Smoking Pol FC by pWh1aG

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									Children’s Services




Smoking Policy for Families who Foster on behalf of Bedfordshire
Children’s Services




Author(s): Head of Adoption & Fostering Service
           Lead Policy & Planning Manager




Agreed: October 2007

To be Reviewed: October 2009
1     Introduction


1.1   There is increasingly strong medical evidence to support the view that smoking and passive
      smoking have a detrimental effect upon the health and development of children. A study by
      Fielding and Phenow in 1988 estimated that only 15% of the smoke from a cigarette is
      inhaled by the smoker, the rest goes into the surrounding air and other people breathe it in.
      A Practice Note published by the British Association for Adoption and Fostering in 2007
      noted that babies and children who cannot avoid smoke where they live and play are
      particularly at risk. Babies whose parents smoke are much more likely to be taken to
      hospital with chest trouble in their first year of life than non-smokers’ children. Children with
      a parent who smokes have more chest, ear, nose and throat infections than non-smokers’
      children. In addition, the more cigarettes smoked at home, the greater the risk to the child.
      Children exposed to smoke are more likely to develop breathing problems as adults.


1.2   The current situation in Bedfordshire is that we have between 140 and 150 in-house foster
      carers, a number of whom are smokers. Where children are in a placement with a foster
      carer who smokes, the carer is given encouragement and support to cease smoking, or at
      the very least not to smoke in the presence of the child(ren).


1.3   Whilst it might reassure professionals that some anti-smoking measures are in place,
      smoking outside will not be sustainable for 52 weeks of the year. In addition, many children
      in the care system have unpredictable behaviour and leaving a child unsupervised whilst a
      carer smokes outside will not be an acceptable solution for most young children.


1.4   The responsibility on local authorities is to promote the welfare of any child looked after,
      and therefore to take a proactive approach to ensure the child’s health is safeguarded.


2     Policy Statement


2.1   This Agency believes that a smoking environment should be avoided, in the best interest of
      children who are to be placed away from home. Bedfordshire County Council Fostering
      Service will encourage its foster carers to undertake cessation programmes and support
      them to do so. Bedfordshire County Council will not make new placements with carers who
      smoke (save in exceptional cases with reasons clearly documented on the files of the child
      and the foster carer) of children under the age of five and older children with disabilities,
      and children with any respiratory, heart or ear conditions (or who are at high risk of these
      conditions).


2.2   Foster carers who smoke will not be approved for any new placements for children falling
      into the above categories.


3     Principles


3.1   Whilst Bedfordshire Fostering Service acknowledges the proven skills and abilities of many
      of our carers who smoke and their right to choose to smoke, it is our view that children’s
      health must be our primary consideration. The main purpose of this policy is to reduce
      children’s exposure to passive smoking within our foster homes, and discourage young

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       people from taking up smoking. As the effects of passive smoking are greater for younger
       children, children with disabilities and children with any respiratory, heart or ear conditions
       (or who are at high risk of these conditions), a move to smoke-free home environments for
       these children is planned.


3.2    Prospective foster carers are assessed on their ability to promote the health, education and
       personal and social development for children in their care. All new fostering applicants who
       smoke will be advised from an early stage in the process that their smoking habits will be
       considered prior to and during assessment and that these habits will impact on their
       approval and matching.


4      How this policy will be put into practice


4.1    In order for this to be achieved:


4.1.1 Where applicants to foster do smoke, discussion will take place with them prior to the start
      of assessment on the dangers of passive smoking to the health and development of
      children, and they should be made aware that this is an issue which will affect their
      approval. If applicants wish to foster children under five the effect this could have on a
      child’s health must be seriously considered. Applicants who smoke will not normally be
      approved for placements of children under 5 years old.


4.1.2 Where applicants are willing to manage their smoking habit so that they do not smoke in
      communal areas of their home or cars, but for example smoke outside or in a private room
      not used by children, their application may be considered for older children.


