Guidelines endorsed by RCPCH - Community child 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 paediatricians working in community child health.

The following have been endorsed or supported by the College:

Endorsed guidelines

Abusive Head Trauma and the Eye in Infancy Guidance (RCOphth-RCPCH)

This guidance update is a joint venture between the Royal College of Ophthalmologists (RCO) and the Royal College of Paediatricians and Child Health (RCPCH). The update is restricted to a target population of children under 3 years of age suspected of being subject to abusive head trauma (AHT).

This guidance covers a review of the existing literature on AHT and the eye to supplement and update previous publications produced by RCO. This guidance also identifies areas of good practice in the management of cases referred with suspected AHT and encourage evidence based standardized assessment of such children. The guidance includes a standardised proforma for documenting retinal findings.

Date of publication: June 2013
Date of endorsement: June 2013

Full guidance (PDF, 1.37MB, 106 Pages)
Standardised proforma (PDF, 744KB, 2 Pages)
 

Alcohol-Use Disorders: Diagnosis and Clinical Management of Alcohol-Related 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)
 

Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol-Dependence (NICE)

This clinical guideline offers evidence-based advice on the diagnosis, assessment and management of harmful drinking and alcohol dependence in adults and in young people aged 10-17 years.

Date of publication: February 2011
Date of endorsement: August 2011 

Full guideline (PDF, 237KB, 51 Pages)
NICE pathways
 

Anaphylaxis (NICE)

This guideline concerns assessment with a view to confirming an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode. The patient groups covered by the guideline are adults, young people and children who receive emergency treatment for suspected anaphylaxis.

RCPCH notes:

The College asks members to note that:

The scope of the guideline covers confirmation of an anaphylactic reaction in an emergency setting and subsequent referral. As such the scope is quite narrow and excludes longer-term management of children who have experienced an anaphylactic episode (e.g. management through diet). Management of associated co-morbidities with anaphylaxis, such as asthma are also not included in the scope of the guideline. NICE however do refer readers to their related Food Allergy in Children and Young People guideline for information on allergy diagnosis and assessment. 

Date of Publication: December 2011
Date of Endorsement: March 2012

NICE guideline (PDF, 164KB, 25 Pages)
Appendices
 

Antimicrobial stewardship (NICE)

This quality standard covers the effective use of antimicrobials (antibacterial, antiviral, antifungal and antiparasitic medicines) to reduce the emergence of antimicrobial resistance (loss of effectiveness of antimicrobials).

It covers all settings, all formulations of antimicrobials (oral, parenteral and topical agents) and is for health and social care practitioners, organisations that commission, provide or support the provision of care, as well as people using antimicrobials and their carers.

RCPCH notes:

The College endorses the quality standards and notes that the document would have benefitted from specifying the route of administration and by adding a reminder that sometimes more than one microbiological sample (or none) might be need to be collected. The option of offering back-up (delayed) prescribing in Primary care would have been preferred to be suggested as a last resort and only in situations where the doctor has a clear opinion as to a likely bacterial cause of an illness that may not be self-limiting.

Date of Publication: April 2016 
Endorsed on: August 2016

Full Quality Standard (PDF, 177KB, 39 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)
 

Atopic Eczema in Children and Young Children (NICE)

This quality standard covers children from birth up to the age of 12 years with atopic eczema. The areas of care considered were diagnosis and assessment, management and treatment, treatment of infected eczema and referral in primary and secondary care.

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

Full standard (PDF, 188KB, 40 Pages)
 

Attention Deficit Hyperactivity Disorder (NICE QS)

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 standard (PDF, 172KB, 46 Pages) 
 

Attention Deficit and Hyperactivity Disorder (NICE CG)

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 notes:

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)
 

Challenging behaviour 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 team, 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, 317 Pages)
NICE guideline (PDF, 337KB, 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

 

Community engagement - improving health and wellbeing (NICE)

This quality standard covers community engagement approaches to improve health and wellbeing and reduce health inequalities, and initiatives to change behaviours that harm people’s health. This includes building on the strengths and capabilities of communities, helping them to identify their needs and working with them to design and deliver initiatives and improve equity.

