Woman's Hour - Anne Longfield, Teenage cancer and fertility, Elsie Widdowson and location sharing apps

Episode Date: January 2, 2020

The Children’s Commissioner for England says that we need an urgent review of the care system. She is concerned that around 30,000 children in care are living miles away from friends and family, while others are living in unregulated and inadequate placements. Anne Longfield explains what she thinks needs to be done. Cancer treatment can have an impact on fertility, but a recent survey by the Teenage Cancer Trust suggests that nearly a third of young people did not have a discussion about their fertility before starting treatment. We speak to 18 year old, Ellie Waters who was diagnosed with a rare form of cancer aged 14, Dr Louise Soanes, a Teenage Cancer Trust Nurse Consultant for Adolescents and Young People and Professor Pamela Kearns, a Consultant Paediatric Oncologist. Elsie Widdowson was one of the British dietitians responsible for overseeing the government-mandated addition of vitamins to food and wartime rationing in Britain during World War II. Dr Venki Ramakrishnan the President of the Royal Society tells Jenni about her achievements. Many parents see location tracking apps as an easy way to keep tabs on their teenagers. We discuss the merits and drawbacks of on keeping tabs on your teenagers.Presenter: Jenni Murray Producer: Ruth Watts

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, Jenny Murray welcoming you to the Woman's Hour podcast for the 2nd of January 2020. You may, over the holidays, have downloaded a tracking app and have known exactly where your teenager has been. How good an idea is it to have your child under constant surveillance? The Royal Society began in 1660. The first fellowship to be awarded to a woman came in 1945. As part of our series on the great female scientists who were honoured today, Elsie Widowson, who worked on diet and nutrition, and the hundreds of teenagers who receive a diagnosis of cancer, the impact of

treatment on their fertility. Now, it's almost a year since we last spoke to Anne Longfield, the Children's Commissioner for England, about the provision of care for children who need to be looked after. Then she told us there'd been poor progress in improving matters and she said the Department for Education didn't understand what was driving demand. One year on she's released a report revealing that some 30,000 children are living miles away from friends and family and she's called on the government to address what she describes as the scandal of private firms making obscene profits by providing residential care for vulnerable children.

There have also been reports of children being placed in homes that are not regulated, which puts them at risk of exploitation. Well, Anne Longfield joins us from Leeds. And there's been a 4% rise in the number of children who need care since we spoke at this time last year. What's been done in that year to address your concern? Well, good morning, Jenny. As you say, there has been an increase. There's also been a particular increase in the number of older children coming into care. If you think back 20 or 30 years, we would all think that these were younger children living with foster families. But now a quarter of all children in care are 16 and 17 year olds, which is a big, big difference.

There's been concerns. I've been pleased to see in the headlines over the last year. I don't want to see any of these experiences for kids. But if children are experiencing this, I'm pleased to see them in the headlines. And we've been talking about children in inappropriate accommodation, many miles from home, and at risk of their own safety. I'm pleased that the government have committed to a manifesto commitment to review the care system. I think it needs reviewing from top to bottom and needs resetting in a way that prevents children getting into crisis and enables them to recover once they're in care. You've called for that review,

you say as a matter of urgency. Why is it so urgent? Well, we've heard a lot about adult social care for many, many years, but much, much less about children's social care. This is a system which is supporting the most vulnerable children, 75,000 children. Many more will need additional help and protection living with their families or with relatives. And, you know, these children are experiencing often low-level care. Most of the children will get a great experience when they're in care, but there are too many where instability is what they experience, where they're being passed from pillar to post, where there isn't the kind of accommodation or treatment that they need, which was particularly the case in the recent report we published, where actually now four in 10 children are living out of the area where they would call home. Many say that they feel like they've been passed around

