This chapter was added to the manual in September 2018.
- Policy Aim
- Relevant Legislation and Guidance
- The Fostering Context
- Children and Smoking Policy
- Assessment and New Placements
- Current Carers who Smoke
- Luton Borough Council Staff in Contact with Children in Care
1. Policy Aim
To protect children in the care of Luton Borough Council from the effects of passive smoking from carers who smoke.
2. Relevant Legislation and Guidance
- Fostering Standards 2011 - Children live in a healthy environment;
- 2006 Health Act;
- CoramBAAF practice note (updated 2006) - Children and Smoking;
- Fostering Network policy paper (June 2007) - Foster carers and Smoking;
- Luton Borough Council – Smoke Free Policy.
The Department of Health and Social Care (DHSC) advice regarding passive smoking (updated on 25.6.07) is that exposure to second hand smoke is dangerous and that there is no safe level of exposure. The 2006 Health Act includes provisions to make enclosed public places and workplaces smoke free because of the risks of passive smoking.
Since 1 October 2007 it has been illegal to sell cigarettes to under 18 year olds in England and Wales.
Research shows that second-hand smoke is a cause of the following conditions in children living in smoking households:
- 17,000 children under the age of 5 are admitted to hospital every year with illnesses resulting from passive smoking;
- 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 in smoking households;
- Asthma and respiratory infections in school age children are more common. 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% 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;
- The Scientific Committee on Tobacco and Health (2004) estimated that non-smokers exposed to second-hand smoke had an increased risk of developing lung cancer of about 24% and of developing heart disease of 25%;
- Children living with parents who smoke are nearly three times more likely to be smokers than those whose parents do not smoke. Children of smokers are more likely to take up the habit because they copy the behaviour of adults. Growing up in a household where adults smoke often means that children perceive smoking as the norm. Parents' approval or disapproval of the habit is a significant factor in determining whether a child will eventually become a smoker. ( WHO, International Consultation on Environmental Tobacco and Child Health, consultation report 1999);
- Young smokers take more time off school than non smokers. Children who smoke are two to six times more susceptible to coughs and increased phlegm, wheeziness and shortness of breath than those who do not smoke.( Nicotine addiction in Britain, Report of Tobacco Advisory Group of Royal College of Physicians, 2000) One study has shown maternal smoking to be associated with an increased rate of absence from school. This is a particularly important issue for Children in Care, whose educational achievements are poor. (Charlton and Blair 1989 - BMJ).
The Fostering Network policy paper on foster carers and smoking (June 2007) said "There is a huge body of evidence that demonstrates the negative effects that smoking has on children." A recent study in the BMJ suggested that the only way of reducing children's exposure to passive smoke is to maintain a smoke free home and that other measures, such as restricting smoke in the vicinity of the child or using fans or open windows to ventilate rooms where smoking had taken place, are ineffective. (Blackburn et al 2003) There are also other health hazards associated with smoking, including poisoning and the increased risk of fire."
In response to the overwhelming evidence about the dangers of smoking and passive smoking and consequent central government initiatives, Luton Borough Council has become a smoke free council. Due to the limited research on E-Cigarettes these are also classified as having potential risks to health and are included in the Council's smoke free policy.
4. The Fostering Context
CoramBAAF's Practice Note 30 (updated in 2006) pointed out that "The issue of smoking and foster carers is controversial and requires that the rights of foster carers to smoke be balanced against the rights of looked after children who frequently come into the care system with neglected or impaired health but who have a right to be healthy". The corporate parent has a responsibility towards Children in Care that has to be balanced against the rights of foster carers to do as they wish in their own homes.
The Fostering Network states: "All fostering agencies should be moving towards a position where children and young people in care are placed only in smoke free homes. We acknowledge that expecting all foster carers who currently smoke to instantaneously give up is not realistic, and we also acknowledge that some foster carers who smoke have recognised sufficiently the needs of the children and young people for whom they care and are already minimizing the impact of their smoking on the children they foster." This policy therefore does not rule out every foster carer or potential carer who smokes but specifies careful assessment and matching processes in respect of carers who smoke, which includes the use of e-cigarettes. It is recognised that this policy reflects the current debate about smoking as well as the current availability of non smoking carers. Reviews of this policy over time are likely to result in an increasingly determined anti smoking position on the part of the Fostering Placement Service.
5. Children and Smoking Policy
Luton Borough Council acknowledges the proven skills and abilities of many of its carers who smoke, but is clear that children's health must be their primary consideration. Luton Borough Council is therefore working towards a position where, in order to ensure that children are not exposed to passive smoking within respite or foster placements and to discourage young people from taking up smoking, no child or young person in care will live in a smoking household. This policy is in line with the CoramBAAF guidance on children and smoking.
6. Assessment and New Placements
- No child under the age of five will be placed with General Carers who smoke;
- Children over 5 who may be more than usually vulnerable to passive smoking, such as children with respiratory problems, heart disease or glue ear or those with disabilities restricting their ability to play outside, will not be placed with carers who smoke;
- Children from non-smoking birth families should not be placed with carers who smoke;
- Older children who are able to express a view should be given a choice about whether they are placed with a smoking family.
- Connected Person foster carers who smoke and wish to care or are caring for children who are age 5 years and under will be expected to enter a cessation programme alongside their GP or health professional with a view of ceasing smoking within the first year of approval. A working agreement will be expected in this regard;
- Very careful consideration will be given to applicants who smoke and wish to care for children who are age 5 years and above. If such applications are pursued, approval will be subject to a written agreement regarding Luton Borough Council's expectations of carers who smoke.
7. Current Carers who Smoke
- All carers who smoke will be required to enter into written agreements regarding safeguarding children in their care from the risks of secondary smoke and providing appropriate role modelling in respect of smoking;
- Carers who currently smoke will be expected to create a smoke free home. Foster carers are expected to smoke only outdoors and to ensure that children play, eat and sleep in smoke free rooms. Foster carers are expected to protect children in their care from being exposed to passive smoking when visiting friends and relatives;
- Even after smoking outside, a carer can still damage a child's health. It is therefore expected that where possible a carer should try to avoid close proximity to a child in their care for a minimum of 2.5 hours as this is the amount of time that smoke can linger in the air when exhaled (NHS Choices 2018);
- Carers should not smoke in any car used for transporting foster children; (As from the 1st October 2015 it has been a criminal offence to smoke in a vehicle that is carrying someone under the age of 18. For further information see Smoking in vehicles and new Guidance Rules about tobacco, e-cigarettes and smoking: 1 October 2015;
- Carers should not smoke in front of children and young people. Carers are expected to make it clear to young people who smoke that they will not support their smoking in any way. For example they should never allow or facilitate access to cigarettes, lighters or tobacco. They are expected to be firm anti-smoking advocates;
- Smoking habits will be considered at a carer's annual review of registration and changes in registrations will be implemented to reflect this policy;
- Information on the effects of passive smoking on children and on the effects of smoking on health will be provided to carers. Support will be offered to carers to stop smoking;
- In line with CoramBAAF guidance, a minimum period of 12 months should elapse after cessation before an individual is considered to be a non-smoker. This reflects increased relapse rates in the first year after cessation.
8. Luton Borough Council Staff in Contact with Children in Care
- Social workers are expected to promote non-smoking attitudes. This would include not smoking within sight of or with children or young people in their care.