Long term conditions in children

Introduction

Long term conditions in children can manifest in a variety of ways, but this section of the JSNA will focus primarily on childhood diabetes (Type 1), asthma and epilepsy.

• Type 1 diabetes is an autoimmune condition where the person’s pancreas fails to produce any insulin to control blood glucose levels, and therefore requires insulin injections for life (‘insulin dependent’). Paediatric diabetes care involves diabetes care for children under the age of 19 years old. This includes new diagnosis, regular follow-ups and the clinic reviews. The majority of these children have type 1 diabetes, but a minority do have type 2 diabetes or other forms such as cystic fibrosis-related diabetes (CFRD) or maturity related-diabetes in the young (MODY)
• Asthma is a long term condition which causes breathlessness, wheezing and coughing. The severity of symptoms varies from person to person from mild to severe. Asthma is an inflammation of the airways, specifically the bronchi. People with asthma often have a ‘trigger’, which is an event, or exposure which leads their airways to tighten and their bronchi to produce excess mucus. Triggers include smoking, pollen, cold air and exercise. Asthma is both treated and prevented by prescribed inhalers. Treatment is taken if an asthma attack is triggered and also for prevention purposes, often taken daily to reduce the impact of triggers
• Epilepsy is a condition diagnosed in those who have had more than one epileptic seizure. An epileptic seizure is when a sudden burst of electrical energy in the brain causes a temporary sensory overload in the brain

Key inequalities and risk factors

• Deprivation – children in higher levels of deprivation are more likely to develop a long term condition.
• Gender – unplanned hospitalisation is higher in boys than in girls.
• Ethnicity – routine recording of ethnicity is not done for diabetes. Unless this becomes a standard practice, future research and recommendations can be skewed.

Facts, figures and trends

Under 19s hospitalisation for asthma, diabetes and epilepsy

Since 2010/11, the rate of unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s in Bracknell Forest has remained at a similar level over the past few years, despite increases in 2013/14 and 2014/15. In 2014/15, the rate stood at 209.5 per 100,000 population which is still significantly lower than the national average of 326.4 per 100,000 population:

Source: Health and Social Care Information Centre, NHS Indicator Portal (accessed 27 April 2016)

With the exception of 2013/14, figures have been consistently higher for males than females: 56% of the unplanned admissions in Bracknell & Ascot CCG were for males from 2010/11 to 2014/15.

Diabetes

Modelled estimates for June 2015 indicate 0.34% of under 19s in the Bracknell & Ascot CCG have diabetes, which is approximately 119 children (rounded):

In 2013/14, Bracknell & Ascot CCG had 16 emergency admissions for diabetes in under 19 year olds. This was a rate of 49 per 100,000 population, compared to 57 per 100,000 in England. As the numbers are so small, overall trend paints a better picture than annual totals:

Bracknell & Ascot CCG’s emergency admissions led to 31 bed days in 2013/14, with an average length of stay of 1.82 days. 56% of these admissions came via Accident & Emergency, which was the same as the national figure.

Asthma

Asthma is the commonest long-term medical condition in childhood.  Nationally asthma effects 1 in every 11 children, and prevalence of asthma in England is amongst the highest in the world.

Modelled estimates based on June 2015 registered population indicate that 10.8% under 19s in the Bracknell & Ascot CCG have asthma, which is approximately 3,758 children (rounded):

Emergency hospitalisations for asthma of under 19s in the borough are declining and consistently lower than the south east and England figures. In 2014/15, the number of hospitalisations was 25 (85.4 per 100,000 population):

Bracknell & Ascot CCG emergency admissions led to 30 bed days in hospital with an average length of stay of 1.1 days in 2013/14 and has been consistently below the national rate.

Epilepsy

Epilepsy is the tendency to have recurrent seizures. There are around 40 different types of seizure and a person may have more than one type. Epilepsy can affect anyone, at any age and from any walk of life.

Nationally epilepsy effects 1 in every 103 people. Modelled estimates for June 2015 indicate that 0.42% of under 19s in the Bracknell & Ascot CCG have epilepsy, which is approximately 147 children (rounded).

In 2013/14, Bracknell & Ascot CCG had 24 emergency admissions for epilepsy in under 19 year olds. This was a rate of 73 per 100,000 population.  This is higher when compared to the previous year (7 or 21 per 100,000 population) but the numbers are relatively small so the overall trend is more helpful than annual figures.

Emergency admissions in 2012/13 led to 21 bed days in hospital with an average length of stay of 0.88 days.  The Bracknell & Ascot CCG’s rate of emergency admissions had remained significantly lower than the national rate over the previous four years, although it is similar to England in 2013/14.

Want to know more?

Asthma Quality Standard (NICE, 2013) – covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.

Commissioning services for children and young people with diabetes (NHS Diabetes, 2010) – sets out key features of high quality care, intervention maps, service specifications and template contracts based on good practice identified from key stakeholders including clinical and social services professionals and patient groups represented by Diabetes UK.

Designing and commissioning services for children and young people with asthma: a good practice guide (Primary Care Commissioning, 2012) – a good practice guide on asthma in children and young people to guide commissioners, service developers and providers across all parts of the care pathway in support of the NICE 2013 Asthma Quality Standard.

Epilepsy in children and young people (NICE, 2012) – quality standard for integrated commissioning across the epilepsy care pathway covering the diagnosis and management of the epilepsies in children and young people aged up to 18 years. Sets out best practice, measures and audience descriptors for the public, health and social care professionals, commissioners and service providers.

The strategy for long term conditions in children are covered in the Joint Strategic Plan for Children and Young People in Bracknell Forest (2011-2014) [link broken] and makes a number of recommendations: Closer engagement with the local diabetes networks and patient support groups for a holistic and more integrated approach and Continuation of training given to schools to help children with long term conditions manage their condition would be valuable.

 

This page was created on 27 February 2014 and updated on 7 June 2016. Next review date July 2017.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Long-term conditions in children. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/long-term-conditions-children (Accessed: dd Mmmm yyyy)