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Reducing the risks of environmental tobacco smoke for looked after children and their carers

Recommendations to protect children from second-hand tobacco smoke: coramBAAF Adoption and Fostering Academy Practice note 68

We fully acknowledge that many excellent substitute carers smoke. There is also a national shortage of both foster carers and adopters. Despite this, all those who recruit foster carers or adoptive parents need to give the protection of the health of children in their care a high priority and will have to balance the positive elements of any placement against the negative impact of smoke exposure. This means that, wherever practicable, all placement exposure to second-hand smoke at home. Placing authorities also need to be aware of potential future legal action if a child develops a smoking-related disorder after being placed in a foster or adoptive home in which family members smoke.

Recommendations

1. All carers should be encouraged to implement a smoke-free home and car.

  • Homes should be smoke-free.
  • If carers or visitors do smoke, they should smoke right away from the house.
  • Carers should not smoke in the presence of children or allow others to do so.
  • Social workers should request that birth family members do not smoke at or immediately prior to contact visits.

2. Children under five years old should not be placed with carers who smoke because of the potential risk to health. This is because of the particularly high health risks for very young children and toddlers who spend most of their day physically close to their carers.

3. All children with a disability, which means they are often dependent on and in close proximity to their carer, and all children with respiratory problems such as asthma, and all those with heart disease or glue ear should not be placed with smoking families.

4. In all long-term fostering, kinship and adoptive 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.

5. Carers who have successfully given up smoking should not be allowed to adopt or foster those children identified in recommendations 2 and 3 till they have given up smoking for a minimum period of 12 months. This is because relapse rates in the first three to six months are high; after six months the risk of relapse is less; and after 12 months most people will be permanent non-smokers.

However, this approach may not be appropriate for kinship carers. While prospective foster carers and adopters have a period of time during recruitment and preparation for their caring roles where they have the opportunity to evaluate and change smoking choices, kinship carers often take up the role within a much shorter time frame. For this reason, we recommend that kinship carers are:

  • advised about the health risks of smoking and second-hand smoking;
  • encouraged to implement a smoke-free home and car;
  • encouraged to give up smoking;
  • signposted to local smoking cessation services and encouraged to use nicotine replacement products.

6. Children from non-smoking birth families should not be placed with substitute carers who smoke.

7. All older children, who are able to express a view, must be given a choice to be placed with a non-smoking family.

8. All children and young people who smoke should be provided with support to give up smoking.

All carers should be advised about the risks of buying cigarettes/e-cigarettes for young people. (It is illegal to purchase cigarettes or e-cigarettes for under-18-yearolds.) They should never be used as a reward for good behaviour.

9. Agencies should encourage all their carers to stop smoking. Stopping smoking will protect not only the health of children but also the health of their carers. Agencies have a primary responsibility to ensure that where a relationship is established between a child and a carer, this is maintained for as long as the child needs it. It is a tragedy for a foster carer or adopter to be unable to continue to care for a child who has already experienced significant loss because of preventable illness or premature death. Agencies can support smoking cessation by:

  • providing information on the effects of passive smoking in children;
  • providing information on the effects of smoking on child and adult health;
  • providing regular training and information for fostering, adoption and permanency panels;
  • advertising and signposting carers to local and national NHS services for stopping smoking;
  • discussing smoking risks as a routine part of the recruitment process and at every foster carer review;
  • giving consideration to the smoking habits of other family members and friends who visit regularly, e.g. grandparents or older children who no longer live at home should also be part of these discussions.

10. E-cigarettes are not the same as cigarettes containing tobacco and are often used by people when quitting smoking.

If carers or other family members are using e-cigarettes, they should be advised to do so only when children (of all ages) are not present. Ideally, carers will not be using e-cigarettes. This position will be reviewed regularly as new research evidence becomes available.

11. Fire safety: carers who smoke should receive extra information about the risks of burns and fires from smoking.

Poorly made or counterfeit chargers for e-cigarettes have caused house fires. Carers need to be advised to buy e-cigarettes only from reputable outlets, use the correct charger for the device, and not to leave an e-cigarette charging unattended or overnight (Royal Society for the Prevention of Accidents, 2014).

12. E-cigarette liquid should always be kept out of reach of children. There is a risk of poisoning from e-cigarette liquid, and this can be serious if large amounts are swallowed, especially by young children (Royal Society for the Prevention of Accidents, 2014).

13. Local authorities and other fostering service providers should move progressively to a situation where children are placed only in smoke-free homes. This will not only improve the health of some very vulnerable children but will protect the agencies from potential legal action in the future.

14. Social workers should carefully consider the importance of promoting non-smoking and the positive messages that they convey to young people. They should actively help all looked after children who smoke to stop smoking.

Social workers and support/key workers who smoke need to ensure that they are not promoting smoking by default through their behaviour. They should ensure that they do not smoke immediately prior to meeting children or young people, share lighters, etc. They should be aware that witnessing e-cigarette usage may influence children.

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