by parcels. Many can't even identify where they are on a map. And this not only has huge impact on their own mental health and recovery, but also means just some of the things that we'd all expect children to experience, like going to a good school, isn't something that's part of their life. I know you've spoken to children themselves. What sort of things have they actually said to you about the worries that they have about the way they're treated? Well, children in these situations often will say, look, we've been moved around very swiftly. We don't even bother to unpack our bags. We don't bother to form relationships because we don't know where we're going next. We don't see anyone familiar. Obviously, if they're many miles

away from home, it's much more difficult for their families to visit or indeed their social workers. So these are things that we would say, you know, are really damaging for any child, but for a very vulnerable child, and often these are the ones with the most complex needs, half of all those children will have social and emotional needs. Particularly, particularly damaging. And rather than helping them recover and being able to build their life for the future,

it really is not only kind of keeping them in the place they are, but also holding them back completely. You've used some very strong words in your report. You used the word scandal and obscene profits in your description of private firms involved in care. Why such strong language? Well, what we've seen is a care system which is fundamentally creaking at the seams. The profile of children and the number of children needing care now is it's much much different from one who was envisaged. Local authorities have been under unprecedented financial strain that's meant that they've all withdrawn from the kind of provision the children's homes and the like that the children would need in the first place. Now that's meant that there just aren't the beds available there aren't the specialist provision available,

and therefore the private sector have come in and are charging huge amounts. Now, what you see with that is councils have done their best, actually. They've protected these budgets. But what means that much, much more money is now being spent on fewer and fewer children. We went to one area where actually 20% of the budget was being spent on just 10 children. And it's not unusual now to see annual costs for a child needing complex needs have been £200 or a quarter of a million pounds a year. Now, by anyone's means, that's not sustainable, even if it was great quality, and it's not always great quality. So something has to change. Now, I think that change can only come from central government. I think they need to intervene with

finance to provide more residential places for this new group of children that's coming into care. They need to provide more money to be able to prevent those children coming into care in the first place and preventing crisis, but also to ensure that actually there is a national system for children in care. Because this is delivered by councils, it's ended up with a system where essentially you've got 150 different care systems. Now, that's not something I think anyone can keep a handle on. And for these most vulnerable children, I think centrally government needs to be sure that they are getting the treatment we'd want for any of our children. Now, the Department for Education tells us £1.5 billion has been pledged for child and adult social services.

You mentioned earlier that they have promised a review of the system. They've also promised £45 million to the Adoption Support Fund. How encouraged are you by those promises? Well, I will always welcome those investments. Money's important. It needs to be well spent, but money's important it needs to be well spent but money's important but the local government association have said that three billion pounds needed just to stand still and if we're going to get ahead and actually offer the support needed by the children who are on the edge of care and by government's own statistics that's one in ten children I think we need much nearer

to 10 billion pounds now looking in the great scheme of things, over this election period, we've seen huge numbers being pledged for investments all over the place. These are the most vulnerable children. Their vulnerability doesn't go away if we don't help them when they need it. And actually, the state needs to become a better parent when they're in that situation. Now the Guardian reported that thousands of children are being placed in unregulated homes. How concerned are you about that? I'm really really worried about children in this situation. These are often 16 and 17 year olds. Again, remember, these are the ones that are the biggest rise in children

coming into care. Many will be involved in gangs and at risk of criminal and sexual exploitation. There aren't the places there and councils will say, look, we ring place after place. And when we get to the 200th place, what do we do? There aren't the places there for them. But it can never be right that they're placed in unregulated provision. And again, government needs to step in here and regulate anywhere where these vulnerable children are living. How encouraged are you by the National Health Service agreeing that an 18-year-old who's been in care should not be transferred immediately to adult services once they achieve their 18th birthday how likely is that to mean an end to what i think has been known for a long time as the cliff edge for children who are leaving care well this is this is a good

move for any children but for those that that are particularly vulnerable, then it is very welcome. The NHS have made some changes in their 10-year plan. I mean, not only being able to get 10 years of money to be able to plan it for the long term, but also specifically looking at children and specifically looking at breaking down that barrier between child and adult services. There's a lot the NHS needs to do for children's mental health. And, you know, that is in the headlines today in itself. But admissions to hospital for eating disorders in under 18, more than doubled in the past year. Yeah, I mean, we know the prevalence of mental health conditions

has been increasing for older teenagers, especially girls. That's often seen in eating disorders. The NHS have done actually relatively well in this area in providing more beds. So it may be that more are being admitted because more is available. But it doesn't let anyone off the hook in terms of what's needed, which I think is actually an NHS counsellor in every school. I mean, all of this comes back to the central point that, you know, we all want children to get the best childhood they can, but mental health is now being seen as part and parcel of growing up for an awful lot of families and children.

