School nurses and health visitors key in identifying children at risk from parental alcohol misuse

A parliamentary report covering the health effects on children of parental alcohol misuse uncovers a widespread hidden issue

A parliamentary report covering the health effects on children of parental alcohol misuse uncovers a widespread hidden issue

Picture: iStock

By the time Jo Huey was six-years-old, she knew the sound of her father coming home from work meant trouble. 


Estimated number of women in the UK who drink during pregnancy

(Popova et al 2017)

'Unsure of his mood, my sister and I would peep around the door, hoping he’d be pleased to see us. But often he’d be drunk and aggressive. We’d have to dodge round the kitchen table to avoid a whack,’ she says.

Ms Huey, who is now a self-help motivational speaker and author, and who discusses her experiences with her father as part of her work around the impact of addiction, adds: ‘Throughout my childhood, my late father’s alcoholism made family life seem like walking on eggshells.’

Today, an estimated 200,000 children in England live with an alcohol-dependent parent, of whom just 15,500 receive treatment, according to a parliamentary report on the long-term health effects on children of parental alcohol misuse (PAM).

Commissioned by a cross-party group of MPs – some of whose own childhoods were affected by PAM – the report reveals that, in addition to its association with child physical abuse and neglect, PAM may leave children taking on family caring responsibilities, as well as feeling isolated, stigmatised and guilty.

Family pressure

RCN children and young people’s staying healthy forum chair Suzanne Watts welcomes the report’s call for a national strategy to raise awareness of PAM.

'This is a widespread, devastating, hidden problem, affecting children from both wealthy and financially deprived families,’ says Ms Watts. ‘I wouldn’t be surprised if it affects double the number of children estimated.’

Hilary Henriques, chief executive of the National Association for Children of Alcoholics (NACOA), which provides advice to those affected by parental drinking, believes nurses can play an important role in identifying and supporting such children. 

'Nurses provide continuity of care to both adults and children, so can establish the trusting relationship which families affected by PAM find so difficult,’ she says. ‘It is family pressure to hide drinking problems from the outside world, which leaves children feeling isolated and unable to ask for help.’ 


Children in England live with an adult receiving treatment for alcohol dependence

(Public Health England and Office for National Statistics 2016)

National Society for the Prevention of Cruelty to Children (NSPCC) policy manager Craig Thorley agrees. 'Health visitors and school nurses, trained to spot signs of child abuse and neglect, play an essential role in identifying whether a parent’s alcohol misuse is affecting their children,’ he says.

Lead professional officer with the Community Practitioners and Health Visitors Association (CPHVA) Obi Amadi says: `The continuity of care and trusting relationships health visitors build during antenatal and new birth visits enables parents to confide in them. This is crucial if they are to assess the levels of parental drinking likely to impact on children’s future mental and physical health.’ 

Anxieties at school

But, at a time when some health visiting services are being cut by 20%, providing enough staff to assess parental drinking problems is challenging, adds Ms Amadi. `Young children seldom speak about this and parents – some of whom are high-functioning alcoholics – usually hide evidence of their drinking habits, so are unlikely to turn up at health appointments or the school gates drunk,’ she says.

Ms Amadi and Ms Watts believe nurses’ best opportunity to identify, support or refer children affected by PAM is at school, where pupils may act out their anxieties away from home through behavioural problems, eating disorders or self-harm.


Children in Scotland who live with parents or guardians whose alcohol use is problematic

(Scottish Health Survey 2008-2010)

By working in partnership with teachers and social services, school nurses, in private and state sectors, are 'absolutely key' to identifying and helping these children, says Ms Watts.

'School drop-in clinics, which offer an open, safe, confidential place to talk with a skilled professional like a nurse, give children an opportunity to confide that though they love their parents, they don’t like what they do when they are drinking. Some school nurses also offer pupils online or texting support services, which teenagers often prefer.’

Council services cut

As most councils cut their alcohol treatment services and more than half lack strategies to help the children of alcoholics, how can this hidden problem be identified and resolved?

Adrian Brown

Describing the report’s findings as 'shocking' but welcoming its call for better data and more resources, alcohol nurse specialist psychiatric liaison at Northwick Park and Central Middlesex Hospital Adrian Brown says: 'Unfortunately, as alcohol services are trimmed back to save money, parents seeking treatment for alcohol problems may be deterred by difficulties in accessing help.


Children in need and registered with a local authority due to parental substance misuse 

(National survey data for Wales 2016)

'But all nurses are in a prime position to identify and refer anyone with early alcohol problems for a “brief alcohol intervention” so they can be helped by alcohol recovery services and peer support networks. And, though such people may not be actively harming their children and can be reluctant to discuss the impact their excessive drinking may have on their families, it is the role and responsibility of alcohol nurse specialists and alcohol health workers assessing these patients, to consider safeguarding their partners and children.’ 

Outreach work

Health professionals have welcomed the government’s announcement of a three-year £6 million package of measures to help support children living with PAM in England.

The programme will aim to provide more early intervention services and outreach initiatives.

'Hopefully today’s children are more aware than I was, that parental alcohol misuse is wrong. As a child I never knew my father’s behaviour was abnormal and not my fault. But I remember no one, such as a school nurse, in whom I felt I could confide,’ says Ms Huey.  

And, if the report’s recommendations are followed, hopefully children today will be less likely to go through the same experience without any support. 

65% of 1,987

Respondents with dependent children who exceeded recommended daily alcohol limits

(National survey data for Northern Ireland 2013) 

Parliamentary report recommendations

  • Introducing a national strategy for children of alcoholics, overseen by a minister to whom local authorities and NHS bodies would report their progress in assessing the scale of parental alcohol misuse (PAM) in their area and supporting affected children
  • Increased support for families affected by PAM, improved multi-agency working and more training for professionals, such as those working in schools
  • Awareness-raising among children, parents and practitioners about the impact of PAM and local support
  • Improved local data collection and evaluation of PAM services, such as the relationship between PAM and issues like domestic violence

Key facts on parental alcohol misuse

Children affected by PAM are:

  • Six times more likely to witness domestic violence. PAM has also been implicated in 37% of cases involving the death or serious injury of a child due to neglect or abuse
  • Have poorer outcomes in child protection cases, than cases where alcohol is not a factor
  • More prone to mental and physical health problems, for example they are five times more likely to have an eating disorder, attention deficit hyperactivity, increased injuries and hospital admissions 
  • Three times more likely to consider suicide and twice as likely to experience difficulties in school
  • More likely to have disrupted family routines, with 15% of affected children reporting inconsistent bedtimes due to their parents’ drinking
  • Experience chronic worry and fear, many feeling socially isolated and reluctant to seek help due to stigma, shame and guilt about betraying their parents, according to evidence from helpline calls 
  • Must often care for their affected parent or younger sibling, which can negatively affect school attendance and homework
  • Are considered twice as likely to develop alcohol or other addiction problems themselves later
  • About 41% of women drink during pregnancy and at least 3% of live births may be affected by some degree of foetal alcohol syndrome 


Helplines for anyone affected by PAM

NSPCC  0808 800 5000
NACOA  0800 358 3456


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