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No alcohol for under fifteens

An alcohol-free childhood is the healthiest option, and if children do drink alcohol, it should not be before they reach the age of 15 years, according to new governmental advice to parents issued by the Chief Medical Officer.

The advice forms a main part of the Youth Alcohol Action Plan, published in June 2008 by the Department for Children, Schools and Families. It is in the form of a consultation document, with parents, health professionals, young people themselves and all other interested parties being invited to comment on the Chief Medical Officer’s assessment of the issue of drinking by children and adolescents and his proposals for reducing the harm associated with it. A particular feature of the new advice is guidance in regard to what counts as low risk drinking for children and adolescents, the generally known guidelines on low risk or `sensible’ drinking being based on evidence pertaining to adult populations. In relation to this, Sir Liam states that alcohol consumption during any stage of childhood can have a detrimental effect on development and, particularly during teenage years, is related to a wide range of health and social problems. Vulnerability to alcohol-related problems, Sir Liam says, is greatest among young people who begin drinking before the age of 15. The safest option, therefore, is for children not to drink at all until they are at least 15 and, preferably, 18. Sir Liam Donaldson formulated the advice on the basis of extensive research and work with a panel of experts who reviewed the latest available medical evidence and data from across the UK on the impact of alcohol and young people. Dr Rachel Seabrook, Research Manager of the IAS, was a member of the expert panel.

Launching the advice, Sir Liam Donaldson said: “This guidance aims to support parents, give them the confidence to set boundaries and to help them engage with young people about drinking and risks associated with it.

“More than 10,000 children end up in hospital every year due to drinking and research tells us that 15 per cent of young people think it is normal to get drunk at least once a week. They are putting themselves at risk of harm to the liver, depression and damage to the developing brain. Resulting social issues can lead to children and young people doing less well at school and struggling to interact with friends and family.”

Ed Balls, Secretary of State for Children, Schools and Families, said: “Parents have told us that they lack the health information and advice they need to make decisions about whether or how their children should be introduced to alcohol. So I hope the Chief Medical Officer’s advice will help them with the tricky task of deciding the best way of doing that.

“We want this advice and information to be a success and really help families. That’s why we’re asking young people, parents and all those interested for their views. I think all of us as parents need to look at this advice, see whether it’s right for us and ask whether we are doing the best thing for our children.

“Alcohol is a part of our national culture and if managed responsibly can have a positive influence in social circumstances. However when it is not managed responsibly it can cause real problems.”

Speaking for IAS, Rachel Seabrook said: “The Institute of Alcohol Studies welcomes these new guidelines recommending that children should not start to drink alcohol before the age of 15 and emphasising the importance of parental influence on young people’s drinking. We know of no evidence supporting the idea that introducing alcohol to children or young teenagers can protect them against dangerous drinking habits, whereas there is a considerable body of research showing a link between starting to drink at a young age and problems with alcohol in later life.

Additionally, young people need to be aware of the risks of drunkenness. Some of the dangers are far worse than vomiting and waking up on a friend’s sofa.”

The Guidance

The new advice specifically addresses the key points requested by Government in the Youth Alcohol Action Plan, and it is given in terms of 5 key points:

  • Children and their parents and carers are advised that an alcohol-free childhood is a healthy option. However, if children drink alcohol, it should not be before they reach the age of 15 years.
  • For those aged 15 to 17 years all alcohol consumption should be with the guidance of a parent or carer or in a supervised environment.
  • Children aged 15 to 17 years should never exceed adult recommended daily maximums. As a general guide, children aged 15 and 16 years should not usually drink on more than one day a week. Children aged 17 should drink on no more than two days a week.
  • Parental influences on children’s alcohol use should be communicated to parents, carers and professionals. Parents and carers require advice on how to respond to alcohol use and misuse by children.
  • Support services must be available for children and young people who have alcohol-related problems and their parents.

The CMO’s advice and the consultation document are accompanied by new reviews of the evidence in regard to alcohol consumption by children and adolescents which provide the scientific basis of the new advice. In regard to the advice that young people should delay the age they start drinking alcohol, this is because the evidence suggests that:

  • children who begin drinking at a young age drink more frequently and in greater quantities than those who delay drinking. They are also more likely to drink to get drunk
  • the earlier they start drinking alcohol, the more they are at risk of alcoholrelated injuries, involvement in violent behaviour and suicide attempts, having more sexual partners and a greater risk of pregnancy, using illegal drugs and experiencing employment problems and driving accidents
  • heavy drinking during adolescence may affect normal brain functioning during adulthood. Furthermore, young people who drink heavily may also develop problems with liver, bone, growth and endocrine development; and
  • the earlier they start drinking alcohol the more likely they are to develop alcohol abuse problems or dependence in adolescence and adulthood.

In regard to levels of consumption, the Chief Medical Officer recommends that :

“Children aged 15 to 17 years should never exceed adult recommended daily maximums (of 2-3 units for women and 3-4 units for men on any single day). As a general guide children aged 15 and 16 years should not usually drink on more than one day a week. Children aged 17 should drink on no more than two days a week.”

The CMO explains that children and young people who drink frequently and binge drink are more likely to suffer alcohol-related consequences. While individuals vary in the way that they react to the consumption of alcohol, young people may have a greater vulnerability to certain harmful effects of alcohol use than adults. Young people also lack drinking experience and decision-making skills about amount, strength and speed of drinking. Brain development continues throughout adolescence and into young adulthood, and drunkenness, binge drinking or exceeding recommended maximum alcohol limits for adults should always be avoided.

The CMO advice is that frequent or excessive drinking by children and young people is particularly dangerous because:

  • it presents particular risks in terms of health, unplanned and unprotected sexual activity and violent behaviour
  • it is more likely to lead to binge drinking and alcohol dependence in young adulthood
  • it leads to a higher likelihood of involvement in illegal drug use, crime, and lower educational attainment

The importance of parents

In regard to the role of parents, the CMO recognises that they face a difficult task, and that many may feel ill-equipped to deal with their children’s current or future drinking. His advice to them is to:

  • set limits and determine the consequences for drinking behaviour
  • negotiate boundaries and rules for appropriate behaviour in relation to alcohol; and
  • show disapproval of alcohol misuse, such as getting drunk, drinking when they have been told not to or getting into trouble after drinking

This advice is based on the evidence that:

  • a permissive approach by parents to the use of alcohol by their children often leads to heavy and binge drinking in adolescence
  • family standards and rules, as well as parental monitoring, delay the age at which young people first drink
  • frequent or excessive drinking by parents increases the likelihood that children will also consume more alcohol and be at greater risk of harm; and
  • warm and supportive parent–adolescent relationships lead to lower levels of adolescent alcohol use and misuse.

Further details can befound at:
www.dcsf.gov.uk/consultations

The closing date for the consultation is 23 April 2009.