Swindon Borough Council: keeping an eye out for the very underweight

Like all areas, Swindon has a well-established range of support for children identified as overweight or obese during NCMP. The school nursing service will offer families an appointment to discuss concerns, give diet and physical activity advice and can refer them on to healthy weight programmes. This case study forms part of our resource on the National Child Measurement Programme.

But the council has also made sure it has a system in place to act on children who are very underweight. For the last eight years, school nurses have been tasked with identifying children whose lack of weight is a medical concern. Any child who falls on or below the second BMI centile mark is classed as underweight. But the school nursing service reviews the NCMP data to identify all children who are on or below the 0.4th centile.

Swindon Borough Council Public Health Programme Manager Fiona Dickens said the 0.4th threshold was chosen on the advice of local doctors and dieticians. “This is an indication of under nutrition, which could be related to a medical problem. We have been doing this since 2010 and this has been part of the NCMP national guidance since 2017. By choosing the 0.4th centile, rather than the second centile we exclude many fussy eaters.

“Where children are on or below the 0.4th centile, the school nursing service reviews their records to see if they are under the care of a paediatrician, GP or nurse. Most are, but we are spotting a small minority each year who are not.”

When a case is identified, the school nurses flag this to the paediatric service at the local Great Western Hospitals NHS Trust via secure NHS email. The paediatricians also check the NCMP raw data set to check for extremes of height to pick up abnormalities. Some of these cases that are not known about are simply to do with the fact that the family have just moved to the area. But there are others where a medical condition has not yet been spotted or there is a case of neglect or abuse.

Ms Dickens said: “The paediatricians were surprised at first that we were able to identify cases they did not know about. It has proved a valuable source of information for them. We also provide a summary of the data each year to the hospital to help keep track of how things are going. NCMP can be really useful for our NHS colleagues too.”

Consultant Paediatrician Dr Nikolaos Daskas said the information has proved invaluable. “It is very important to identify, treat and in some cases protect these children from an early stage, which is what the NCMP can deliver by providing robust surveillance data.”

But Ms Dickens said the trained staff who carry out the weighing and measuring are also on alert to look out for other signs that there maybe problems. “We don’t treat it as just a weighing and measuring process. Children may tell the staff something in confidence or they may notice something perhaps to do with what the child is wearing. They flag any concerns they have to the school nurses for them to investigate.”

It forms part of a continuous process of self-improvement for the service. At the start of each year, the public health team and school nursing lead meet to review how NCMP has gone over the previous 12 months and any changes that could be introduced in the future. “It is such a valuable opportunity where we have contact with children. It is important to make the most of it,” Ms Dickens added.

Contact details

Fiona Dickens

Public Health Programme Manager

Swindon Borough Council

[email protected]

This case study was produced jointly with Public Health England (PHE). For more information about the NCMP and current guidance from PHE on how the programme should be operated by local authorities, in line with the relevant legislation and best practice, go to: NCMP Operational Guidance.