampshire by 7 to
11 year olds where commissioned.
4.
Duties / Responsibilities
4.1
Southern Health NHS Foundation Trust
Southern Health NHS Foundation Trust Board has the responsibility to ensure that
the health contribution to Health Visiting, School Nursing, Children in Care and Family
Nurse Partnership Services is discharged across Southern Health through
commissioning processes.
4.2
Divisional Director
The Children’s Divisional Director is accountable for performance within the
Children’s Division and has the overall strategic and operational accountability for
delivery of Children’s Services.
4.3
The Senior Management Team
The Senior Management Team is responsible for operational management of the
Health Visiting and School Nursing Service and are required to ensure that Children’s
Division receive appropriate training and supervision in the use of this guideline.
Barriers to compliance with this guideline will be escalated to the Divisional Director.
4.4
Clinical Team Leads [CTL]
Have the daily operational management of the Health Visiting and School Nursing
Service and are required to ensure all staff are suitably trained and competent to
deliver the HCP and are compliant with all relevant policies. CTLs will ensure that all
staff are conversant with and adhere to relevant policies and guidance. Compliance
to this guideline will be audited annually and exceptions to service delivery will be
raised to Area Managers.
4.5
Community Practice Teachers
Are skilled in training and education and will ensure pre and post registration students
placed within health visiting and school nursing teams are aware of evidence based
practice to promote improved outcomes for children, young people and families.
CPTs will assist staff within health visiting and school nursing teams to develop skills
and knowledge to support delivery of the HCP, Health Visiting high impact areas and
School Nursing key performance indicators.
4.6
Health Visiting and School Nursing Teams
Health Visiting, FNP team & School Nursing Teams have a duty to comply with this
guideline and report to their line manager if they are not able to fulfil this aspect of the
HCP Service delivery. The Health Visitor/ School Nurse may delegate aspects of this
health review and episode of care relating to healthy weight to a Community Staff
Nurse or a Community Nursery Nurse, but remains accountable to ensure the
integrity of the contact in maintained as per Nursing & Midwifery Council (NMC)
guidelines.
4.7
Professional Accountability
Professionals are accountable to the Codes of Conduct of their regulatory body. The
Nursing & Midwifery Council (NMC) (2008) Code states qualified nurses should;
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 “only delegate tasks and duties that are within the other person’s scope of
competence, making sure that they fully understand your instructions
 make sure that everyone you delegate tasks to is adequately supervised and
supported so they can provide safe and compassionate care
 confirm that the outcome of any task you have delegated to someone else meets
the required standard.”
5.
Main guideline introduction and content
5 key themes are highlighted in Healthy Weight: Healthy Lives: A cross-government
strategy for England (DH, 2007)
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Children : Healthy growth and healthy weight – The importance of prevention
of obesity from childhood
Promoting healthier food choices.
Building physical activities into our lives
Creating incentives for better health
Personalised support for overweight and obese individuals
Staff from the Health Visiting, School Nursing, FNP teams and Specialist Nurses
should consider these factors and ensure practice reflects Making Every Contact
Count and that partnership work supports delivery of consistent evidence based
messages to support healthy weight.
The following guidance consists of information relevant to all contacts and then
specifically to support women during the antenatal period, children aged 0 to 1 years,
1 to 5 years and 5 to 19 years.
5.1
General principles
Staff from the Health Visiting, School Nursing, FNP teams and Specialist Nurses
 will practice in line with the principles of Making Every Contact Count (MECC)
 should practice utilising the principles of Strengths-based, partnership work with
families and raise weight related issues through an open, non-judgemental
discussion preferably with the whole family including grandparents/ carers where
possible
 must explain the growth and/ or BMI chart and healthy weight expectations to
children, young people and families
 need to promote the benefits of early intervention before lifestyle behaviours
become entrenched
 should not routinely aim for weight loss with children but may where specialist
intervention is in place e.g. dietician support families, children and young people in
line with a specific plan of weight management intervention
 must encourage long term healthy eating and an active lifestyle, not short term
changes and never a diet
 should undertake an assessment of the child’s needs using the Assessment
Framework in order to identify any vulnerable risk factors.(Working Together to
Safeguard Children 2013)
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 must document in the Electronic Patient Record in accordance with the Trust and
NMC Record Keeping Guidelines.
