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South West Safeguarding and Child Protection Procedures
South West Safeguarding and Child Protection Procedures South West Safeguarding and Child Protection Procedures

5.1.5 Smoking Policy


  1. Introduction
  2. The Immediate Effects of Environmental Tobacco Smoke in Children
  3. The Implications of becoming a Smoker whilst being Looked After
  4. Recommendations

1. Introduction

The rights of substitute carers to smoke must always be balanced against the rights of children to remain healthy. This is especially true for Children Looked After, who frequently come into the care system with neglected or impaired health.

The National Minimum Standards for Fostering Services (England), 2011) emphasise the importance of foster carers receiving sufficient training on health with particular emphasis on health promotion. The outcome in Standard 6, Promoting Good Health and Wellbeing, is about children living in a healthy environment, “where their physical, emotional and psychological health is promoted and where they are able to access the services to meet their health needs”.

The issue is therefore not one of banning prospective adopters and new carers, but of engaging with them, providing information and advice and facilitating access to smoking cessation programmes. Stopping smoking is the single most important thing that any adult can do to protect their health and increase their life expectancy.

CoramBAAF strongly recommend that all substitute carers should be pro-actively encouraged to stop smoking. If they are unable to stop smoking, they should always follow the National Safety Council Guidelines for parents that are listed in the recommendations below.

2. The Immediate Effects of Environmental Tobacco Smoke in Children

Young children are particularly susceptible to the effects of second-hand smoke because their lungs and airways are small and their immune systems are immature. Consequently, when exposed to environmental tobacco smoke they are more likely than adults to develop both respiratory and ear infections. Children also have higher respiratory rates than adults and consequently breathe in more harmful chemicals, per pound of body weight, than an adult would in the same period of time.

3. The Implications of becoming a Smoker whilst being Looked After

The World Health Organisation (WHO) (1999) reported that children living with parents who smoke are nearly three times more likely to be smokers than those whose parents do not smoke. Children of smokers are more likely to take up the habit because they copy the behaviour of adults. Growing up in a household where adults smoke often means that children perceive smoking as the “norm”. Their parents’ approval or disapproval of the habit is a significant factor in determining whether a child will eventually become a smoker.

Many young people come into the care system as smokers. Others only become smokers whilst being looked after. The health implications for all these young smokers are serious and those responsible for their welfare should do everything that they can to help them quit the habit.

Carers should also be supported in providing an environment which encourages improvements in the health and wellbeing of children and young people in their care National Service Framework for Children, Standard 2, Supporting Parents or Carers (archived).

All who recruit foster or adoptive parents need to give the protection of the health of children in their care a high priority and will, in the future, have to balance the positive elements of any placement against the negative impact of smoking.

This means that, wherever practical, all placement teams should try to protect children from exposure to second-hand smoke at home. Placing authorities also need to be aware of potential legal action in the future if a child develops a smoking-related disorder after being placed in a foster or adoptive home in which family members smoke.

4. Recommendations

The latest recommendations for foster carers and prospective carers were made in 2007 by CoramBAAF (Practice note 51). Assessing social workers, supervising social workers and children’s social workers in Torbay should ensure that all the following recommendations are followed:

  • Children under two years old should not be placed with carers who smoke because of the potential risk to health. This age limit should be increased to all children less than five years old. 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. In practice this applies to all children up to 5 years old;
  • All children with a disability which means they are often physically unable to play outside, all children with respiratory problems such as asthma, and all those with heart disease or glue ear should not be placed with smoking families;
  • 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;
  • Children from non-smoking birth families should not be placed with substitute carers who smoke;
  • All older children, who are able to express a view, must be given a choice to be placed with a non-smoking family;
  • All carers should be advised about the risks of buying cigarettes for adolescents. Cigarettes should never be used as a reward for good behaviour in adolescents;
  • The National Safety Council (NSC) (2004) has produced guidelines for parents on what practical steps they can take to minimise children’s exposure to tobacco smoke, if they are unable or unwilling to stop smoking. All foster carers, respite carers, adopters and childminders should follow these guidelines, which should also be incorporated into preparation courses. This advice includes:
    • Don’t smoke around children or permit others to do so. Their lungs are particularly susceptible to smoke;
    • Keep your home smoke-free. Because smoke lingers in the air, children may be exposed to smoke even if they are not around while you are smoking;
    • Smoke only outside the house;
    • If you must smoke inside, limit smoking to a room where you can open windows for cross-ventilation. Be sure the room in which you smoke has a working smoke detector to reduce the risk of fire. We should advise carers that they should only smoke outside;
    • Never smoke in the room where your child sleeps and do not allow anyone else to smoke there;
    • Never smoke while you are washing, dressing, or playing with your child;
    • Never smoke in the car with the windows closed, and never smoke in the car when children are present. The high concentration of smoke in a small, closed space greatly increases the exposure of other passengers.
  • 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 that 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. All agencies should therefore encourage all their carers to stop smoking by:
    • Providing information on the effects of passive smoking in children;
    • Providing information on the effects of smoking on adult health;
    • Providing regular training and information for fostering, adoption and permanency panels;
    • Advertising local and national NHS services for stopping smoking;
    • Resourcing nicotine patches for carers, if necessary;
    • Discussing smoking risks as a routine part of the recruitment process and at every review for all foster carers;
    • 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.
  • Carers who smoke should receive extra information about the risks of burns and fires from smoking. Fire and burns are the leading cause of death in the home for children. In the UK, 10 per cent of fires ignite with smoking related material and cause between 130 and 180 deaths annually, or one in three of all deaths from fires (Department of Health, 2001);
  • Carers who have successfully given up smoking should not be allowed to adopt or foster high-risk groups (children under five, children with a disability, chest problems, heart disease or glue ear) until they have given up smoking successfully 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. After 10 years of not smoking an applicant is classed as a non-smoker for insurance purposes;
  • Local authorities and other fostering service providers should move progressively to a situation where no more smoking carers are recruited. This will not only improve the health of some very vulnerable children but will protect the agencies from potential legal action in the future;
  • 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 Children Looked After to stop smoking. Promoting a positive health message also means that they should not smoke in a car which will be used later to collect children and young people; not smoke outside case conferences or reviews; and not smoke with young people, nor in the view of children.

CoramBAAF (2007) Reducing the risks of environmental tobacco smoke for looked after children and their carers: London

Department of Health (2004) National Service Framework for Children, Young People and Maternity Services, London: The Stationery Office

National Safety Council (2004) The ABCs of Secondhand Smoke, Washington DC: Environmental Health Center, National Safety Council.

Office of the United Nations High Commission

World Health Organisation (1999) International Consultation on Environmental Tobacco (ETS) and Child Health, Consultation Report, Geneva: World Health Organisation WHO/NCD/TFI//99.10

Department of Health (2012), Smoking Health Harm Campaign Launched