Tackling the growing problem of air pollution and children’s health

Researchers, including nurses, will monitor the effects of low emission initiatives on children’s health

Researchers, including nurses, will monitor London and Luton children’s health to see if low emission initiatives have an effect

Children taking part in The CHILL study launch
Picture: Queen Mary, University of London

Schoolgirl Romilly Slovach says she can 'smell and feel pollution in the air' outside her school, which is situated on a busy road.

‘It just makes my lungs feel so cramped. We normally do PE outside and the first time we did a mile round, I got very wheezy and had to take my asthma pump’, she says.

1 in 3

children in the UK grow up in areas with unsafe levels of levels of vehicle particulate pollution

(Source: UNICEF UK)

In 2,000 UK schools and nurseries, children like Romilly are being exposed to illegal levels of nitrogen dioxide from traffic exhaust, with 4.5 million (1 in 3) growing up in UK towns and cities with unsafe levels of vehicle particulate pollution, according to UNICEF UK research.

The World Health Organization warns that 90% of children worldwide now breathe polluted air which can affect their major organs and stunt lung growth, and nurses in Luton are involved in a study assessing the impact of local traffic pollution on schoolchildren’s health.

The Children’s Health in London and Luton (CHILL) study, will test if the planned April launch of central London’s Ultra Low Emission Zone (ULEZ), has a positive effect on schoolchildren’s health, by encouraging them to take more exercise, improving their lung growth and reducing chest symptoms, such as recurrent infections and lifelong breathing conditions like asthma.

Hazel Guth is one of two primary care research nurses, from the North Thames Clinical Research Network, working on the universities of London and Bedfordshire’s comparative CHILL study in Luton.

Ms Guth says: 'I’m proud and excited to be part of this new study, which, by closely monitoring Luton schoolchildren’s lung health, will have important results, which may influence how councils control future traffic flow in our big cities.’

Research nurse colleague Helen Espline adds: 'As a former community paediatric respiratory nurse, who remembers how many children on my caseload lived in areas of high traffic pollution, this role ties in well with my nursing background.'


of pollution exposure happens on children’s journeys to and from school

(Source: UNICEF UK)

Monitoring study

Over the next four years, Ms Guth and Ms Espline will monitor the lung health of 1,500 Luton primary schoolchildren between six to nine years. The results will be compared with those of 1,500 schoolchildren in central London, where ULEZ is being implemented.

Visiting Luton schools annually, researchers will:

  • Record each child’s height and weight.
  • Measure their lung size and function by spirometer.
  • Fit children with a GPS or activity monitor for a week, to monitor their movements.
  • With their family’s permission, check each child’s health records annually, to ascertain if they have visited a GP, an emergency department, or been admitted to hospital for chest infections or other lung conditions.
  • Monitor children’s exposure to a range of traffic pollutants, such as nitrogen oxides and particulates.

Children may be 60% more vulnerable
to the adverse health effects of air pollution
Picture: Queen Mary, University of London

Ms Espline says: 'The children love being involved in this research: learning about the adverse effects of traffic pollution on their health in science classes. They have also made a film explaining what their research project involves.’

A poll for the environmental law charity, Client Earth – which is lobbying the government for a national network of clean air zones – reveals that 75% of UK parents, like Romilly’s mother, Alyson Slovach, want measures to protect children whose schools are in polluted areas.

'Everyone expects their child’s school to be a safe place for work and play. But when break times and PE lessons pose a potential health hazard, urgent action must be taken. Whether asthmatic or not, every child needs air that is safe to breathe,’ says Ms Slovach.

In partnership with the British Lung Foundation (BLF), Client Earth runs a Clean Air Parents’ Network (CAPN) which indicates, by postcode, which UK schools are within 150 metres of illegally-polluted roads.

Parental anxieties about pollution

But are nurses aware of parents’ anxiety about their children’s exposure to traffic pollution? If so, what can they do to reduce its potential adverse health effects?

Collette Datt, nurse consultant and head of children and young people’s services at Whittington Health NHS Trust in north London, has developed an award-winning children’s asthma service in her trust and is aware of this problem.

'Traffic pollution is on the minds of parents bringing their children to our asthma clinic, particularly as some local schools are close to busy roads. They often ask if pollution has caused their child’s asthma and if they should move house.

'It’s difficult to answer such questions. But we can explain that, because most traffic pollution accumulates in cars or at pavement level, it is better to walk their children to school along quieter, traffic-free, side roads.'


of children worldwide now breathe polluted air

(Source: World Health Organization 2018)

Karen Rodenso, the trust’s children and young peoples’ long-term conditions nurse, responsible for ensuring Islington schools meet high asthma standards is also concerned.