5.2
Prevention and Early Intervention, Universal Health Visiting and School
Nursing Services
Staff from the Health Visiting, School Nursing, FNP teams and Specialist Nurses
should be aware of Obesity risk factors:
 Perinatal risk factors including excess weight gain during pregnancy, teenage
pregnancy, limited maternal education and poverty, gestational diabetes and
ethnicity ( Asian or Black origin)
 Parental obesity, the strongest indicator of obesity risk is either parent being
overweight or obese.
 Post-natally. A birth weight over 4.5 Kg, rapid early growth, bottle feeding, early
introduction of solids and poor sleep pattern
 Arrival of a new baby may increase risk of overweight and obesity for older
siblings, impact on toddlers (1-2 years)
 Children with family members who have any of the components of metabolic
syndrome are a higher risk of metabolic syndrome themselves if they become
overweight or obese.
5.3
Antenatal women
Universal
All women in Hampshire known to the Health Visiting/ Family Nurse Partnership
service will be offered a universal antenatal health visitor contact in line with delivery
of the HCP 0-5 years. Utilising Promotional Guide the health visitor will work in
partnership with the woman and her family to promote healthy weight, to include
promoting healthy food choices and building physical activity into daily life. The role
parents have in influencing their children’s weight and healthy lifestyle choices should
be discussed.
Universal Plus and Universal Partnership Plus
 The health visitor/Family Nurse will have a face to face meeting with midwife
monthly ( ref guideline) to support a partnership approach to service delivery
between midwifery and health visiting services.
 Any women identified with a BMI greater than 30 or referred for additional weight
management support by the midwife to be highlighted to the Health Visitor for
further assessment at the universal antenatal contact.
 Health Visitor/Family Nurse as part of their antenatal assessment of health needs
utilising Promotional Guide will consider obesity risk factors to include gestational
diabetes, BMI >30 and rapid weight gain during pregnancy.
 The health visitor will support the women and significant family members to
identify realistic goals to support healthy weight
 This assessment will inform the basis of analysis of risk and resilience factors
impacting on the mother, partner and the unborn baby and identification of
vulnerability factors.
 The HV will introduce the key messages for the prevention of obesity to include
discussion of healthy weight expectations and encourage breastfeeding in line with
SHFT Infant Nutrition Policy, and explain growth charts in Personal Child Health
Record (PCHR) book.
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Interventions should, where possible, involve the whole family including grandparents
and carers
5.4
Infants aged 0 to 12 months
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5.5
All children in Hampshire known to the Health Visiting Service will be offered the
Universal Healthy Child Programme and visited for a New Birth Contact by 14
days, a Post Natal Contact by 6 weeks and for a 1 year health review prior to their
first birthday.
Every contact with the infant and their family is an opportunity to discuss key
messages that support maintenance of a healthy weight.
Encourage the continuation of breastfeeding in conjunction with the infant
nutrition policy
If an infant is artificially feeding via a bottle, ensure the family have received
instruction in making up feeds correctly.
Advise that sugar or solid food e.g. rusks should never be added to bottle feeds
Explain centile charts in the PCHR to families and discuss expectations. To
include frequency of weighing during the first year, (WHO Guidelines) a
discussion that infants with no underlying aetiology or health concerns usually
grow steadily along centile lines or parallel to them. Weight and length/height will
not necessarily be on or close to the same centile lines. That weight
measurements are likely to vary more than length/height measurements in
relation to centile lines. Small ups and downs in weight may be seen with short
term illnesses that affect food intake.
Discourage rapid weight gain in the first year of life (crossing centiles upwards).
Rapid weight gain may be associated with later insulin resistance and childhood
and adult obesity.
Discourage the introduction of solid foods before 6 months of age DH Guidelines
If an infant or toddler crosses the centiles upwards, feeding and lifestyle
behaviours should be reassessed and further intervention considered including
seeking advice from a medical professional
Consider referral to HENRY group sessions
Refer to specialists including GPs, dieticians, community paediatricians,
Paediatricians if professional concerns in relation to any factors impacting on
growth and development to include allergies, underlying medical condition
Universal 1 year health review to be completed and to include monitoring and
recording of weight and length on centile charts.
