Guidelines endorsed by RCPCH - Neurology

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following publications will be of interest to paediatricians working in this neurology.

The following have been endorsed or supported by the College.

Endorsed guidelines

Attention Deficit and Hyperactivity Disorder (ADHD) (NICE)

The guideline covers the treatment and management of attention deficit and hyperactivity disorder (ADHD) in children over 3 years, young people and adults in primary, secondary and community care. It is particularly relevant to primary, secondary and community healthcare professionals and educational services that have direct contact with, or make decisions concerning the care of children, young people and adults with ADHD.

The guideline is accompanied by algorithms, a quick reference guide, audit tools, costing report, costing tools, a slide set, implementation advice and information for parent/carers, and includes audit criteria.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • This guideline does not define the term, "full psychiatric assessment".

Date of Publication: September 2008
Date of Endorsement: March 2009

Full guideline (PDF, 1.86MB, 374 Pages)
NICE guideline (PDF, 333KB, 59 Pages)
Key messages (PDF, 886KB, 20 Pages) 
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia.

Date of Publication: June 2012
Date of Endorsement: July 2012

Full quality standard (PDF, 211KB, 40 pages)
 

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (NICE)

The guideline covers the diagnosis, treatment and management of mild to severe chronic fatigue syndrome/myalgic encephalitis (CFS/ME) in adults and children over the age of five, including the transition of care from child to adult services. It is particularly relevant for healthcare professionals who have direct contact with and make decisions about the care of people with CFS/ME in primary and secondary care, in specialist centres and teams, those working in occupational health services, social services, educational services and the voluntary sector.

The guideline is accompanied by a quick reference guide, information for parents/carers, slides highlighting the key messages, costing tools, audit support and implementation advice. It includes key priorities for implementation and audit criteria.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline covers an area for which good quality research is lacking. Many of the recommendations are consensus based (modified RAND/UCLA appropriateness method). They apply to both children and adults, but children are somewhat overlooked.
  • The NICE guideline recommends that all children and young people with symptoms suggestive of CFS/ME should be referred to a paediatrician for assessment. The RCPCH guideline is of the view that in "'mild' or early cases, an informed and experienced GP would be able to diagnose and manage the patient without referral to a paediatrician". However, recommendations in both guidelines are consensus based. There are also differences between the two guidelines in the list of routine tests.

Date of Publication: August 2007
Date of Endorsement: June 2008

Full guideline (PDF, 847KB, 317 Pages)
NICE guideline (PDF, 336KB, 52 Pages)
 

Chronic Fatigue Syndrome/Myalgic Encephalopathy in Children and Young People (RCPCH)

This guideline covers management of children and young people up to the age of 18. It covers epidemiology, clinical features and diagnostic criteria for children with CFS/ME, recommendations on making a diagnosis, management, treatment interventions, educational needs and the transfer of care to adult health services.

The guideline includes an executive summary and research priorities.

The RCPCH asks its members to note that this guideline has been post-dated by the NICE CFS/ME guideline although it may still be of relevance.

Date of Publication: December 2004
Date of Endorsement: December 2004

Full guideline (PDF, 392KB, 124 Pages)
 

Epilepsies in Children and Young People (NICE)

This quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of the epilepsies in children and young people.

Date of Publication: February 2013
Date of Endorsement: May 2013

Full quality standards (PDF, 196 KB, 45 pages)
 

Head Injury: Early Management of Patients (SIGN)

The guideline is an update of the 2000 guideline and covers the early management of head injury in adults and children. It is based upon the best available evidence.

The guideline is accompanied by supporting information and advice leaflets for patients, and includes key priorities for audit.

The RCPCH welcomes the publication of this update but asks Members to note the following:

  • The College recommends that members refer to the NICE guideline on 'When to Suspect Child Maltreatment' for indicators for the possibility of non accidental injury.
  • There are differences between this guideline and the NICE guideline on Head Injury (2007) in the following areas: criteria for referral to hospital and for admission; recommended versions of the Glasgow Coma Scale; criteria for referral for CT scanning; criteria for discharge; transfer where CT facilities are not available; and, follow-up advice.

Date of Publication: May 2009
Date of Endorsement: July 2009

Full guideline (PDF, 4.03MB, 84 Pages)
Quick reference guide (children) (PDF, 275KB, 2 Pages)
ROCKET (Recommendations Online: Clinical Knowledge Evidence Translation) (PDF, 1.45MB, 12 Pages)
 

Headaches in Young Children and Adults (NICE)

This quality standard covers the diagnosis and management of the most common primary headache disorders (tension-type headache, migraine and cluster headache) and medication overuse headache in adults and young people aged 12 years and older.