For the most vulnerable, everyone is chasing their tails, trying to put into place something where children could be seen to have kind of reduced risk for that period of time. Actually, we need to get ahead of the game, help children before they fall into crisis, ensure that well-being is part of school and ensuring where children are in a tough place when they're growing up, they get specialist help that helps them recover and helps them plan for their future. Anne Longfield, Children's Commissioner for England. Thank you very much for talking to us. Now, the Royal Society was established in 1660, and it's the world's

oldest independent scientific academy. But it was not until 1945 that the first woman was invited to become a fellow. Well, as part of our series remembering some of the great female scientists who were eventually honoured, today we focus on Elsie Widowson, who was made a fellow in 1976 for her work with Dr Robert McCance on diet and nutrition. Dr. Venki Ramakrishnan is the president of the Royal Society. Venki, how would you describe the work she did? I think the work she did with Robert McCance laid the foundation for how we know what nutrients we have in all of the common foods we eat. And she and McCance went on to look at the nutritional composition,

not just proteins and carbohydrates, but also what we call micronutrients, minerals, vitamins, trace elements, and so on, of every kind of food that people in Britain would eat. And in fact, in their tables, there are 15,000 items which have been characterized. It was an encyclopedic work. And I believe it went through four or five editions over a period of 50 years. How did she and McCance work together? Was it a completely equal relationship?

Well, McCance was eight years older, and he was initially, anyway, very much considered the senior partner in the collaboration. She met McCance because she was working at a hospital looking at the nutritional composition of foods, and he was visiting, and he had looked at the sugar content of various fruits, something that Widdowson had actually done for her master's work. And she pointed out that McCance was wrong because the way he was determining it would destroy some of the sugars in the fruit.

So he had underestimated it. And he was so impressed that he invited her to work with him and obtained a grant for her through the Medical Research Council. Now, what was their contribution to the diet of World War II, which, of course, our parents and grandparents used to tell us, oh, you know, it was all very rationed. Yeah. So, you know, Britain, the joke is that Britain was never as healthy either before or after as during the war because there was severe rationing due to blockade and a shortage of food.

And so as their contribution to the war effort, Wittelsen and McCance developed a set of rations for the British population. They had figured out that not everybody needs exactly the same amount, and so they knew what the variation was. And when they came out with their diet, a lot of people were, you know, furious because the rations for milk, eggs, and meat was very, very low. And they, you know, many of her critics thought it was insufficient. But they did realize that if you had to take less milk and meat and cheese, you had to fortify bread with calcium. And in fact, even today, when there's no such shortage,

bread is fortified with calcium as a result. And the critics said that this diet wouldn't be enough to lead a very active life. And so they went to the Lake District and hiked for 36 hours nonstop with elevation climbs of 7,000 feet. And so, you know, they showed that it was a perfectly healthy diet. She did seem to go to great lengths in her experiments, using herself as a guinea pig, not just long walks in the Lake District. Yes, they both did. And what they would do is they wanted to see, for example,

they discovered by accident that the iron released in the body was not immediately excreted. It wasn't excreted at all. And so they injected themselves with iron and found it wasn't excreted. And so the body controls iron by absorption, not by regulating the excretion. And so then they started wondering about other minerals, and they started injecting themselves with all sorts of minerals to see how quickly the body would get rid of them and whether it would be through the urine or through sweat, there's a picture of Widdowson sort of dousing someone with water to collect this woman's sweat to find out what salts and minerals were in the sweat. So they were very thorough, and they would experiment on themselves. And at one point, they injected themselves with strontium,

which was contaminated with some sort of bacterial toxin. And they developed very high fever and had to be taken to the hospital. So that was the end of their strontium experimentation. So science has a risky business for yourself. I know your parents met her in this country. They were also nutritionists. What kind of woman was she? They, you know, they, Whittleson, of course, was a world famous leading authority in nutrition.