Date of Publication: March 2017

Endorsed on: April 2017

 

Full Quality Standard(PDF, 118KB, 22 Pages)

 

Depression in Children and Young People (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)
 

Diabetes in children and young people (NICE)

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services. Preparations should also be made for the transition from paediatric to adult services, which have a different model of care and evidence base.

This quality standard covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. It is expected to contribute to improvements in the following outcomes:

  • prompt diagnosis of type 1 diabetes
  • glycaemic control: blood glucose and HbA1c levels
  • diabetes complications
  • quality of life
  • patient, parent and carer satisfaction
  • life expectancy

RCPCH notes:

The RCPCH asks its members to note that the quality standards does not provide information on children and carers with marked anxiety about nocturnal hypoglycaemia, or young children who are unable to communicate their symptoms of hypoglycaemia, and screening for emotional health and wellbeing.

Date of Publication: July 2016
Endorsed on: August 2016

Full Quality Standard (PDF, 194KB, 40 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, 185 Pages)
NICE guideline (PDF, 245KB, 35 Page)
 

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, 2.08MB, 332 Pages)
NICE guideline (PDF, 240KB, 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) 
 

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 standard (PDF, 235KB, 45 Pages)
 

Feverish illness in children (NICE)

This quality standard the assessment and initial management of unexplained feverish illness in infants and children (from birth to 5 years).
 
Feverish illness is very common in young children (under 5), with between 20 and 40% of parents reporting such an illness each year. Fever is the most likely reason for a child to be taken to the doctor and the second most common reason for a child being admitted to hospital.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • Mortality in infants and children under 5 years
  • Morbidity in infants and children under 5 years
  • Number of emergency admissions to hospital of infants and children under 5 years
  • Parent and carer experience of services.
Date of Publication: July 2014
Endorsed on: February 2015
 
Full quality standard (PDF, 196KB, 32 Pages)
 

Gastro-oesophageal reflux disease (GORD) in children and young people (NICE QS)

GOR is a normal physiological process that usually happens after eating in healthy infants, children, young people and adults. In contrast, GORD starts when symptoms of reflux become severe and need medical treatment. 
 
GOR and GORD affect many children and families in the UK, who commonly seek medical advice. In clinical practice, it may be difficult to differentiate between GOR and GORD. There is no reliable and accurate diagnostic test to confirm whether the condition is GOR or GORD, and this affects research and clinical decisions. The term GORD covers a number of specific conditions that have different effects and present in different ways - this makes it difficult to identify GORD and to estimate its real prevalence.
 
This quality standard covers managing symptoms of gastro-oesophageal reflux (GOR) and recognising, diagnosing and managing gastro-oesophageal reflux disease (GORD) in children and young people under 18. It contributes to improvements in the following outcomes:
  • Change in symptoms and signs
  • Investigative findings, including healing of erosive oesophagitis
  • Adverse events of interventions (diagnostic or treatment)
  • Unnecessary prescribing
Date of Publication: January 2016
Endorsed on: Febraury 2016
 
Full quality standard (PDF, 165KB, 34 Pages) 
 

Gastro-oesophageal reflux disease (GORD) in children and young people (NICE CG)

Gastro‑oesophageal reflux (GOR) is a normal physiological process that usually happens after eating. In contrast, gastro‑oesophageal reflux disease (GORD) occurs when the effect of GOR leads to symptoms severe enough to merit medical treatment. GOR is more common in infants than in older children and young people, and it is noticeable by the effortless regurgitation of feeds in young babies.
 
This clinical guideline focuses on signs and symptoms and interventions for GORD. Where appropriate, clear recommendations are given as to when and how reassurance should be offered. The clinical guideline also advises healthcare professionals about when to think about investigations, and what treatments to offer.
 