Date of publication: August 2013
Date of endorsement: October 2013

Full quality standard (PDF, 155KB, 31 pages) 
 

Management of the Child with a Decreased Conscious Level (PAERG)

The scope of the guideline includes children aged 0-18 years who have a decreased conscious level and are being reviewed in a hospital setting. Decreased conscious level is defined as a modified Glasgow coma score less than 14, being unresponsive only to voice or being unresponsive on the AVPU scale. The guideline does not apply to pre-term infants on a NICU or full term infants with a decreased conscious level from birth onwards. The guideline does not apply to children with a previously diagnosed condition that is known to cause the decreased conscious level.

The guideline is accompanied by a quick reference algorithm, guide to implementation and audit criteria.

Date of Publication: November 2005
Date of Endorsement: October 2006

Full guideline (PDF, 211KB, 12 Pages)
 

Pathways to Diagnosis: The Diagnosis of Brain Tumours

The guideline covers the symptoms and signs that may occur in all children aged 0-18 years with brain tumours, the assessment of children, and indications and waiting times for imaging these children. Recommendations were formulated using the evidence that supported them. Where no substantial clinical research evidence was identified, formal consensus methods (modified Delphi technique) were used to formulate recommendations.

The guideline is accompanied by an algorithm and quick reference guide and includes key audit criteria and an algorithm.

Date of Publication: 2008
Date of Endorsement: June 2008

Full guideline (PDF, 804KB, 44 Pages)
Quick reference guideline (PDF, 951KB, 20 Pages)

The HeadSmart programme (formerly The Brain Pathways project) aims to reduce the length of time it takes to diagnose brain tumours in children. Click here to find out more about the HeadSmart project and how you can get involved.
 

Post-Seizure Management (PAERG)

The guideline covers the management of children presenting following afebrile or febrile seizures based on the best available evidence. It aims to promote consistency of care of patients with similar clinical problems and helps clinicians recognise those children at higher risk of meningitis and to take appropriate action and to determine the cause of the fever if febrile seizure is diagnosed.

The guideline is accompanied by an algorithm for use in clinical areas.

RCPCH notes: 

This guideline is due for review by the Paediatric Accident and Emergency Research Group.

Date of Publication: July 2002
Date of Endorsement: December 2002

Full guideline
 

Pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and/or the tissues below are damaged as a result of being placed under sufficient pressure or distortion to impair its blood supply. Typically they occur in a person confined to a bed or a chair most of the time by an illness; as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This quality standard covers the prevention, assessment and management of pressure ulcers in all settings, including hospitals, care homes with and without nursing and people’s own homes. It covers people of all ages: neonates, infants, children, young people and adults (including older people).
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • incidence of category 2 pressure ulcers
  • incidence of category 3 pressure ulcers
  • incidence of category 4 pressure ulcers
  • health-related quality of life
  • length of hospital stay
  • discharge destination 
Date of Publication: June 2015
Endorsed on: July 2015
 
Full quality standard (PDF, 228KB, 54 Pages)
 

Pressure ulcers: prevention and management of pressure ulcers (NICE)

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as 'bedsores', or 'pressure sores'.
 
This guideline offers best practice advice on the care of people with pressure ulcers. 
 
Date of Publication: April 2014
Endorsed on: October 2015
 
Full Guideline (PDF, 233KB, 38 Pages) 
 

Spasticity in Children and Young People with Non-Progressive Brain Disorders (NICE)

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders.

 Cerebral palsy is the most common condition associated with spasticity in children and young people. The guideline covers the management of spasticity associated with cerebral palsy, but not all aspects of the management of cerebral palsy. The impact of spasticity and co-existing motor disorders and their early musculoskeletal complications

Date of Publication: July 2012
Date of Endorsement and Badging: July 2012

Full guideline (PDF, 2.2MB, 302 pages)
NICE guideline (PDF, 506KB, 48 pages)
Appendices
 

Sedation in Children and Young People (NICE)

This guideline covers the sedation of infants, children and young people up to the age of 19 years for diagnostic and therapeutic procedures.

The guideline is accompanied by a quick reference guide, audit support, a costing report, a baseline assessment tool and a slide set.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline recommends that referral to a mental health specialist should be considered for all children who are severely anxious or who have a learning disability undergoing an elective procedure. The College notes that this may significantly increase the waiting times for procedures, given the existing pressures upon mental health services.

Date of Publication: November 2010
Date of Endorsement: January 2011

Full guideline (PDF, 3.67MB, 385 Pages)
NICE guideline (PDF, 2.4MB, 30 Pages)
Quick reference guide (PDF, 1.7 MB, 16 Pages)
 

Standards for Services for Children with Disorders of Sleep Physiology (RCPCH)

This guideline covers the diagnosis and management of disorders of sleep physiology and respiratory control in children and the organisation of such services nationally. It is particularly relevant to parents, primary and secondary care physicians, surgeons and health service managers.

The guideline is accompanied by an executive summary and lay summaries and includes a proforma for peer review of sleep services, discussion of services and resource implications and key points for audit.