For Children 12 months to 5 years and 5 to 19 years
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Children in Hampshire known to the health visiting service will be offered the
Universal HCP (0-5 years) and be offered a universal contact for an Integrated 2
Year Review including an assessment of development between 24 and 30
months. This will include monitoring and recording of weight, height and BMI.
Healthy weight advice including discussion and provision of suitable written
material to support healthy eating and physical exercise.(NCE QS84).
All children in Hampshire excluding those whose parents decline the service, will
be seen by the School Nursing Team in Year R and Year 6 for growth monitoring,
height and weight as part of the NCMP.
Results are entered into the child’s Electronic Patient Record by the Child Health
Information Service and a feedback letter with the results is sent to the child’s
parent/carer.
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5.6
Parent/ carers are encouraged to access further information or advice from the
School Nurse team and from approved websites
School Nurse teams may target schools and offer healthy weight advice to
children, young people and parents within school
Every contact with the child and their family is an opportunity to discuss key
messages that support maintenance of a healthy weight
Ensure portion sizes are appropriate to the age of the child if over 6 months of
age. Discuss the concept of fist-size portions and utilise supporting resources e.g
Caroline Walker Trust, 1st Year of Life Practical Guide, Eating Well 1- 4, Practical
Guide and Recipe Booklet / Southern Health Foundation Trust resources
including portion sizes for little ones, 6 months -1 year/ 1-2 years and Healthy
Meal Ideas for the whole Family
Advise the avoidance of sugar-sweetened drinks and fruit juices. Encourage
water as the drink of choice.
Recommend that families set achievable goals and utilise recognised behaviour
change strategies e.g. brief intervention, motivational interviewing, strengthsbased partnership approach to developing healthy lifestyle to impact on healthy
weights – Signpost to supporting resources such as DH Eatwell Plate
Encourage the rewarding of good behaviour by offering non-food treats (e.g.
colouring books) and set limits on snacking behaviours
Promote physical activity for the whole family from an early age and recommend
a limit to screen time
Encourage families to set a good example with the food choices they make for
themselves.
Food diaries may help families, and professionals recognise where energy intake
is exceeding expenditure
Provide families with opportunities to improve their skills – e.g. learn to cook
healthy meals Signpost to local Children Centres and Community Centres with
details of available programmes which encourage healthy eating
For pre-school children consider referral to HENRY group programme.
Encourage children from around 12 years to monitor their own eating, physical
activity and sedentary behaviour [NICE 2013]
Physical Activity Guidance by age
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Physical activity should be encouraged from birth, particularly through floor-based
play and water-based activities in safe environments.
Children capable of walking unaided should be physically active daily for at least
180 minutes (3 hours), spread throughout the day.
All children should undertake a range of moderate to vigorous activity for at least
60 minutes over the day.
Children aged over 5 years should undertake vigorous activities including those
that strengthen muscle and bone at least 3 days per week.
Children should minimise the amount of time they spend being sedentary (being
restrained or sitting) for extended periods ((except sleeping)
Parents should try to complete at least some local journeys with young children
using a physically active mode of travel with the aim of establishing active travel
as a life-long habit from early age.
Written information detailing the above and to include the benefits of physical
activity and how enjoyable it is and local opportunities to be physically active
should be given to parents or carers at the 2 year integrated review and to
parents/carers of children measured as part of the NCMP. (NICE QS84)
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5.7
Management of babies, children and young people identified as overweight or
obese. Universal plus/ Universal partnership plus interventions by HV or SN
teams
5.7.1
Growth monitoring plan 0-5 years
Infants or children under 5 who have been identified as overweight or obese must:
 Be weighed and plotted on an appropriate chart once a month up to 6 months of
age
 Be weighed and plotted on an appropriate chart once every 2 months from 6-12
months of age
 Be weighed and plotted on an appropriate chart at 3 month intervals over the age
of one year to two years
 Have length measured and plotted on an appropriate chart at 2 weeks, 6 weeks
(GP), 6, 12, 18 and 24 months
 From 2 years be weighed and measured every 6 months until the child starts
school.
 From the age of 2 years BMI should be calculated and plotted on a paediatric
BMI Identification chart (please refer to 3.8)
 From 2 years be weighed and measured every 6 months until the child starts
school.
