How Much Do Paediatricians Know About Poverty within the Paediatric Population?

ABSTRACT

Aims Poverty is an ever increasing problem with 4.2 million children living in poverty in the UK in 2019, an increase of 600,000 from 2011(1). This has been particularly exacerbated by the COVID pandemic with an estimated 200,000 more children living in poverty in the UK since the pandemic(1). Poverty can affect multiple aspects of children's health and wellbeing, putting additional strain on already stretched NHS recourses. We wanted to assess paediatricians' knowledge about poverty, particularly around prevalence, risk factors, the effect on children's health and wellbeing and how to help families if there are concerns of poverty. From this we hoped to highlight areas where more education and support is required. Methods We designed an online survey with 11 questions including a mixture of multiple choice and free text answers. The questionnaire was distributed to all doctors working in paediatrics at a tertiary paediatric hospital, over a 4 week period. Results There were 29 respondents in total, with grades ranging from FY1 to consultant. Nearly two-thirds of respondents underestimated the prevalence of poverty in the UK and 38% underestimated the prevalence by half or more. Over 80% of respondents underestimated the percentage of children living in poverty locally. All respondents recognised parental disability and unemployment as risk factors for poverty and 90% recognised child disability or serious illness as a risk factor. Only one person suggested parental drug and alcohol use as a risk factor. The respondents were able to list a wide range of health implications of poverty, the most common answers being failure to thrive/poor nutrition, obesity, tooth decay and poor mental health. Two-thirds of respondents admitted not feeling at all comfortable about asking parents about poverty and 40% felt that they never screen for poverty when assessing patients. To assess for poverty 34% would ask about employment, 24% about housing and 41% about benefits and additional supports. All respondents would like further education and support around poverty. Conclusion Overall there was good understanding of the health implications associated with poverty and the risk factors for poverty, but an under-appreciation of the scale of the problem. The majority of doctors do not feel comfortable asking patients and families about poverty, and do not regularly ask about poverty when assessing patients. In order to identify children living in poverty and be able to signpost families to resources that could be beneficial to them, we need to equip paediatricians with the knowledge and skills to assess for poverty and what resources are available for families in the local area. To aid this we have produced a poster to be used to in the local Emergency Department and outpatients to remind doctors about poverty, advice on how to approach the topic and resources available in the hospital and in the local area that be used to sign post families.