'When we entered the postcode of our local schools onto the CAPN website, we were shocked to discover that those in the most polluted areas, had the most pupils with asthma.’

Advice sessions

Ms Rodenso talks regularly to local school nurses, teachers and pupils on how to avoid the adverse health effects of traffic pollution. If walking to school is impossible, she suggests they park away from schools or avoid leaving car engines running outside playgrounds. But Ms Rodenso admits there are challenges: 'Unfortunately, some busy parents want to quickly drop their children off at school by car on the way to work.

'The government risks storing up problems unless it tackles this public health issue as a matter of urgency’

Fiona Smith, RCN professional lead for children and young people’s nursing

‘Fear of pollution should not prevent children from being active outdoors, all young people need exercise, including those with asthma, who must lead unrestricted, active lives, to keep their airways functioning well.’  

School and Public Health Nurses Association chief executive Sharon White believes school nurses 'have a duty’ to uphold all children’s rights to play and exercise in clean air.

'We know poor air quality affects health because hospital admission rates rise sharply on high pollution days. Although schools tend to be accessibly-sited near busy roads, school nurses should, as part of the school health curriculum, be advising children, parents and teachers how to cut down school children’s traffic pollution exposure.

'Now many school nurses are employed by local authorities, they have an excellent opportunity to ask councils and public health teams to create clean air zones around schools,’ she adds. 

Anti-idling campaign

As programme lead for children and young people with the Healthy London Partnership (HLP), former cardiac nurse, Sara Nelson, liaises with councils, public health teams and health professionals to reduce traffic pollution near schools. Hackney schools in inner London for example, run an anti-idling campaign, encouraging parents to switch off car engines outside schools.

Having developed the HLP’s Ask About Asthma campaign and a toolkit advising NHS trusts on reducing air pollution, Ms Nelson believes school nurses can raise awareness of the impact traffic pollution is having on children’s health.

Pollution facts

  • Toxic traffic pollution has been shown to affect children’s cardiac, lung and neurological development
  • Although children spend 30% of their time at school, they can receive 6O% of their pollution exposure on journeys and during break times
  • Children may be 60% more vulnerable to the adverse health effects of air pollution than adults. This is because their faster breathing rates mean they inhale more air relative to their smaller body weight
  • Children’s small stature and toddlers’ transportation in buggies at car exhaust pipe level, mean they inhale high concentrations of toxic traffic emissions near busy roads

But Ms Nelson adds: 'It is crucial that the government also recognises this enormous public health problem – as with the smoking ban – and introduces such initiatives, such as car-free days, across the UK’s big towns and cities.’

'Public health emergency'

Fiona Smith, RCN professional lead for children and young people’s nursing, describes air pollution as a 'public health emergency’.

'The number of children with asthma and other allergies is increasing and exposure to pollution can exacerbate their symptoms, with long-term consequences on the health of future populations.

'The government risks storing up problems unless it tackles this public health issue as a matter of urgency.’

Meanwhile in Luton, Helen and Hazel relish the health education opportunity their new roles provide. 'It’s lovely to see children so enthusiastically involved in this project, asking questions, so they can explain to their parents and friends the importance of reducing and avoiding traffic pollution to stay healthy,’ says Helen.                                                 

Tips to reduce children’s traffic pollution exposure

Children in the CHILL study undergo tests to determine the impact of air pollution. Picture: Queen Mary, University of London

  • Avoid car travel as pollution levels are highest inside cars. Use public transport, lift share, or walk if possible and if car use is a must, keep car windows closed in heavy traffic
  • If walking, avoid traffic hotspots and use quiet side-roads, to reduce pollution inhalation. Plastic pram covers help
  • If choosing a pollution mask, ensure it has a well-fitting seal and fine, replaceable, filters. However, there is little evidence that pollution masks are effective, says the British Lung Foundation, most users finding them uncomfortable or making breathing seem difficult
  • Pollution updates for your area are available on the Department for Environment, Food and Rural Affairs UK Air website and 0800 556677 helpline. There are pollution apps or local alerts are available, for example AirText
  • Children should be encouraged to wear local message badges such as I Walked to School or We Park and Stride
  • Vehicles, such as ice cream vans, school buses and private cars, should be discouraged from running their engines outside schools and playgrounds
  • As two thirds of people with asthma find pollution exacerbates their condition, Asthma UK recommends always carrying an inhaler in case air pollution levels increase during the day



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