And, but despite that, I just spoke to my father about it. And he said that she was extremely friendly to both my mother, who was really primarily interested in the effect of malnutrition on learning. And she said that Wittesen was extremely interested because they were working on problems of malnutrition in India and how reversible it could be. And they found her extremely hospitable, not at all kind of standoffish and, you know, arrogant or anything like that. She was very approachable. Why did it take the Royal Society so long to recognize the value of her work? Yeah, it's interesting. So McCance was eight years older, and I believe he was elected to the Royal partner in the collaboration. And so when they recognized McCants, they thought, well, that they'd done that. But I think a lot

of it was also, you know, the sexism that's prevalent, probably prevalent today as well, but much more so in the 40s and 50s. But, you know, if you read Wittesen's biography, you didn't get the feeling that she thought of herself as somehow under-recognized. And she went on not only to become a fellow of the Royal Society, but she was made a dame and even more distinguished, she was a companion of honour. And how important was her contribution to what we understand about food now, today? I think the idea that, you know, you have to break down, you have to look at food as you eat it, not the raw material, but the actual prepared food, and break it down into its various component parts. That is very important. And it's her training as a chemist. You know, she was one of only three of 100 chemistry undergraduates in

Imperial in the early 1900s. I think her training as a chemist gave her that precision to look at food. Dr Venky Ramakrishnan, thank you very much indeed for joining us this morning. Now still to come in today's programme, the rise and rise of the tracking app. You can always know where your teenager is, but will he or she thank you for your surveillance? And the serial, another episode of Charlotte and Lillian. Now, earlier in the week, you may have missed Joan Smith discussing the case of the young woman accused of lying about being raped and convicted for public mischief in Cyprus.

And yesterday, we looked ahead to the new year and the big questions, social care, health and women in the workplace. And if you listened to the phone in on Monday about habits and how to make and break them, there is now an article with tips for creating good habits on the Women's Hour website. And whenever you miss the live programme, you can always catch up by downloading the BBC Sounds app. Now, we know that every year some 2,600 teenagers are told they have cancer. Treatment can be brutal, and a recent report from the Teenage Cancer Trust revealed that 29% of the young people who need to be treated don't have any discussion about the impact it might have on their fertility.

What difference could such a discussion make? Well Professor Pamela Cairns is a consultant paediatric oncologist and joins us from Birmingham. Dr Louise Soans works with the Teenage Cancer Trust and Ellie Waters is 18 and was diagnosed with a rare tissue cancer when she was 14. Ellie how did you discover you had cancer? So essentially it was a an accumulation of symptoms over time the biggest one being I had this lump in my left butt cheek that just kept growing but I never really thought anything of it and as I was quite a fiercely independent person I didn't want to tell anybody about it and I was under this naive

impression that I'd just go away and all my problems would go away but it wasn't until you know I got constipation trouble urinating those kind of symptoms that I eventually went to the GPs and I had an emergency abscess removal operation, but they discovered it wasn't an abscess, it was actually a tumour. What treatment did you have to have? So together I had 18 months of treatment, I had nine cycles of intensive chemotherapy, I had 28 sessions of radiotherapy and one year of maintenance chemotherapy.

