Brambles is a pre-school nursery setting with 106 children on roll. Karen Nash is the Manager, Nicola is the Deputy Manager and Karen Neal is the Family Coordinator. Here, they discuss the Early Childhood Health Promotion research they carried out in partnership with Jackie Musgrave, who works at The Open University.

Karen, Nicola and Karen: Why are you interested in promoting the health of children?

We have always been committed to healthy eating and to becoming a healthy nursery. For several years we have had a campaign to encourage the children, parents and the staff to think about what they can do to promote their health. The health issues that affect the children in our nursery include dental decay, speech and language delay, obesity, infectious diseases and some mental health problems.

Last autumn, we started to discuss what we could do to make the nursery a place where children could eat even more healthily. We were becoming concerned about the quality of some of the food that children were bringing in from home. We are really aware of the pressure that parents are under for a range of reasons, but we wanted to work with parents to encourage them to provide similar meals at home to those they are provided with at nursery.

It was at this time that Jackie got in touch with us to ask if we would be willing to be involved in a piece of research that she was hoping to carry out. During our initial meeting to discuss the research, Jackie described a toolkit that she had devised to help practitioners to identify ways to promote health in settings.

Jackie: what was your motivation for doing the child health promotion research?

I was a Children’s Nurse before I started teaching children’s health to early years students at the local college. When I moved into higher education, I became even more fascinated by the ways that practitioners support children’s health; adapting routines and activities to ensure that children with on-going health conditions, for example, eczema and asthma, are included as much as possible. More recently, partly because of the school-readiness agenda, I started to think about the ways that practitioners promote children’s health. I started to look at publications and research relating to promoting health in pre-school children and realised that there was very little available that practitioners could use to develop their knowledge in general about health promotion. Neither was there anything available to guide thinking about how to identify health promotion activities in settings. Most of the publications relate to health promotion in school-aged children. It’s as if children can only have their health promoted once they get to school. However, the staff at Brambles are really aware of the need to ‘get them early’ and to teach children about making healthy choices. So, when I showed them the Toolkit for Early Childhood Education and Care Practitioners they were really interested to be involved in the research. The Toolkit is in two parts, the first part includes information about health promotion in early childhood. It includes definitions of health promotion, there is a section on the benefits of promoting children’s health, an explanation of the ways that many of the health issues can be prevented. It also includes clear links about the ways that the aims of the Early Years Foundation Stage can promote health in children aged 0–5 years. The second part includes a series of 5 steps: each step has been designed to guide practitioners to identify the health priorities for the children and families in their setting; consider ways to select a health promotion intervention; support them in preparing an action plan and finally, to evaluate the impact of the intervention.

I was delighted when the staff at Brambles agreed to take part in the research; Karen N is the Family Coordinator at the nursery, so she was my co-researcher.

Karen N: what are your thoughts about the reasons for taking part in the health promotion research?

As Family Coordinator, I work closely with the parents and I am very aware of some of the difficulties that they have in their lives and how this can impact on children’s health. It is really important to be sensitive to that. However, we wanted to find ways of working with them to make eating healthier at home. Becoming involved with Jackie’s research helped us put a plan in place. Discussing the plan with the practitioners in each of the rooms made us look at what we can do to promote health, in ways that can benefit the children that are relevant to the age and stage of development. Although we started off talking about healthy eating, we quickly realised that we needed to look at healthy drinking too and we needed to encourage children to drink more water. We had gone juice-free last year, but we were concerned that the children may not be drinking enough water, and of course, there is a risk of the children becoming dehydrated. Very young children don’t always make the links between how they feel when they are thirsty and may not have the vocabulary to express the way they feel. So, part of our plan included activities aimed at increasing the children’s water intake in ways that were appropriate.

As part of our plan to work with parents, I sent out questionnaires to parents to find out more about their knowledge of healthy eating. Some of the results were surprising, especially in relation to their knowledge about food types and nutrition in general. In response to the findings from the questionnaires, I decided to create a healthy eating display board for parents’ evening.

Jackie: How useful was the parents’ evening health education display?

