Guidelines endorsed by RCPCH - Child mental health

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 professionals working in child mental health.

The following have been endorsed or supported by the College:

Endorsed guidelines

Alcohol-Use Disorders: Physical Complications (NICE)

This guideline covers the management of acute alcohol withdrawal, lack of thiamine, liver disease and inflammation of the pancreas in adults and young people over the age of 10 years.

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

Date of Publication: June 2010
Date of Endorsement: September 2010

Full guideline (PDF, 2.97MB, 295 Pages)
NICE guideline (PDF, 471KB, 30 Pages)
 

Antisocial behaviour and conduct disorders in children and young people (NICE)

This quality standard covers the recognition and management of antisocial behaviour and conduct disorders in children and young people (under 18 years of age).

The behaviour associated with conduct disorders can become more severe and problematic as the child gets older. There is evidence to suggest that up to 50% of children and young people with a conduct disorder go on to develop an antisocial personality disorder in adulthood. Therefore selective prevention and early intervention can help to reduce the likelihood of the child developing more complex behavioural problems. 
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • Emotional wellbeing of children and young people.
  • Emotional wellbeing of the parents and carers of children and young people.
  • Reducing contact with the youth justice system.
  • Educational attainment.
  • Number of 16–18 year olds in education, employment or training.
Date of Publication: April 2014
Endorsed on: December 2014
 
Full quality standard (PDF, 265KB, 48 Pages)
 

Attention Deficit Hyperactive Disorder (ADHD)

This quality standard covers the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children aged 3 years and older, young people and adults.

Date of Publication: July 2013
Date of Endorsement: November 2013

Full quality standards (PDF, 172KB, 46 Pages) 
 

Attention Deficit and Hyperactivity Disorder (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.

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

Full guideline (PDF, 1.91MB, 374 Pages)
NICE guideline (PDF, 334KB, 59 Pages)
Key messages (PDF, 886KB, 20 Pages) 
 

Autism Spectrum Disorders in Children and Young People: Recognition, Referral and Diagnosis (NICE

This guideline covers the recognition, referral and diagnosis of autism in children and young people from birth up to 19 years. It emphasises the need for coordination between health agencies and other key services.

RCPCH comment: We note that some of the service descriptions may have implications for trainees. NICE states that "the GDG acknowledge that it is important to consider the different ways in which these services operate, and how trainees are supported and supervised. The descriptions are not meant as specific blue prints for how services should operate."

Date of publication: September 2011
Date of endorsement: September 2011

Full guideline (PDF, 262KB, 57 Pages)
 

Borderline Personality Disorder (NICE)

This guideline covers the treatment and management of borderline personality disorder in adults and young people (less than 18 years) who meet the criteria for the diagnosis. It includes some specific recommendations for Child and Adolescent Mental Health (CAMHS) professionals.

The guideline includes a quick reference guide, costing report, audit criteria, slide set and a service user/carer information leaflet.

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

  • The guideline development group did not include a paediatrician; however, children were not recognised to be a significant proportion of the target population. 

Date of Publication: January 2009
Date of Endorsement: April 2009

Full guideline (PDF, 3MB, 495 Pages)
NICE guideline (PDF, 271KB, 41 Pages)
 

Challenging behaviours and learning disabilities (NICE)

A learning disability is defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood. 
 
Some people with a learning disability display behaviour that challenges. 'Behaviour that challenges' is not a diagnosis and is used in this guideline to indicate that although such behaviour is a challenge to services, family members or carers, it may serve a purpose for the person with a learning disability. 
 
This behaviour often results from the interaction between personal and environmental factors and includes aggression, self-injury, stereotypic behaviour, withdrawal, and disruptive or destructive behaviour. It can also include violence, arson or sexual abuse, and may bring the person into contact with the criminal justice system.
 
This guideline covers the care and shared care provided or commissioned by health and social care, in whatever care setting the person lives.
 
Date of Publication: May 2015
Endorsed on: January 2016
 
Full guideline (PDF, 4095KB, 371 Pages) 
NICE guideline (PDF, 245KB, 57 Pages)
 

Children's attachment (NICE QS)

Attachment is a type of behaviour displayed by children to draw their primary caregiver towards them at moments of need or distress. Children whose caregivers respond sensitively to their needs at times of distress and fear in infancy and early childhood develop secure attachments to them. 
 