4.1.3 Approved foster carers need to know that if they smoke, placing social workers are more
      likely to choose non-smokers for preference. They should be asked to seriously consider
      giving up if they wish to be considered for fostering a wider range of children.


4.1.4 Currently approved foster carers who smoke will be encouraged to create a smoke-free
      environment. Foster carers will also be advised to restrict their smoking to certain areas of
      their house and to ensure that children play, eat and sleep in smoke free rooms and are not
      exposed to excessive smoking when visiting friends and relatives of the foster carers, or
      when other smokers visit the foster home. It is recommended that foster carers do not
      smoke in cars which are used for children.


4.1.5 It is advisable that foster carers do not smoke in front of children and young people. Carers
      will also be expected not to advocate smoking by Looked After Children, for example by
      ensuring that they do not provide cigarettes or tobacco, and ensuring that any
      cigarettes/lighters in the home are kept securely. New legislation make it illegal for children
      under the age of 18 to purchase cigarettes or tobacco products. Foster carers should never
      agree to purchasing these on behalf of children.


4.1.6 Bedfordshire Fostering Service will ensure that all carers know about the effects of passive
      smoking through preparation and training programmes, and foster carers who smoke will be


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       encouraged to give up smoking with the support of professionals and specialist services
       such as the Bedfordshire Stop Smoking Service, run by the Primary Care Trusts.


4.1.7 Where foster carers are accommodating a young person with a smoking habit, clear
      guidelines must be agreed with the child’s allocated Social Worker and parents when they
      are placed. This should be discussed at a placement agreement meeting. It should be
      clearly noted where foster carers decide that young people in their care who smoke cannot
      do so in the foster home, as this is a very significant matching issue.


4.1.8 Smoking habits will be considered at a carer’s annual review of approval (e.g., never smoke
      in a car which is used for children).


4.1.9 In all long-term fostering placements, the additional health risks to the child of being placed
      in a smoking household need to be carefully balanced against the available benefits of the
      placement for the child. This is because the significant risks of exposure to passive
      smoking increase with time. It is also a tragedy for a foster carer, because of preventable
      illness or premature death, to be unable to continue to care for a child who has already
      experienced significant loss.


4.1.10 All older children, who are able to express a view, must be given the option of being placed
       with a non-smoking family.


Reference




BAAF Practice Note 51 –       Reducing the Risks of Environmental Tobacco Smoke for Looked
                              After Children and Their Carers.


National Care Standards for Foster Care and Foster Placement Services (DFES)




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                                                                                      Appendix A


What is second-hand smoke?


Breathing other people’s smoke is called passive, involuntary or second-hand smoking. Tobacco
smoke in the home is an important source of exposure to a large number of dangerous
substances. The US Environmental Protection Agency (EPA) (1992) identified tobacco smoke as
a major source of indoor air pollution which contains over 4,000 chemicals in the form of particles
and gases.


Unlike adults, who can choose whether or not to be in a smoky environment, children have little
choice. Outside school, children spend most of their time at home, indoors with their parents or
carers. The younger the child, the more likely it is that the child will spend most of the day
physically in the same room as his or her smoking parent(s).


A child breathes both the “sidestream” smoke from the burning tip of the cigarette and also the
“mainstream” smoke that has been inhaled and then exhaled by the smoker. Fielding and Phenow
(1988) estimated that nearly 85 per cent of the smoke in a room results from sidestream smoke.
Many potentially toxic gases are present in higher concentrations in sidestream smoke than in
mainstream smoke.


The particles in tobacco smoke include tar, nicotine, benzene and benzopyrene. The gases
include carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde and hydrogen cyanide.
Some of these have marked irritant properties, and 60 are known or suspected carcinogens
(substances which cause cancer). The US Environmental Protection Agency has classified
environmental tobacco smoke as a Class A human carcinogen.