Date of Publication: January 2015
Endorsed on: February 2015
 
Full guideline (PDF, 165KB, 34 Pages)
 

Head injury (NICE QS)

Head injury is any trauma to the head other than superficial injuries to the face. This quality standard notes that head injury is the most common cause of death and disability in people 1 to 40 years of age in the UK. It also reports that 1.4 million people per year attend accident and emergency departments in England and Wales with a recent head injury and that 33–50% of these are children and young people less than 15 years of age.
 
This quality standard covers assessment, early management and rehabilitation following head injury in children, young people and adults. 
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • mortality after head injury
  • recovery after head injury
Date of Publication: October 2014
Endorsed on: May 2015
 
Full quality standard (PDF, 232KB, 44 Pages)
 

Head Injury, Early Management of Patients with (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.

RCPCH notes: 

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) - children (PDF, 1.45MB, 12 Pages)
 

Headaches in Young People 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 standard (PDF, 155KB, 31 Pages)
 

Health and Wellbeing of Looked-After Children and Young People (NICE)

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. This quality standard defines best practice for the health and wellbeing of looked-after children and young people.

This quality standard covers the health and wellbeing of looked-after children and young people from birth to 18 years and care leavers (including young people planning to leave care or under leaving care provisions). It applies to all settings and services working with and caring for looked-after children and young people, and care leavers, including where they live.

Date of Publication: April 2013
Date of Endorsement: May 2013

Full standard (PDF, 355KB, 66 Pages)  
 

Jaundice in newborn babies under 28 days (NICE)

Jaundice is one of the most common conditions needing medical attention in newborn babies; approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life. For most babies, this early jaundice is not a sign of underlying disease and is generally harmless. 
 
Breastfed babies are more likely than formula-fed babies to develop physiological jaundice within the first week of life. 
 
This quality standard covers the recognition and management of neonatal jaundice in newborn babies (both term and preterm) from birth to 28 days in primary care (including community care) and secondary care. 
 
Date of Publication: March 2014
Endorsed on: October 2015
 
Full Quality Standards (PDF, 144KB, 29 Pages)
 

Management of Obesity (SIGN)

The guideline covers the primary prevention of obesity, the treatment of obesity by diet and lifestyle, the treatment of obesity by pharmacological and surgical treatment and the prevention of weight regain following treatment, in adults, children and young people. 

The guideline includes key messages for parents, BMI charts, and healthy eating advice for children.

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

Full Guideline (PDF, 1.66MB, 96 Pages)
Quick Reference Guide (PDF, 1.14MB, 26 Pages)
 

Management of Obesity in Children and Young People (SIGN)

This guideline provides recommendations based on current evidence for best practice in the management of obesity in children and young people, up to the age of 18. It covers definition and prevalence, consequences of obesity in childhood, and prevention and treatment.

The guideline includes key messages for parents, BMI charts, and healthy eating advice for children.

RCPCH notes: 

This guideline has been updated by SIGN and was published in February 2010.

Date of Publication: April 2003
Date of Endorsement: April 2003

Full guideline (PDF, 2.55MB, 96 Pages)
 

Management of Sore Throat and Indications for Tonsillectomy (2010 Update) (SIGN)

The guideline covers the diagnosis of acute of recurrent sore throat, as well as pain management, antibiotic use, indications for surgical management and postoperative care in children and adults. 

The guideline is accompanied by a quick reference guide, patient information leaflets and a CPD training manual.

Date of Publication: April 2010
Date of Endorsement: July 2010

Full guideline (PDF, 699KB, 44 Pages)
Quick Reference Guide (PDF, 207KB, 2 Pages)
 

Melanoma: assessment and management (NICE)

Melanoma is the fifth most common cancer in the UK, with 13,348 cases diagnosed in the UK in 2011. In males and females separately, melanoma is the 6th most common cancer (4% each of the male and female total). The age-standardised incidence rate of melanoma in the UK in 2012 was higher for men (25.0 melanomas per 100,000 men) than for women (22.1 melanomas per 100,000 women). 
 
