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Signs and symptoms

   Guidance on identifying a child from a family where parental alcohol misuse is a factor

The information in this section is for professionals whose role is solely in relation to children (mainly teachers, school nurses and other primary care workers) seeing under 16 year olds without a parent being present).

In the absence of information from other sources, and unless a child discloses that one or other or his parents have drinking problems, it is difficult, if not impossible, to identify children in this specific situation. The signs and symptoms are generally the same as those exhibited by children experiencing a range of other problems. The lack of specific signs and symptoms of family alcohol misuse is one of the reasons professionals working with children are wary of dealing with this problem. The question asked - 'well how would I know?' expresses an understandable concern, especially where making direct enquiries can be so difficult and, sometimes, ill advised.

Firstly it is important to say that if a child with whom you work is showing no signs of stress or distress of any kind, there is no action to be taken.

Essentially this is a child-centred approach starting with how the child is and reacting to that.

Professionals working with children need only to be aware that alcohol misuse could be a factor for a child for whom they have concerns, and to be aware of what they can do within their role to support the child.

Signs and symptoms in children
The way this problem presents - i.e. the signs and symptoms - are set out in detail below. These are drawn from case examples and the evidence base. So if the child in front of you is reacting in any of these ways then professionals should be concerned and should be aware that parental alcohol misuse is a possible factor.

As stated above these signs and symptoms are also seen in children with a range of other problems - particularly that of a having a parent with a mental health problem. It is the combination of information, starting from the presentation of the child, through to what they may say and what else is known from other sources, that will confirm family alcohol problems.

However expert opinion on this topic stresses the importance of adopting a child centred approach and reacting appropriately to what the child presents. This is an adequate response - i.e. it is not always essential to confirm whether parental alcohol misuse is, or is not a factor.

Knowledge of the parents
Many professionals are only likely to attribute parental alcohol misuse as a problem in cases where they have knowledge and experience of the parents. School playground staff reporting that a parent showed signs of having been drinking, a parent behaving inappropriately, who is argumentative or aggressive and whose breath smells of alcohol are the situations most commonly experienced by teachers and primary care workers.

Whilst these situations should alert primary care workers and school staff to keep an eye out for distress in the children, to react only when there is knowledge of the parents in this way would be a mistake. Knowledge about the parents, for professionals working solely with children, is perhaps best seen as:-

• confirmation that concerns about the children might well be caused by family alcohol misuse and therefore confidence, for those working solely with the children, that enabling and facilitating factors that promote resilience will be helpful to the child
• a prompt to watch a child who is not causing concern to check that any distress has not been overlooked.

Parental drinking reported by a third party
This is another source of information. A colleague might have noticed that a parent was under the influence of alcohol, or it might be that professionals report this across professional boundaries, either formally or informally. If formally reported, it is likely that parental alcohol misuse is a concern for at least one professional group and that they are concerned that other professionals working with the children are aware of the circumstances in which a child is living. Informal reporting is more likely to be part of the general information exchange between professional groups - between practice staff for example. The value of the information is the same as in the above situation. It should not be the only reason professionals become concerned about the effect of parental drinking on a child. Observation of the child should dictate any action taken and, again, this information is only either confirmation of the cause of your concern or a prompt to keeping a watchful eye on children for whom you are presently concerned.

Community knowledge
Some families, particularly in areas with small populations, can become known locally as a 'problem family', with at least one component of this problem possibly being parental alcohol misuse. Generally, awareness and prior knowledge (perhaps via previous siblings in the case of school teachers, or even via the local paper) might confirm or add to knowledge about a child's circumstances. In one way, at least, such information can be unhelpful - attributing a child's behaviour to 'being one of the Jones's' can deny the fact that professionals in contact with that child can make a significant contribution to supporting that child and building in resilience.

Key points Most children from families where parental alcohol misuse is a factor exhibit signs of distress of one kind or another These, taken from the evidence base, are listed in more detail in the toolkit However these are similar to the symptoms of child under duress for a number of reasons A child-centred approach - reacting appropriately to how the child is, is the recommended approach The likelihood of alcohol misuse being a factor means that enabling and promoting resilience factors need not wait until proof is obtained However the absence of symptoms means that there is no action to be taken by professionals working solely with children, whether or not information is known about parental drinking Knowledge about parental drinking should be seen as 'supporting' information, prompting a watchful eye in asymptomatic children and not prerequisite to taking action with children exhibiting symptoms.

 

To a review of the literature: resilience factors section

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