The immediate effects of environmental tobacco smoke in children


Young children are particularly susceptible to the effects of second-hand smoke because their
lungs and airways are small and their immune systems are immature. Consequently, when
exposed to environmental tobacco smoke they are more likely than adults to develop both
respiratory and ear infections. Children also have higher respiratory rates than adults and
consequently breathe in more harmful chemicals, per pound of body weight, than an adult would in
the same period of time.


There is consistent scientific evidence to support the association of an increased risk of the
following conditions in children brought up in smoking households.


Sudden Unexpected Death in Infancy (SUDI) or cot death is the most common cause of death in
children aged 1-12 months. Compared to those infants whose mothers do not smoke, the infants
of smoking mothers have almost five times the risk of dying from SUDI.


Lower respiratory tract infections (pneumonia and bronchitis) in pre-school children occur more
frequently if a parent smokes.


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Asthma and respiratory infections in school-age children are more common in a smoking
household. It is estimated that between 1,600 and 5,400 new cases of asthma occur every year as
a result of parental smoking. In addition, established asthma tends to become more severe in
smoking households.


Parental smoking is responsible for a 20-40 per cent increased risk of middle-ear disease in
children. This is associated with hearing loss, a need for surgery, secondary speech delay,
schooling difficulties and social isolation.


In the UK, 17,000 children under the age of five are admitted to hospital every year with illnesses
resulting from passive smoking.


The evidence for some of these conditions is dose-related – the greater the number of cigarettes
smoked by the adults, the greater the risk. The risks to children will also be increased by the
frequency of visits of smoking relatives and family friends.


Reducing parental smoking would result in significant reductions in respiratory morbidity and
mortality in infants and children. Further detailed information and references are available in
Children Exposed to Parental Substance Misuse (Phillips, 2004, published by BAAF) and in
Smoking and the Young (Royal College of Physicians, 1992).


The long-term effects of environmental tobacco smoke in children


The long-term effects of growing up in a smoking household are not yet fully known, but they are
likely to be significant, bearing in mind the recognised risks to adults exposed to passive smoking.
The Department of Health’s Scientific Committee on Tobacco and Health (2004) issued a report
that concluded that exposure to second-hand tobacco smoke can cause both lung cancer and
heart disease in adult non-smokers. This report estimated that non-smokers exposed to second-
hand smoke increased their risk of developing lung cancer by about 24 per cent. The best
estimate for the increased relative risk of heart disease was about 25 per cent.


Charlton and Blair (1989) looked at absenteeism amongst 2,800 young people aged 12 and 13 in
the North of England and showed maternal smoking was associated with an increased rate of
absence from school. The issue is particularly important for looked after children, who frequently
come into the care system with neglected education, are more likely to be excluded from school for
other reasons and whose educational achievements in care are poor (Department of Health,
2002b).


Young Smokers


Many young people come into the care system as smokers. Others only become smokers whilst
being looked after. The health implications for all these young smokers are serious and those
responsible for their welfare should do everything that they can to help them quit the habit.


The Royal College of Physicians (1992) reported on the significant ill effects of taking up smoking
in adolescence. The earlier in life that children start smoking, the greater the risk of developing

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heart disease and lung cancer in later life. Children who smoke are between two and six times
more susceptible to coughs, wheeziness and shortness of breath than those who do not smoke.
Smoking is known to be a cardiac stimulant, which magnifies the effect of stress on the heart. It
also increases blood coagulability and adversely affects blood lipids. Sub-arachnoid brain
haemorrhage is six times more common in young smokers than in non-smokers.


The Royal College also reported that young smokers take more time off school than non-smokers.
They are less physically fit than other children and are slower at both sprints and endurance
running. The performance in a half-marathon of a young smoker of 20 cigarettes per day is the
same as that of a non smoker who is 12 years older. Smoking increases skin ageing and skin
wrinkling. Female smokers are two to three times more likely to be infertile than non-smokers.




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