The incidence of melanoma is rising rapidly and is predicted to increase by 50% in the next 15 years. This is the fastest projected increase in incidence for any cancer. Most melanomas occur in white skinned people. The risk factors are skin which tends to burn in the sun, having many melanocytic naevi, intermittent sun exposure and sunburn.
 
This guideline covers children, young people and adults with suspected melanoma, and who have been newly diagnosed with cutaneous melanoma, including vulval and penile melanoma.
 
The guideline is relevant to all healthcare professionals who come into contact with people with melanoma, as well as to the people with melanoma themselves and their carers. It is expected that the guideline will be of value to those involved in clinical governance in both primary and secondary care to help ensure that arrangements are in place to deliver appropriate care to this group of people.
 
Date of Publication: July 2015
Endorsed on: August 2015
 
Full clinical guideline (PDF, 2297KB, 246 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)
 

Obesity: identification, assessment and management of overweight and obesity in children, young people and adults 

Overweight and obesity is a global problem. The World Health Organization predicts that by 2015 approximately 2.3 billion adults worldwide will be overweight, and more than 700 million will be obese.
 
In the UK obesity rates nearly doubled between 1993 and 2011, from 13% to 24% in men and from 16% to 26% in women. In 2011, about 3 in 10 children aged 2–15 years were overweight or obese.
 
This guideline addresses three main areas: 
  1. follow‑up care packages after bariatric surgery; 
  2. the role of bariatric surgery in the management of recent-onset type 2 diabetes; 
  3. very-low-calorie diets including their effectiveness, and safety and effective management strategies for maintaining weight loss after such diets. 
Date of Publication: November 2014
Endorsed on: July 2015
 
Full clinical guideline (PDF, 318KB, 65 Pages)
 

Obesity: prevention and lifestyle weight management in children and young people (NICE)

This quality standard covers a range of approaches at a population level to prevent children and young people aged under 18 years from becoming overweight or obese. It includes interventions for lifestyle weight management. 
 
These statements are particularly relevant to local authorities, NHS organisations, schools and providers of lifestyle weight management programmes.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • excess weight in children and young people under 18 years
  • dietary habits
  • time spent being inactive or sedentary
  • prevalence of type 2 diabetes in children and young people
  • use of children and adolescent mental health services (CAMHS)
  • self-esteem
  • mental wellbeing
Date of Publication: July 2015
Endorsed on: July 2015
 
Full quality standard (PDF, 227KB, 44 Pages)
 

Obesity: prevention, identification, assessment and management of overweight and obesity in adults and children (NICE)

The guideline covers the prevention, identification, assessment and management of overweight and obesity in adults and children over the age of two. It is particularly relevant to all healthcare professionals working with overweight and obese adults and children in primary, secondary and where appropriate, tertiary care. The guideline includes public health recommendations as well as clinical recommendations.

The guideline is accompanied by a costing report and template, audit support, an implementation support tool, slide sets (one of which is aimed at schools), a commissioning guide and an online educational tool. 

RCPCH notes: 

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

  • The guideline recommends that individuals follow a low-fat diet. It is not made clear in the guideline, but this should be read alongside the sources of advice and information listed in Appendix D of the NICE guideline. The RCPCH recommends that advice regarding minimising sedentary activities be supplemented by a cap on television viewing time of two hours.

Date of Publication: December 2006
Date of Endorsement: May 2008

Full guideline (PDF, 1.29MB, 189 Pages)
NICE guideline (PDF, 997KB, 84 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)
 

Paediatrics Allergy Action Care Plans (BSAC)

The plans have been designed to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training or equipment apart from access to an adrenaline auto injector (AAI). They may also be used to provide a framework for management of anaphylactic reactions to health professionals who are less familiar with this aspect of clinical care.