 From the age of two years, if a child is achieving a healthy weight at any of the
monitoring sessions, the weight should be monitored at 9 month intervals until
the child starts school
 Additional height and weight measurements outside of the universal HCP should
be entered into a Health Review 8 form so that the centile chart is populated.
 If there is no improvement after 6 months or if families need specific extra advice
or support, refer family to appropriate specialist services
 If a child/ young person crosses the centiles upwards, diet and lifestyle
behaviours should be reassessed and further intervention considered including
seeking advice from a medical professional
 All interventions should be recorded on the EPR and a care plan initiated with a
clear action plan.
 Consider a referral to Mental Health or Children’s Services if appropriate
 Signpost or refer to weight management programmes [e.g. HENRY 1:1] or
dietician if appropriate.
 All information must be transferred to the School Nursing Service
 All interventions should be documented in the child’s EPR with a clear action
plan and Healthy Weights care plan in place with a review date established.
5.7.2 Children and young people over 5
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If a child/ young person crosses the centiles upwards, diet and lifestyle
behaviours should be reassessed and further intervention considered including
seeking advice from a medical professional
All interventions should be recorded on the EPR and a care plan initiated with a
clear action plan.
Consider a referral to Mental Health or Social Care Services if appropriate
Signpost or refer to weight management programmes [e.g. MEND, 7-11 years] or
dietician if appropriate.
Children are not routinely reviewed following the NCMP however those children
identified as overweight or obese with co-morbidities [including emotional issues]
should be offered advice and support
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5.8
Referral to Specialist Services
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6.
A referral to a GP or specialist service must be considered in the following instances;
A child who is extremely obese – BMI ≥ 99.6 centile
A child who is obese – BMI ≥ 98th centile with significant co-morbidities. These
may include raised blood pressure, daytime sleepiness, and nocturnal snoring
with apnoea and/ or symptoms of diabetes, learning or educational difficulties.
Infants and toddlers whose weight does not begin to stabilise after 6 months
despite advice and increased monitoring and management
A child over 2 years who is obese – BMI ≥ 98th centile and has not reduced their
BMI within 6 months despite advice and increased monitoring and management.
Children with a height below the second centile (or short for family size) and
whose weight is 2 or more centile lines above their height centile should be
referred to the Paediatrician for consideration of possible endocrinopathy.
Training Requirements [refer to TNA in Appendix 1]
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7.
Parent/ carers can contact the School Nurse team if they would like advice and
support about their child’s weight following the NCMP or at any other point.
Children and young people who are referred or self-refer to the School Nurse
team for overweight or obesity will have their height and weight assessed.
Children and young people who are in local authority care will have their height
and weight assessed at their Statutory Health Reviews.
At local induction all new members of the Children’s Division will be made aware
of this guideline and individual training needs will be identified.
On-going training needs will be identified at yearly appraisal and during
management supervision
Training needs will be addressed in the Children’s Services Training Needs
Analysis.
Monitoring Compliance
This guideline will be monitored by qualitative and quantitative data.
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8.
Quantitative data will be collected through the Electronic Patient Record
Qualitative data annual audit of HCP
Patient Experience Survey
Patient Experience Champions
Data Warehouse
Policy Review
This guideline will be reviewed in three years or earlier if necessary and will be
discussed at;
 Health Visiting, School Nursing, Family Nurse and Children in Care Teams’
Business Meetings.
 New Staff Induction Programme.
 Allocation meetings.
 Away days.
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 PDRs and/or reviews.
 Management Supervision.
9.
Associated Documents
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The Health Visiting Overarching Policy [SHFT 2013]
The School Nursing Overarching Policy [SHFT 2013]
School Entry Health Review guidelines [SHFT 2013]
Clinical Information Assurance [Record Keeping] Policy [SHFT 2012]
Corporate and HR policies
Safeguarding Policy [SHFT 2014]
A simple guide to classifying body mass index in children (National Obesity
Observatory June 2011)
 Infant Nutrition Policy (SHFT 2013)
 National Child Measurement Programme Operational Guidance [Public Health
England 2014]
10.