The display that Karen created was fantastic: she set it up in the entrance to the nursery which was also the area where the parents waited before going to see their child’s practitioner at the appointed time. Karen had carefully identified the areas that the parents had indicated they wanted more information about, and then she researched the information she wanted to pass on. She decided to make the display really visual, as you can see in the photo, she measured out the actual sugar content that was in some of the products that children brought into the nursery in their lunch boxes. I was invited to attend the parents’ evening and it was striking how many of the parents took the time to really look at the display; nearly all were shocked at the sugar content in some of the products that they considered to be healthy. What was really interesting was that many of the parents went on to ask Karen questions about other health-related issues, such as weaning, dental health and toilet training.

Another really impressive part of the health education display, was that Karen had created a recipe booklet of the children’s favourite easy-to-cook, cheap but nutritious meals that were served at nursery. She had carefully identified the meals that the children enjoyed: these included a West African stew, a Polish cabbage dish and even pilchard curry! To show the parents that the children really did enjoy the dishes, photos were sent of the children eating them via the electronic communication system. Parents commented that they were really surprised that the children did eat the food. To try and encourage the parents to cook the dishes at home, Karen included a list of ingredients as well as the cooking instructions.

Nicola: what are your thoughts about the health promotion research?

he biggest thing that has come out of it is the staff awareness of health and wellbeing, not just for the children, but for themselves as well; it’s almost as if they have changed some of their lifestyle choices too. They’re embedding it into their own lives as well as their own practice.

Jackie: what are your thoughts about how Brambles have used the Toolkit and how they have approached their healthy eating and drinking campaign for 2019?

The staff at Brambles have demonstrated that early years practitioners have a vital role to play in promoting children’s health. Although their campaign started off as looking at healthy eating, this quickly included the need for them to think about healthy drinking, in particular how they could teach children about the need to keep hydrated with water. They then realised that whilst healthy eating and healthy drinking are vitally important, these concepts also affect the children’s dental health and in turn, this can impact on speech and language development. If a child is not given food that will help jaw muscle development, for example, fruits and vegetables that require chewing, this can mean that the muscles required for speech don’t develop and language can be affected. If children have food that helps teeth to decay and teeth can become unsightly, even in very young children, they can become aware of this. One of my students described how a 7-year-old child had been referred for speech and language therapy, and when he was being assessed by the therapist, it turned out that his teeth were so badly decayed, he tried to conceal this by keeping his mouth tightly closed and of course, this meant he wasn’t able to speak properly. Of course, there are lots of other ways that healthy eating and drinking contribute to healthy living.

At Brambles they have developed what can be called a ‘whole systems’ approach to healthy living. We started calling it the Rs of Early Childhood Health Promotion because they have selected interventions that are relevant to the children and families; they are embedding healthy living activities into the routines of the nursery; the practitioners have become role models for the children, teaching the children the importance of the approaches by demonstration and example. What is also really important is that the interventions are realistic and some have no, or very little, extra resource. The biggest resource need is for a commitment to spend time reflecting and developing their approach. And of huge importance, is the way that Brambles have developed their health promotion approach on the foundations of their relationships with the children and their families in the setting.

It is so important that we identify ways of promoting children’s health and are doing all we can to turn the tide in relation to some of the important issues that are making children unhealthy. After all, healthy children will have higher levels of wellbeing and will learn better. What Brambles are doing is a great example of high-quality attention to promoting good health in their children.

About the author

Jackie Musgrave joined the Open University as Programme Lead for Early Childhood in October 2017. Before that, she worked in the Centre for Children and Families at the University of Worcester from April 2012 as the Course Leader for the BA (Hons) in Early Childhood (Professional Practice).

Jackie trained as a General Nurse and she did post-registration training to become a Sick Children’s Nurse at Birmingham Children’s Hospital.  Her professional interests as a Practice Nurse included chronic disease prevention programmes, childhood immunisations and women’s health promotion.

Jackie graduated with a Master’s degree in Early Childhood Education from the University of Sheffield, gaining a distinction for her dissertation as well as being awarded the Rutland Prize for Early Childhood Education. Her doctoral research explored the effects chronic health conditions on young children and ways in which practitioners could create inclusive environments for these children.

Jackie’s research-based book, Supporting Children’s Health and Wellbeing was published by Sage in May 2017.




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