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

Personal plan for individuals prescribed EpiPen (PDF, 324KB, 1 Page)
A generic plans for individuals assessed as not needing AAI (PDF, 188KB, 1 Page)
Personal plans for individuals prescribed Jext (PDF, 340KB, 1 Page)
 

Performance of the Sweat Test for the Investigation of Cystic Fibrosis in the UK (ACB)

This evidence based guideline was produced by the Association for Clinical Biochemistry and Laboratory Medicine (ACB). They are aimed at the following staff involved in the pathway for the diagnosis of cystic fibrosis by sweat test: laboratory staff, scientists and chemical pathologists, clinicians requesting the test and overseeing patient care, nursing staff involved in patient care.
 
The guideline applies to subjects of all ages from neonates, through infancy, childhood and adulthood; however, is primarily geared toward the paediatric population, where the majority of testing is undertaken.
 
It is intended that the recommendations contained in this updated guideline will be adopted for local use in the UK, wherever sweat testing for the investigation of cystic fibrosis is performed. 
 
This guideline outlines how to perform the sweat test for the investigation of cystic fibrosis in the UK. It outlines the evidence available and what the recommendations are (e.g. what patient information needs to be provided, which patients are suitable to a have sweat test, and how should sweat be collected and analysed).
 
This is an update of the 2003 Performance of the Sweat Test for the Investigation of Cystic Fibrosis.
 
Date of Publication: March 2014
Date of Endorsement: March 2014
 
Full guideline (PDF, 697KB, 121 Pages)
 

Personality 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)
 

Physical Signs of Child Sexual Abuse (RCPCH)

This handbook is a revision of the 1997 RCP publication 'Physical Signs of Sexual Abuse in Children' and is based on the best available evidence. The review focuses on evidence for the physical signs of CSA in the following areas: female genitalia, male genitalia, anal signs, oral signs and sexually transmitted infections.

This was developed with The Royal College of Physicians of London and its Faculty of Forensic and Legal Medicine.

Date of Publication: April 2008
Date of Endorsement: April 2008

Further information can be found here
 

Postnatal Care (NICE)

This quality standard covers postnatal care, which includes the core care and support that every woman, their baby and if appropriate, their partner and family should receive during the postnatal period. This includes recognizing women and babies with additional care needs and referring them to specialist services.

Date of Publication: July 2013
Date of Endorsement: October 2013

Full standard (PDF, 244KB, 64 Pages)
 

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) 
 

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) 
 

Promoting the Quality of Life of Looked-After Children and Young People (NICE)

The guidance sets out how agencies and services can work together to improve the quality of life of looked-after children and young people. The focus is on putting the child or young person at the centre of every activity that affects their life.

Date of Publication: October 2010
Date of Endorsement: March 2011

NICE guideline (PDF, 751KB, 170 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

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

Sickle cell acute painful episode (NICE)

Acute painful sickle cell episode (also known as painful crisis) is an acute condition that occurs in people with sickle cell disease. In these people red blood cells behave differently under a variety of conditions, including dehydration, low oxygen levels and elevated temperature. Changes in any of these conditions may cause the red blood cells to block the small blood vessels, restricting blood flow. This damages the tissue, which causes pain. 
 
This quality standard covers the management of sickle cell acute painful episode in people in hospital from the time of presenting to hospital until the time of discharge.
 
Date of Publication: April 2014 
Endorsed on: October 2015
 
Full Quality Standards (PDF, 207KB, 39 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
 

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, 1.15MB, 144 Pages)
Executive Summary (PDF, 398KB, 40 Pages)
Lay Summary 1- Sleep Services and Sleep Studies (PDF,  34KB, 3 Pages)
Lay Summary 2- Obstructive Sleep Apnoea (PDF, 37KB, 3 Pages)
Lay Summary 3- Obstructive Sleep Apnoea in Downs Syndrome (PDF, 21KB, 2 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, 3 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, 721KB, 82 Pages)
 

Surgical Management of Otitis Media with Effusion (NICE)

This guideline covers the referral, assessment and surgical management of children under 12 years old with a suspected diagnosis of otitis media with effusion (OME) and suspected hearing loss, including individuals with Down's Syndrome and Cleft Palate.