Supporting References
Hampshire Healthy Weights Strategy 2012-2015 (HCC, Hampshire PCT)
Care Quality Commission
Every Child Matters: 5 Outcomes 2003 HMSO
Health Visitor Implementation Plan 2011-2015: A Call to Action (DH, 2011)
Healthy Child Programme 0-5 and 5-19 [DH DCSF 2009]
Systematic review and meta-analyses of risk factors for childhood overweight
identifiable during pregnancy (Weng et al 2012)
Southern Health NHS Foundation Trust School Nursing webpages
http://www.southernhealth.nhs.uk/services/childrens-services/school-nursing/
Southern Health NHS Foundation Trust Health Visiting webpages
http://www.southernhealth.nhs.uk/services/childrens-services/health-visitors/
Physical activity guidelines for Early Years (under 5s) For children who are capable of
walking (DoH, July 2011)
Physical activity guidelines for children and young people [5-18 years] [Department of
Health 2011]
NICE Clinical Guidelines: 47 Managing overweight and obesity among children and
young people; lifestyle weight management services (October 2013)
NICE Clinical Guidelines: 11 Maternal and Child Nutrition (2011)
NSF for Children, Young People and Maternity Services: Standard 2.
The 1001 Critical Days: The importance of the conception to age two period. (Wave
Trust, 2013)
The training of health professionals for the prevention and treatment of overweight
and obesity (Foresight: Royal College of Physicians March 2010)
Healthy Weight, Healthy Lives: A Cross-Government Strategy for England (DoH
2009)
National Childhood Measurement Programme: Results from the School Year
2007/08). Information Centre (March 2009)
The Eatwell Plate [NHS Choices 2014]
Nursing and Midwifery Council (2015) The Code. NMC.
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Appendix 1: Training Needs Analysis (TNA)
If there are any training implications in your policy, please complete the form below and make an appointment with the LEAD department (Deputy
Head of LEAD or LEAD Strategic Education Lead) before the policy goes through Policy Board.
Training Programme
Frequency
Course Length
Delivery Method
Trainer(s)
Recording
Attendance
Strategic &
Operational
Responsibility
How long will the
programme run
How often will the
(April – April?) and
target audience need to
how long will each
attend this course?
course take (3
hours?)
How and where do you
intend delivering this
programme (face to
face, e-learning,
Essential Training
Days)?
Who is accountable
Who will be delivering
Who do you
for this training
this programme if
anticipate recording strategically and who
delivery method is face
attendance?
is operationally
to face?
accountable?
Growth and Obesity
3 yearly
1 day
Face to face
Cons Paediatrician
LEAD
Senior Management
Team
Nutrition
3 yearly
3 hours
Face to face
Paed Dietician
LEAD
Senior Management
Team
MECC
Once
3 Hours
Face to Face and ELearning
SHFT via LEaD
LEaD
Senior Management
Team
Title and Level (if
appropriate) of your
training programme
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Appendix 2: Healthy weight care plan 0-19
Date
Team
Title
Problem/Need Category
Problem/Need Type
Children's Services School Nursing /Health Visiting / Looked after Children
Weight management
Problem/Need Detail
Universal plus intervention - Healthy eating and healthy weight management
advice and support in line with the Healthy Child Programme, local pathways and
NICE guidance [PH47 Managing overweight and obesity among children and
young people, PH 49 Behaviour Change, PH17 Promoting physical activity for
children and young people]
1 Intervention Category
1 Intervention Type
1 Goal
School Nursing/ Health Visiting/ Looked after Children
Assessment
To ensure the infant/ child/ young person has a holistic assessment of family,
social and environmental factors that may impact on their weight
1 Interventions/Action
Assessment of infant/ child/ young person's;
Height, weight, BMI if over 2 years of age and Nutritional status
Knowledge around healthy eating and exercise
Current situation including social history, family dynamics, environmental issues,
finance, access to cooking facilities
Associated health problems including family history
Emotional resilience, bullying, body image
Assessment of support network available to the family
Access to physical activity
1 Person/Team Responsible
Young person, School Nurse, Children in Care Specialist Nurse, Health Visitor,
Parent/ Carer, Social Worker, Community Nursery Nurse, Community Staff Nurse
2 Intervention Category
School Nursing /Health Visiting / Looked after Children
2 Intervention Type
Advice
2a Goal for birth to I year
Education and advice
2a Interventions/ Action
2b Goal for 1 year to 19 years
Introduction and promotion of solids at optimum age (6 months)
Provide parents with evidence based guidelines for the introduction of solids
Provide parents with online resources such as Introducing Solids NHS Change for
Life Leaflet, APP and NHS Your Health, Your Choices, Healthy Eating Information
Encourage tummy time and other physical activities
Promote use of a beaker and advise offering water or sugar-free fluids
Increase parental awareness of fullness, hunger cues and portion size
To assess if further advice or support is needed
To ensure the child/ young person/ parent/ carer has knowledge of healthy
Lifestyles and strategies to enable them to make informed decisions
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2b Interventions/Action
1 year - 19 years
Discussion around maintaining a healthy lifestyle including nutrition and physical
activities
Food types, 5 a day, Portion size, fluid intake
Keeping a Food diary
Triggers
Emotional impact
Cooking and preparing food
Physical activity - Access to sport facilities, parks etc.