Date of Publication: September 2009
Date of Endorsement: June 2008

Full guideline (PDF, 1.12MB, 144 Pages)
Executive summary (PDF, 397KB, 40 Pages)
Lay summary 1- Sleep Services and Sleep Studies (PDF 34 KB)
Lay summary 2- Obstructive Sleep Apnoea (PDF, 37KB, 3 Pages)
Lay summary 3- Obstructive Sleep Apnoea in Downs Syndrome (PDF, 21KB, 3 Pages)
Lay summary 4- Sleep Related Breathing Disorders in Children with Neuromuscular Disease (PDF, 21KB, 2 Pages)
Lay summary 5- Obstructive Sleep Apnoea in Children with Craniofacial Abnormalities (PDF, 35KB, 2 Pages)
Lay summary 6- Sleep Related Breathing Disorders in Children with Prader-Willi Syndrome (PDF, 21KB, 2 Pages)
Lay summary 7- Congenital Central Hypoventilation Syndrome (PDF, 20KB, 2 Pages)
Lay summary 8- Narcolepsy (PDF, 20KB, 1 Page)
 

Stroke in Childhood (RCP)

This guideline covers the prevention, acute management, rehabilitation and longer-term management of acute arterial ischaemic stroke arising beyond the neonatal period, as well as the organisation of services

The guideline is accompanied by a parent/carer booklet, and includes proposed audit criteria.

RCPCH notes: 

This guideline is due for review by the Royal College of Physicians.

Date of Publication: November 2004
Date of Endorsement: November 2004

Full guideline (PDF, 720KB, 82 Pages)
 

The management of children and young people with an acute decrease in conscious level (RCPCH)

This guideline aims to give clinicians working acutely a framework to aid the timely and safe care of children and young people (aged four weeks to 18 years) presenting with a decreased conscious level of unknown cause.
 
The first guideline for 'The Management of Decreased Conscious Level' was published in 2005. Since, there have been changes in the demographics of the children and young people presenting to emergency settings with a decreased conscious level. 
 
Consistent with the previous guideline, this version emphasises the importance of managing this condition in a standard manner from first presentation to health services, to ensure the best outcome for patients and their families.
 
The continuing support of the National Reye's Syndrome Foundation UK (NRSF-UK) has allowed the work required to update the guideline.
 
Date of Publication: April 2015
Date of Endorsement: February 2015
 

Transition from children’s to adults' services for young people using health or social care services (NICE)

Transition occurs during the period when young people and their families are thinking about their hopes for the future. If people are likely to have care and support needs when they are 18, they need information and advice so that they can make the necessary plans. Despite this, there is evidence that the transition process is variable, with previous good practice guidance not always being implemented.
 
This clinical guideline focuses on young people passing through transition to adult services with health and/or social care needs. 
 
It covers the period before, during and after a young person moves from children's to adults' services, and aims to help young people and their carers have a better experience of transition by improving the way it’s planned and carried out.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 1,710KB, 218 Pages)
NICE Clinical Guideline (PDF, 173KB, 31 Pages) 
 

Tuberculosis: Prevention, diagnosis, management and service organisation (NICE)

TB is a curable disease caused by a bacterium called Mycobacterium tuberculosis (‘M. tuberculosis’ or ‘M.Tb’), or other bacterium in the M. tuberculosis complex (that is, M. bovis or M. africanum). It is spread by one person inhaling the bacterium in droplets coughed out by someone with infectious tuberculosis. Not all forms of tuberculosis are infectious. 
 
Those with TB in organs other than the lungs are not infectious to others, nor are people with just latent tuberculosis. Some people with pulmonary tuberculosis are infectious, particularly those with bacteria which can be seen on simple microscope examination of the sputum, who are termed ‘smear positive’. The risk is greatest in those with prolonged, close household exposure to a person with infectious TB.
 
This guideline makes recommendations on the prevention, diagnosis and management of latent and active tuberculosis (TB), including both drug susceptible and drug resistant forms of the disease. It covers the organisation of relevant TB services. It relates to activities undertaken in any setting in which NHS or public health services for TB are received, provided or commissioned in the public, private and voluntary sectors.
 
Date of Publication: January 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 4,849KB, 551 Pages) 
NICE Clinical Guideline (PDF, 575, 177 Pages)
 

Supported guideline

Antisocial Personality Disorders (NICE)

This guideline covers the treatment and management of antisocial personality disorders in adults and preventative interventions in children and adolescents at significant risk of developing Antisocial Personality Disorders.

The guideline is accompanied by a costing report and costing template, slide set, audit support and a quick reference guide.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline presents recommendations relating to children, particularly as the focus of preventative recommendations, however the guideline group did not include a paediatric representative.

Date of Publication: January 2009
Date of College Support: September 2009

Full guideline (PDF, 1.8MB, 393 Pages)
NICE guideline (PDF, 274KB, 47 Pages)