The guideline is accompanied by a quick reference guide, information for women and their carers, costing tools, slides highlighting the key message and implementation advice and includes audit criteria and key priorities for implementation.

Date of Publication: March 2008
Date of Endorsement: April 2008

Full guideline (PDF, 2.88MB, 92 Pages)
NICE guideline (PDF, 161KB, 22 Pages)
 

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) 
 

Urinary Tract Infection in Infants, Children and Young People Under 16 (NICE)

This quality standard covers the care of infants, children and young people under 16 years with a first or recurrent upper or lower urinary tract infection and without known underlying uropathy.

Date of Publication: July 2013
Date of Endorsement: October 2013

Full standard (PDF, 170KB, 31 Pages)
 

Use of Home Oxygen in Children (BTS)

The guideline covers the practice of administering supplemental oxygen to children outside hospitals and makes recommendations for best practice. It is based on available evidence published up to March 2008 and informal consensus.

The guideline is accompanied by an algorithm and quick reference guide, and includes key priorities for audit.

RCPCH notes: 

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

  • The guideline is particularly useful given that existing guidelines focus on adult home oxygen users, who unlike paediatric users are often housebound.
  • The recommendations are not likely to represent a significant change from existing practice. However, implementation of the guideline may have resulting cost implications should children who meet the criteria for home oxygen be discharged from children's wards and neonatal units at an earlier time.

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

Full guideline (PDF, 864KB, 29 Pages)
Quick reference guide (PDF, 111KB, 8 Pages)
 

Vaccine update in under 19s (NICE)

This quality standard covers increasing vaccine uptake among children and young people aged under 19 in groups and settings that have low immunisation coverage. It describes high-quality care in priority areas for improvement.
 
RCPCH notes:

The RCPCH asks its members to note that the quality standard does not provide a quality statement regarding routine vaccination of premature neonates. 

 
Date of Publication: March 2017
Endorsed on: March 2017
 
Full Quality Standard (PDF, 118KB, 22 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, audit support tools and an educational tool.

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).
  • Please note that as of December 2009, Recommendation 5.8 on Inappropriately Explained School Attendance has been amended. This recommendation has been changed from:"Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and formally approved home education is not being provided."
    to
    "Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and home education is not being provided."

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

Full guideline (PDF, 1.40MB, 156 Pages)
NICE guideline (PDF, 372KB, 39 Pages)
Key Messages (PDF, 886KB, 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)
 

Guidelines for Management of Children with Infections Attending Schools and Day Care Facilities (HPA/RCPCH)    

This guidance covers the inclusion and exclusion of children in day care settings, nurseries and schools in order to minimise the risk to other children and reduce the disease transmission, for 36 infectious diseases. It is based upon available evidence and expert consensus. The guidance is accompanied by professional fact sheets and public fact sheets.

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

  • The guideline has not been externally peer reviewed by RCPCH Members prior to publication and thus the College standard that the guideline adequately addresses comments made during consultation could not be assessed.

Date of Publication: August 2009
Date of College Support: July 2009

Full guideline (PDF, 173KB, 6 Pages)
 

Guidelines for the Management of Children Referred for Dental Extractions Under General Anaesthesia (APAGBI)

The guidelines are designed to provide evidence-based information on the management of children and young people who are referred for dental extractions under general anaesthesia.

Date of Publication: September 2011
Date of College Support: September 2011

Full guideline (PDF, 570KB, 52 pages)
Executive summary (PDF, 282KB, 12 pages)
 

Management of HIV in Pregnancy (RCOG)

This guideline covers the management of HIV in pregnant women in the UK.  It contains recommendations on antenatal HIV screening, interventions to prevent disease progression and prevent mother-to-child transmission of HIV, antenatal care of women with HIV and antenatal complications, as well as management of delivery, postpartum care, pre-pregnancy management and care of the neonate.

The guideline is accompanied by an executive summary and patient information.

Date of Publication: June 2010
Date of College Support: October 2010

Full guideline (PDF, 371KB, 28 Pages)