Awareness of impact of high sugar content fluids.
Dental health and hygiene
Signpost to supportive information including websites, drop-in sessions
2 Person/Team Responsible
Young person, School Nurse, Children in Care Specialist Nurse, Health Visitor,
Parent/ Carer, Social Worker, Community Nursery Nurse, Community Staff Nurse
3 Intervention Category
School Nursing /Health Visiting / Looked after Children
3 Intervention Type
Healthy Weights
3 Goal
To monitor and promote heathy weight and lifestyle
3 Interventions/ Action
Increase parental awareness around portion sizes (using the Eat Well plate as a
visual guide) and discuss the five food groups
Explore if any organic cause for weight loss/ gain
Highlight foods and drinks that are high in fat and sugars
Importance of positive parenting to promote healthy eating patterns
Healthy meals and snacks
Offer advice on activities/ exercise
Access Change4Life resources
To consider a referral to Let's Get Healthy with Henry/ MEND group course
3 Person/ Team Responsible
Young person, School Nurse, Children in Care Specialist Nurse, Health Visitor,
Parent/ Carer, Social Worker, Community Nursery Nurse, Community Staff Nurse
4 Intervention Category
4 Intervention Type
4 Goal
4 Interventions/Action
4 Person/Team Responsible
School Nursing/ Health Visiting/ Looked after Children
Referral to other disciplines
To ensure timely access to weight management services
Offer referral to dietician if meets referral criteria
Signpost to HENRY/ MEND
Refer to Paediatrician, endocrinologist if meets referral criteria
Refer to CAMHS if appropriate
Liaison with specialist services, Paediatrician or GP if the client has particular
needs
Support to attend appointment if appropriate
Young person, School Nurse, Children in Care Specialist Nurse, Health Visitor,
Parent/ Carer, Social Worker, Community Nursery Nurse, Community Staff Nurse
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Appendix 3
Healthy Weight Pathway for Children Aged 0-5 Years and their Families
Make every contact count:
Universal/ Community
Universal Plus
Universal Partnership Plus
Assess safeguarding risk
Health Visitor leads delivery of the HCP
Completion of relevant Electronic
Patient Record (EPR) including
contact forms and care plans and
documentation in the Personal Child
Health Record ( PCHR) (Red Book).
Universal Healthy Child Programme (HCP) 0-5.
Antenatal, New Birth Visit, Postnatal, 1 Year
Review and Integrated 2 Year Review.
Families access timely, expert advice
from Health Visitors on a specific health
related issues.
(Care plan for children at risk of obesity or
those who are overweight/underweight or
obese)
Health Visitor provides ongoing support,
playing a key role in bringing together relevant
services, helping families with complex needs.
(Care plan for mother and child and safeguarding
alert if appropriate)
Communication with colleagues and
partner agencies if appropriate
Explain growth charts to parents/child
and growth check requirements.
How often to weigh under 1 years:
The World Health Organisation’s
recommendations (WHO, 2009) for
weighing are:
2 weeks – 6 month Once a month
6-12 months Once every 2 months
Over 12 months Once every 3
months
Use of HCP/Healthy Lifestyle.
The Health Professional will introduce the key
messages for healthy weight management and
the prevention of obesity:

Discussion of healthy weight
expectations and concerns about obesity.
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Encourage breastfeeding and
introduction to solids in conjunction with
SHFT Infant Nutrition Policy.
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Discussion of guidance in relation to
amount of physical activity. (Specifically
at integrated 2 year review in line with
NICE guidance, QS84)
Encourage attendance at Child Health Clinic and
for families to engage with Children’s Centres.