Ah, horrible. Yeah, quite the ordeal. Ah. Yeah. Horrible. Yeah, quite the ordeal. Yeah, a real ordeal. Now, how did you discover that there might be worries about your fertility? Did anybody raise it with you? No. The doctors obviously knew from the onset that this type of aggressive treatment would affect my fertility but I was never told about that not until I went for my first radiotherapy kind of induction

appointment and they read out this huge list of possible side effects and infertility was one so yeah it did take me by surprise and I was quite shocked but at that moment I was kind of in survival mode so I you know I just kind of accepted the fact and focused on surviving the treatment rather than the implications of the treatment. What about now that you're much older looking back on it? It is hard now because I realise how disadvantaged I am in that sense I can't it's kind of hit me that not only am I infertile but I will never be able to carry a child so my only real option is adoption so I just think it is hard and it's an obstacle that you have to overcome and it just makes your life and future a lot more difficult but I believe you kind of have a choice in life.

You can either take it in your stride and embrace the fact or you can grieve the loss in a sense. But I'm going to choose a former and just kind of take it in my stride and embrace it. Louise, what concerns does the Trust have about this fertility question? I mean, the kind of chemotherapy and radiotherapy that Ellie had to somebody who had a short course of chemotherapy, i.e. me, I really sympathise with you. Mine was short and not sweet at all.

It's a big worry, isn't it? It is a big worry. And the Teenage Cancer Trust, as you said, have surveyed our young people and she said 29% of them said they didn't have a conversation about their fertility preservation or the risk to their fertility from their cancer treatment. And from the same survey, 44% told us if they did have a conversation that they weren't satisfied with what information was given to them

or how the information was given to them. And we know there are places that do this extremely well and lots of people who do do it well. But for those young people who don't get that information, then it's difficult for them, as Ellie sort of described really, to make decisions about their future as a parenthood. And there are lots of young people we know want to be parents and look forward to being parents.

And if they aren't given the information that enables them to make the decisions that will enable them to do that as an adult then what we're asking for is for more conversations and for providers of health care to follow the guidance that exists and for those conversations to be tempered so that they meet the needs of the young person sitting in front of clinicians and nurses who are involved in those conversations. Pamela, what guidelines do cover treating teenagers for cancer as regards fertility? So there are guidelines. The Children's Cancer and Leukaemia Group, which is the professional group who most nurses and paediatric oncologists

and related healthcare professionals are a part of. And they have published guidelines that were actually updated last year about, you know, what the risks to fertility of different types of treatment are and what the options are available. But I think what is really important from what both Elio and Louise says is that initial conversation. When any young person or child is diagnosed with cancer, they have an awful lot of information given to them at that point. First of all, the diagnosis, and then all the details of treatment, be it chemotherapy, radiotherapy, surgery or a combination of all three. And part of that conversation has to be the side effects of treatment.

Now, for most of the time, that initial conversation focuses on the acute side effects, the things that are going to happen to somebody immediately, the risk of hair loss, the risk on the immune system, for example. But that conversation does need to also include the longer-term side effects, and the impact on fertility is one of those really important ones. It's all very well, Pamela, giving information and then expecting somebody to make a decision.

What kind of decisions can a young person make? Here they are faced with treatment for cancer. They're worried about their life. Are they really going to be able to make a decision about their fertility and what might be done to help them? I think one of the big questions is what are the options available? It is also, you know, you're quite right. Most people are reeling with the fact that they've just been told they have cancer and then the treatment they have to go through. But if they're given the options with regard to fertility,

well, the types of treatment that impact on fertility, the radiotherapy, as Ellie described, or some of the intensive chemotherapies they are required to cure the cancer that's the aim of the treatment and so the options at that stage are is there anything we can do to mitigate the chance of that treatment impacting fertility and that's where the choices come into play so but sometimes there isn't really an option. So, for example, if the radiotherapy is going to, in order to treat the cancer, is going to take in either the testes, the ovaries or the uterus, that's a very direct impact that protects the ovary or the testes from the radiotherapy. But that can only be done if the effect of the radiotherapy can still impact on the tumour. So that kind of thing is perhaps a more straightforward choice. The other choices, so for somebody as young as Ellie who is

pre-puberty, are really quite limited. So for a young lady pre-puberty are really quite limited so for a young lady pre-puberty it's not possible to collect the eggs for example which is something we offer to older young people and older women where you can give hormone injections to induce the eggs and then collect them now that takes about three weeks so first all, you have to be at an age where you're cycling. And secondly, you have to be in a situation with your cancer to delay the treatment for three weeks. Ellie, what sort of experiences have you heard from other young people who've been through similar experiences to yours?