This quality standard covers the identification, assessment and treatment of attachment difficulties. It focusses on children and young people up to age 18: 
  • on the edge of care (those considered to be at high risk of going into care) 
  • looked after by local authorities in foster homes (including kinship foster care) 
  • in special guardianship 
  • adopted from care 
  • in residential units and other accommodation
It is expected that this quality standard will contribute to improvements in the following outcomes:
  • Children’s social and emotional development
  • Children’s behavioural functioning
  • Quality of parent or carer child relationship
  • Wellbeing and quality of life for children and parents or carers
  • Mental health problems in children and parents or carers
  • Breakdown in fostering placements or adoption
  • Youth offending rates
  • Educational progress and attainment
  • School absences and exclusions
Date of Publication: October 2016
Endorsed on: January 2017
 
Full quality standard (PDF, 165KB, 34 Pages) 
 

Children's attachment (NICE CG)

Infants are born equipped with a range of innate behaviours to maximise their survival. Attachment behaviour allows the infant to draw others towards them at moments of need or distress. Infants who experience a secure attachment relationship develop a reasonably firm expectation of feeling protected and safe, which in turn allows them to explore their world more confidently.
 
This guideline is relevant in any setting in which healthcare, social care and educational professionals have contact with children and young people with attachment difficulties who are in care, adopted from care or on the edge of care, and their families and carers. 
 
The guideline makes recommendations for the identification, assessment and treatment for attachment difficulties in children. It aims to:
  • improve access and engagement with treatment and services for children with attachment difficulties and their carers
  • evaluate the role of specific psychological, psychosocial and pharmacological interventions in the treatment of children’s attachment
  • evaluate the role of psychological and psychosocial interventions in combination with pharmacological interventions in the treatment of attachment difficulties
  • evaluate the role of specific service-level interventions for people with attachment difficulties
  • integrate the above to provide best-practice advice on the care of individuals throughout the course of their treatment
  • promote the implementation of best clinical practice through the development of recommendations tailored to the requirements of the NHS in England and Wales.
Date of Publication: November 2015
Endorsed on: January 2016
 
Full clinical guideline (PDF, 4797KB, 496 Pages)
NICE guideline (PDF, 191KB, 42 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, 848KB, 217 Pages)
NICE guideline (PDF, 337MB, 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.

RCPCH Notes:

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

Further information can be found here.
 

Constipation in Children and Young People (NICE)

This guideline covers the diagnosis and management of idiopathic constipation in children up to 18 years of age in primary and secondary care.

The guideline is accompanied by a quick reference guide, audit support, a baseline assessment tool, slide set and parent/carer version.

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

  • Although not explicit in the NICE guideline, the College thinks that the goals of treatment should include 'no pain' and 'no overflow'.
  • The guideline recommends some dosages which vary from those recommended in the British National Formulary for Children (2009 Edition). These are highlighted in the guideline. Please note that the BNF-c has been updated since publication of the guideline in 2010.

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 2.55MB, 255 Pages)
 

Depression in Children and Young People (2013 Update) (NICE)

This quality standard covers the diagnosis and management of depression in children and young people aged 5 up to their 18th birthday.

Date of Publication: September 2013
Date of Endorsement: October 2013

Full quality standards (PDF, 172KB, 34 Pages)
 

Depression in Children and Young People (NICE)

The scope of the guideline includes children and young people from the age of 5 years up to their 18th birthday. The guideline covers the care provided by primary, community, secondary and other healthcare professionals who have direct contact with, and make decisions concerning the care of, children and young people with depression. The guideline will also be relevant to the work, but will not cover the practice of, occupational health services, social services and the independent sector. The guidance does not specifically address depression in children 4 years of age and under, bipolar disorder, or how learning disabilities and challenging behaviour moderate the effect of various interventions.

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

Full guideline (PDF, 876KB, 233 Pages)
NICE guideline (PDF, 267KB, 68 Pages)
 

Drug Misuse - Opioid Detoxification (NICE)

The aim of this guideline is to evaluate the role of opioid detoxification in adults and young people who misuse drugs and to integrate these findings to provide advice regarding care of these individuals and implementation of these recommendations. It is intended to be used by all health professionals who have contact with and make decisions regarding the treatment and care of adults and young people who misuse drugs.

The guideline is accompanied by costing tools, a quick reference guide and presenter slides on implementation and includes audit standards.

Date of Publication: July 2007
Date of Endorsement: February 2008

Full guideline (PDF, 847KB, 332 Pages)
NICE guideline (PDF, 244KB, 185 Pages)
 

Drug Misuse - Psychosocial Interventions (NICE

The aim of this guideline is to evaluate the role of specific psychosocial interventions alone and in conjunction with pharmacological interventions in the treatment of drug misuse. It also aims to integrate these treatments to provide advice on providing the best practice care of individuals throughout the course of their drug misuse and promote the implementation of best clinical practice with specific reference to the requirements of the NHS. It is intended for use by all health professionals who have contact with and make decisions regarding adults and young people who misuse drugs.