Signpost to Community Resources according to
local provision (HENRY GROUP/ PARENTING)
Liaison with midwifery service and GP as needed.
Following assessment in partnership with
family, Health Visiting team provides
additional input to support healthy weight.
Health Professional to consider weight
management input to include:
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Portion size
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Food types
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Increase physical activity for family
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Limit ‘screen time’
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Keep food/activity diary
Signpost and/or refer to:
Local interventions and voluntary agencies
as available (HENRY 1:1/PARENTING)
Consider liaison with GP and/or midwife,
Children’s Centres, Early Years Setting and
School.
Following intervention, review impact and
family need and, if continued concerns,
consider universal partnership plus
intervention.
Following assessment and in partnership with
family if ongoing need identified, Health visitor to
refer to appropriate support services.
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Consider referral to GP/Dietician as per
local pathway for specialist assessment
and advice
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Children with significant family history
/endocrinothopy refer to GP/Paediatrician
as per local pathway.
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Consider referral to GP/Community
Paediatrician as per local pathway if
other co-morbidities or concerns
Signpost and/or refer to Local interventions and
voluntary agencies as available
(HENRY1:1/PARENTING)
Liaison with GP and/or midwife, Children’s Centre,
Early Years and School.
Consider completing a Vulnerable child
assessment form which should be completed for
each child.
Where weight management contributes to
safeguarding concerns, consider referral to
Children’s Services.
This referral pathway for 0-5 years to be used in conjunction with referral pathway for 5-19 years and SHFT Healthy Weight Guideline, 0-19 Years and SHFT Infant Feeding
Policy.
Appendix 3
Healthy Weight Pathway for children and young people aged 5 – 19 Years and their Families
Age
Community
Universal
School
Entry
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5-7
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7-11
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11-16
16-19
Link to national health
awareness days
o Walk to school
week
o National Healthy
Eating week
Website information and
resources
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Healthy eating
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Physical activity
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National Child
Measurement
Programme [NCMP]
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Public Health events in
communities, schools and
colleges
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Support schools to offer a
whole school approach to
healthy lifestyles, healthy
eating and physical activity.
Offer advice re policy
development
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SCPHN to offer advice to
PSHE leads around
incorporating healthy eating
messages into the
curriculum and PSHE
lessons
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School Nursing newsletter
has healthy eating and
physical activity
information/messages
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Collation of data from
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New parent talks offered to all schools. Presentation
to have whole family focus and include information on
o Healthy eating
o Physical activity
o Promotion of School meals
o Healthy snacks
o 5 a day
o Water in schools
o School entry health review
o NCMP
Publicise community activities and weight
management programmes MEND
Resources/ leaflets taken to all new parent talks
Signpost to SN webpages
New entrant health review questionnaire distributed to
all parents via school.
All families receive letter and leaflet explaining NCMP
programme
All children weighed and measured in reception year
Growth assessed
All families receive NCMP feedback letter
All families receive letter and leaflet explaining NCMP
programme
All children weighed and measured in year 6
All families receive NCMP feedback letter
Universal Plus
Partnership
Plus
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Multi-agency
support for
identified
vulnerable
children
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Children with possible growth
failure or endocrinopathy referred
to Paediatrician/ GP as per local
pathway following discussion with
parent
Offer advice and support to
parent/ carers who request
further input around weight
management including
o Portion size
o Food types
o Increase physical
activity for family
o Limit “screen” time
o Keeping a food/activity
diary
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Signpost to SN webpages
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Refer to community projects –
Cook and eat, activity clubs etc
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Refer to specialist weight
management support e.g. MEND
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Individual basic work with young
people following referral or dropin
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Referral to specialist service
Healthy eating and physical activity to be offered at
year 6/7 transition
Healthy eating and exercise questions to be included
on the 6/7 questionnaire
Health drop-ins in secondary schools offering health
information
Supporting
information

School entry
health review
guideline

Management
of children
who are
overweight
or obese
guideline

Healthy
weight care
plan

Growth and
obesity
training 3
yearly for
clinical staff
in SN teams

Nutrition for
School
Nurses
Appendix 3
NCMP. Targeting of public
health work in highlighted
schools/localities.
[including for underweight]