So with other people that I've talked to, some have been able to talk to the? So with other people that I've talked to some have had been able to talk to the Teenage Cancer Trust aftercare nurses and these are nurses that specialize in that aftercare so whilst being on treatment is difficult kind of dealing with the implications of the treatment is equally difficult so I had one friend who got to see the aftercare nurse who got to kind of speak about her fertility options and going on to hormone replacement therapy and things like that and then I've also had other friends who've had an ovary removed and then that will be implanted

after their treatment so that their hormones come back to normal levels. What concerns Louise have I mean I know you talk to a lot of young children what sort of concerns have been expressed to you by young people? So in my role as a teenage cancer trust nurse and there's over well the teenage cancer trust funds and support 50 to 60 nurses and a group of people called youth support coordinators who look after the emotional needs and support young people through treatment. It's similar sort of issues about that sort of, these young people are going through so much, they're going through puberty and young adulthood,

then they have cancer and then they have this massive decision, as Pam and Ellie have described, to say. So it's having that sort of time to take stock of that decision amongst a lot of other decisions. And the nurses and as a nurse I spent a lot of time listening to people about weighing up the options how the emotional impact of of suddenly having a risk to your fertility was being made and just having the time to sit and process some of that explain some of the detail of the amount not understood from

clinicians but also having access to a wider multidisciplinary team that can then support that young person to explore some of the options if they have time and to support, because it's not just one conversation about fertility, it is an ongoing conversation as that young person matures across their life. What about helping parents? I mean, parents must be desperately worried about their child being so sick. And the fertility here or sometimes mums and dads want to ask questions or both parties want to ask questions without the other party being there really and it is a

concern parents also express the loss that they may not be a grandparent or can I you know should I be putting my son or daughter through another set of treatment another set of options when they're already as Pam said you know set of treatment, another set of options when they're already, as Pam said, facing cancer treatment and survival is of primary. Ellie, mums and dads, what's their role in all of this? Well, yeah, as Louise said, it's very hard for them as my mum is having to deal with the fact that she won't, one of her children won't be able to have biological grandchildren.

But I think it's just involving the parents as much as the young person wants. So if the young person doesn't feel comfortable to talk about fertility in front of their parents, then the consultant should kind of facilitate that and lead the consultation so that only the young person is involved if that's how they feel. Now, what, Louise, would you say the Trust would like to see across all health authorities as standard practice? So as we've said before I think what the Teenage Cancer Trust would like was for every young person to have a conversation about their

fertility that is meaningful that they remember having and that enables them to be supported by nurses and other professionals who can support them during that, but also for people to have wider access to funded cryopreservation, so the freezing of sperm for boys, and as Pam's described, some of the preservation options that are open to young women, free at a point of care. So that would be our two asks. Dr Louise Soames, Ellie Waters and professor pamela cairns thank you all very much indeed and we would like to hear from you on this question if you've been

through this how did you cope with it you can always send us a text or of course a tweet or an email now christmas and new Year are not always easy parents if you have teenage children. There are the parties before the holiday and then, of course, the very late one on New Year's Eve. So some of you may have invested in a tracking app which allows you to establish surveillance of your child at any time of the day or night.