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

Date of Publication: July 2007
Date of Endorsement: February 2008

Full guideline (PDF, 847KB, 332 Pages)
NICE guideline (PDF, 244KB, 35 Pages)
 

Early years: promoting health and wellbeing (NICE)

Social and emotional wellbeing is important in its own right. It also provides the building block for healthy behaviours and educational attainment. Poor social and emotional wellbeing increases the likelihood in later life of antisocial behaviour and mental health problems, drug or alcohol misuse, teenage pregnancy, poor educational attainment and involvement in criminal activity.
 
This quality standard covers services to support the health, social and emotional wellbeing of children under 5, and includes the following: 
  • home visiting
  • childcare
  • early intervention services in children’s social care
  • early education
While the standard includes vulnerable children who may need additional support, it does not cover clinical treatment or the role of child protection services.
 
Date of Publication: August 2016 
Endorsed on: January 2017
 
Full quality standard (PDF, 146KB, 28 Pages) 
 

Nocturnal enuresis in children (2014 Update) (NICE)

Nocturnal enuresis is the medical term for 'bedwetting'. It is a widespread and distressing condition that can have a deep impact on a child or young person's behaviour, emotional wellbeing and social life.
 
The causes of bedwetting are not fully understood. Bedwetting can be considered to be a symptom that may result from a combination of different predisposing factors. There are a number of different disturbances of physiology that may be associated with bedwetting. These disturbances may be categorised as sleep arousal difficulties, polyuria and bladder dysfunction. 
 
This quality standard covers the assessment and management of nocturnal enuresis (bedwetting) in children and young people aged 18 years or younger.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • quality of life for children, young people and their families and carers
  • psychological wellbeing of children, young people and their families and carers.
Date of Publication: September 2014
Endorsed on: May 2015
 
Full quality standard (PDF, 203KB, 36 Pages)
 

Nocturnal Enuresis In Children (NICE)

This guideline covers recommendations for the management of night time bedwetting, with or without daytime urinary, in children under the age of 19, with or without special needs.

The guideline is accompanied by guidance for patients and carers, audit support, a costing statement, a baseline assessment tool, costing template and slide side.

Date of Publication: October 2010
Date of Endorsement: October 2010

Full guideline (PDF, 2.52MB, 473 Pages)
NICE guideline (PDF, 293KB, 43 Pages)
 

Paediatric Continence Commissioning Guide (PCF)

The Paediatric Continence Commissioning Guide is a resource to assist commissioners, clinicians and managers to deliver integrated and evidence-based community paediatric continence services that meet the needs of children and young people with continence difficulties (bladder and bowel dysfunction) across England.

Its aim is to improve the health and wellbeing of these children and young people through supporting local service redesign that is high quality and cost effective and takes into account patient experience.

Date of Publiction: September 2014
Date of Endorsement: September 2014

Full guideline (PDF, 1.11 MB, 41 Pages)
 

Personalilty disorders - borderline and antisocial (NICE)

Borderline personality disorder is characterised by significant instability of interpersonal relationships, self‑image and mood, and impulsive behaviour. There is sometimes a pattern of rapid fluctuation from periods of confidence to despair, with fear of abandonment, rejection, and a strong tendency towards suicidal thinking and self‑harm. Borderline personality disorder is often comorbid with depression, anxiety, eating disorders, post‑traumatic stress disorder, alcohol and drug misuse, and bipolar disorder (the symptoms of which can often be confused with borderline personality disorder). 
 
This quality standard covers treatment and management of borderline and antisocial personality disorders. For borderline personality disorder, this quality standard applies to adults aged 18 and over and young people post puberty. 
 
Date of Publication: June 2015
Endorsed on: October 2015
 
Full Quality Standards (PDF, 244KB, 50 Pages) 
 

Practical Guidance for the Management of Palliative Care on Neonatal Units (NHS)

This guideline covers all aspects of the management of palliative care on neonatal units and focusses on practical aspects of infant care. It includes details on pain relief, symptom relief, comfort and dignity, the management of prognostic uncertainties, and the provision of support.

Developed by members of the multidisciplinary neonatal medicine team at Chelsea and Westminster NHS Foundation Trust, in collaboration with the Royal College of Paediatrics and Child Health, this guideline, which complements existing resources, equips staff working on a neonatal unit with a clear set of principles to underpin the care they provide to babies in life-limited situations and support parents.

The project is supported by a wide group of stakeholders including ACT, APPM, BAPM, BLISS, RCM, RCN, SANDS and the UK Neonatal Networks.