It may well be a relief for you to keep constant track, but how good is it for a teenager to feel mum and dad are following them all the time? Well, Nicola Morgan is a writer and the author of Blame My Brain, the amazing teenage brain revealed. She joins us on the line. And Debbie Penton has a 14 and 11 year old and uses a tracking app. Debbie why did you go for a tracking app? Well I think it was at the point that my children or my eldest actually had started secondary school. We had until that point picked him up and dropped him off at school every single day and it was my husband's idea just less about tracking them every minute of every day because no one's really got the time to do that. But you could do it if you wanted to. If I wanted

to but you spend a lot of time staring at a dot at school for example or sitting at home so it was more the ability to set what they call geo fences or kind of locations on a map that you get a little alert every time they move in and out of that area. So as a working mother the big thing for me was that my children would be coming home and without me being there and I guess in the old days you might ask your child to give you a call when they got home or you might try and call them and now I just get a small alert that pops up on my phone and I've got that peace of mind that I know that they're home. What do the children make of it? The children, well it was a condition of them getting their phone much in the same way as not changing their password is a condition of them keeping their

phone. We pay for the phones and that requires some sort of kind of supervision and access to make sure that they don't misuse the phones and so having the app on there is is part of that condition it started when they were 11. I would wouldn't want to be the parent who tried to install the app on a 16 year old's phone for the first time but that's exactly where I was going to go next we we're having trouble getting hold of Nicola okay we will get her I'm sure eventually um but I was wondering you know 11 and 14 yeah okay you might get away with it 15 16 17 no I mean the my sister just tried to do it for her 13 year old um I was met with a little resistance and typical teenage reactions.

But again, I think she's just kind of just told him that was that. But I think beyond 15 and 16, I don't really see myself using the app on the children or even needing to know where they are. If they learn to turn it off and they're out with their mates, as long as they're doing all the other things you'd expect them to do like stick to the curfews call in if you've asked them to then i'm not going to sit at home i mean i have a full life and i and i really don't feel the need to know the whereabouts of my children at every single moment what concerns do

you have about using such an app i think um as you know i didn't catch the very beginning of that but i caught um debbie's last last comment and i think that she has encapsulated the the not having a need to concern but there are other parents who are using these apps in somewhat different ways that are more like surveillance or spying. And in fact, some of the apps even have the word spy in the title. And I think that if you have an atmosphere of trust, a relationship of trust with your teenager, then the way that you might use this app is entirely healthy. But if you don't, then it's likely to be unhealthy. And also, if you don't, it's entirely likely that the teenager is going to find all sorts of ways around the app anyway. You know, they can use blocking techniques, download software themselves that's going to allow them to avoid, to evade your surveillance.

And thereby creating the likelihood of an even worse, even more dangerous, risky situation and and more problems ahead but what about the question of of independence i mean let's accept okay that the teenagers may well be more adept at the technology than the parents are but what do you suppose is the feeling in a child that i'm not really independent i can't really go and defy my parents because they're spying on me exactly and that goes to the heart of it so adolescence is as an evolutionary mechanism it's a mechanism to develop independence it's about separation it's about moving the child away from being the dependent protected baby and child that they obviously needed to be towards being the independent unprotected adult that we all want them to be

and that's what um adolescents program teenagers to do so teenagers are biologically programmed at some point to try to acquire this separation and that's entirely right and proper. Unfortunately, parents are biologically programmed to protect and there's nothing biological that happens in a parent's brain when their child becomes a teenager that stops that drive towards protection. And so if you've got this possibility of using technology to continue to protect for far too long, then you've got a recipe for helicopter parenting and you've got a much less likelihood of the child or teenager

developing that independence on their own in the way that they're programmed to be. One interesting aspect to this is to do with the age at which the prefrontal cortex, the part of the brain that allows us to have this independence fully developed. And when I was first writing about this in Blame My Brain in 2005, scientists thought that this full development happened at about the age of 23 on average. And now scientists are saying that that full development seems to be happening later. And the question must be asked is whether perhaps

there's something we are doing as parents and in societies like ours that is extending that independence to a later time. And I don't think that's, if that is the case, I don't think that's something we should be proud of. Debbie, you're obviously being very careful about this and you're very aware of the problems that might come if you try to continue it to a greater degree. Have you ever thought of it as spying or surveillance, which are very scary words? No, I think, I mean, there's a brilliant

episode of Black Mirror where this kind of surveillance is taken to the extreme. I think the fact fact is I can only see where the children are I can't see what they're doing I don't want to know what they're doing I fully expect them to be pushing boundaries trying new things mucking about the boys they're teenage boys that's what they're going to do and girls too but I don't have them but I was one and I don't assume it's only boys who are that no no true um i think the there are some really practical advantages of using technology children are using technology everyone's using technology to to enhance their lives make their lives easier there are practical reasons why we've used this app whether it's, and there's a lack of communication. The other thing about children is they don't,

their brains don't understand consequences. They don't understand the impact of that action or inaction. Therefore, they don't remember or think it's important necessarily to answer their phone, to turn it off silent, to ring your parents. So they, so at the end, you come home from, I've come home from work and my youngest is missing. And I'm thinking, oh, he's supposed to be at home. And of course, he hasn't communicated to me he should be at school.

He won't answer the phone, but I can see that he's at a rugby match or something. I was talking to Debbie Penton and Nicola Morgan, ending Thursday's edition of Women's Hour. Now, we had lots from you on the question of teenage cancer and fertility. Charlene tweeted I'm a childhood cancer survivor and was told I may have problems with fertility but I'm lucky and have three gorgeous children. I wasn't told of the risks to my heart from chemo though and had no cardiology input during my pregnancies. Now as a midwife I've made

it my mission to educate and disseminate information on the effects of cancer treatment in childhood, on fertility and pregnancy. We need more awareness. Diana emailed my daughter was diagnosed with osteosarcoma at the age of 14. we brought up the question of fertility, which led to her having an ovary removed prior to starting treatment. The tissue was preserved and can be replaced in her other ovary if she has fertility problems. This is experimental, but an option that was not mentioned. And then someone else emailed, we went through this with our son who was diagnosed with leukemia when he was seven and underwent aggressive chemo and total body radiotherapy we had the discussion with his consultant and oncology team about the loss of his fertility but to be honest at the time

we just wanted our son to live we couldn't think too much about the future. Now, 10 years down the line, he's a healthy teenager with his first girlfriend. And whilst we've had the conversation in the intervening years, I'm never confident that he's actually absorbing the enormity of it. I guess until he seriously is considering having a serious relationship and family, it's not uppermost. But having a child with cancer never leaves you. I look at him every day and feel blessed, but all with the nagging worries about the long-term side effects. And then from you on location tracking, Melanie tweeted,

I'd prefer my child call me to say they were safe rather than rely on an app. Children need to learn that this communication is part of being in a considerate relationship. I'm in my 40s and my partner and I still send each other messages about when we'll be home. Amanda tweeted, my daughter, age 16, asked me to download an app. She's 17 now and has peace of mind knowing I know she's where she should be. Amelia emailed, I use a tracking app for my 15-year-old daughter who's always out with her friends. Teenagers are still kids and many parents turn a blind eye to what their teens are doing. If my daughter wants to stay at a friend's house. I always wanted to know the name and the address of the parents so I can contact them if need be.

It's my responsibility to keep my daughter safe and we give her consequences, removing pocket money if she doesn't let us know or comes home later than her curfew. Ruth tweeted, My two sons are 39 and 37. The three of us have a tracking app if i'm driving to one of them he knows where i am on the journey and it's all just harmless but we enjoy it a bit of fun and paul emailed tracking apps are a crazy bad idea trust in both directions learning about the world's and society's complexities living with uncertainty learning from mistakes learning about the world's and society's complexities, living with uncertainty, learning from mistakes, learning about consequences, being on the receiving end of disapproval are all things we have to trust to our children.

Human evolution over the past 100,000 years has done fine without spying on our children. Now do join me for tomorrow's programme if you can. We'll be discussing caring from the elderly, the ill and the young in Australia's extreme heat and bushfires. We know that temperatures have exceeded 40 degrees centigrade in every state and territory at the start of the week. How do you look after the vulnerable in such a terrible situation? Join me tomorrow, two minutes past ten if you can. Bye-bye. I'm Sarah Treleaven, and for over a year,

I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this?

What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.