Date of Publiction: February 2014
Date of Endorsement: February 2014

Full guideline (PDF, 714KB, 40 Pages)
Supporting documents are available from the Chelsea and Westminister Hospital.
 

Post-Traumatic Stress Disorder (NICE)

The guideline covers adult and children aged 2 to 18 years who meet, or are at risk of meeting, criteria for post-traumatic stress disorder (PTSD) and covers care provided by primary, secondary, and other healthcare professionals who have contact with PTSD sufferers. Recommendations are made on psychological and pharmacological interventions, the role of early interventions, and issues with diagnosis and screening.

The guideline is accompanied by a costing report and template, a slide set, and a commissioning guide. It includes key recommendations for implementation.

Date of Publication: March 2005
Date of Endorsement: October 2005

Full guideline (PDF, 746KB, 176 Pages)
NICE guideline (PDF, 148KB, 41 Pages)
 

Preventing unintentional injury in under 15s (NICE)

The likelihood of unintentional injury is affected by a number of factors, including personal attributes (such as age and any medical conditions), behaviour (such as risk-taking) and the environment (such as poor quality housing). The physical, psychological and behavioural characteristics of children and young people make them more vulnerable to injuries than adults.
 
This quality standard covers preventing unintentional injury in children and young people under 15, and is expected to contribute to improvements in the following outcomes:
  • unintentional injuries in children and young people in the home
  • preventable child deaths related to unintentional injury in the home
  • hospital admissions
  • A&E attendances
  • health and wellbeing of children and young people.
Date of Publication: January 2016
Endorsed on: February 2016
 
Full quality standard (PDF, 147KB, 39 Pages) 
 

Psychosis with Coexisting Substance Misuse: Assessment and Management in Adults and Young People (NICE)

This guidance offers best practice advice on the assessment and management of adults and young people (aged 14 years and older) with psychosis and coexisting substance misuse.  Recommendations include: recognition of psychosis with coexisting substance misuse in adults and young people as well as specific issues for young people.  

RCPCH notes: The complex yet important issue of transition has not been covered in as much depth as warranted as it is unfortunately outside of the scope proposed by NICE. NICE state that transition should be planned and managed according to the best practice guidance described in ‘Transition: getting it right for young people’ (available from http://www.dh.gov.uk/).

Date of Publication: March 2011
Date of Endorsement: November 2011

Full guideline (PDF, 240KB, 43 Pages)
 

Self-harm: Longer-Term Management (NICE)

This guideline is concerned with the longer-term psychological treatment and management of both single and recurrent episodes of self-harm. It does not cover recommendations for the physical treatment of self-harm or for psychosocial management in emergency departments (these can be found in NICE clinical guideline 16 which covers treatment of self-harm within 48 hours of an incident). The term self-harm used in this guideline refers to any act of self-poisoning or self-injury.

Date of Publication: November 2011
Date of Endorsement: February 2012

NICE guideline (PDF, 212KB, 40 Pages)
Appendices
 

Self-harm: Short-term Physical and Psychological Management and Secondary Prevention (NICE)

This guideline covers the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. It covers all children aged 8 years and older, young people and adults who have carried out self-harm, regardless of whether accompanied by mental illness. The guideline makes recommendations that cover the first 48 hours following an act of self-harm but does not address long-term psychiatric care.

The guideline is accompanied by key recommendations for implementation.

Date of Publication: July 2004
Date of Endorsement: February 2005

Full guideline (PDF, 584KB, 200 Pages)
NICE guideline (PDF, 121KB, 49 Pages)
 

When to Suspect Child Maltreatment (NICE)

This guidance covers the clinical features (including physical and psychological symptoms) associated with maltreatment which may be observed by health professionals when a child presents to them. It is aimed at all health professionals, including GPs, primary health and child health teams, professionals groups who are routinely involved in the care of children and families and those who may encounter children in the course of their professional duties. 

The guideline is accompanied by a quick reference guide, costing tools, slides highlighting the key messages and audit support tools.

The RCPCH welcomes the publication of this valuable and important guidance and fully endorses it. The College notes that:

  • The NICE guideline uses less technical terms which in some areas may appear to differ from RCPCH documents. This is because the intended audience of the NICE guideline is front line health professionals rather than specialist paediatricians (although the guideline is of relevance to paediatricians also).

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

Full guideline (PDF, 1.49MB, 156 Pages)
NICE guideline (PDF, 372KB, 39 Pages)
Key messages (PDF, 235KB, 12 Pages) 
RCPCH press statement (PDF, 6KB, 1 Page)

 

Supported guidelines

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, 48 Pages)