Guidelines endorsed by RCPCH - Gastroenterology, hepatology and nutrition

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 gastroenterology, hepatology and nutrition.

The following have been endorsed or supported by the College. 

Endorsed guidelines

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

NICE guideline (PDF, 458KB, 54 Pages)
NICE pathways
 

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)
 

Allergy Care Pathways (RCPCH)

The RCPCH has developed care pathways for children with allergic conditions following the Department of Health publication on the "Review of allergy services" (2006).  These can be dowloaded below.

  • Anaphylaxis
  • Food allergy
  • Asthma/Rhinitis
  • Eczema
  • Urticaria/Mastocytosis/Angio-oedema
  • Drug allergy
  • Venom allergy
  • Latex allergy

Further information including leaflets and videos for families can be found at www.rcpch.ac.uk/allergy
 

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)
 

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)  
 

Coeliac disease - recognition, assessment and management (2015) (NICE)

Coeliac disease is an autoimmune condition associated with chronic inflammation of the small intestine, which can lead to malabsorption of nutrients. Dietary proteins, known as glutens, which are present in wheat, barley and rye activate an abnormal mucosal immune response. Clinical and histological improvements usually follow when gluten is excluded from the diet.
 
People with autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease, or people with a first-degree family history of coeliac disease, have an increased likelihood of coeliac disease.
 
This clinical guideline covers the recognition, assessment and management of coeliac disease in children, young people and adults.
 
Date of Publication: September 2015
Endorsed on: January 2016
 
Full clinical guideline (PDF, 122KB, 21 Pages) 
 

Constipation in children and young people (2014 Update) (NICE)

This quality standard covers the diagnosis and management of idiopathic constipation in children and young people (from birth to 18 years).
 
Children and young people with idiopathic constipation can present to different types of healthcare professionals, such as GPs, pharmacists, school nurses, health visitors, practice nurses, continence advisors, paediatricians or a specialist continence service.
 
The quality standard is expected to contribute to improvements in the following outcomes: 
  • Rates of accident and emergency department attendance and unplanned hospitalisation for constipation in children and young people. 
  • Rates of recurrent constipation and/or impaction in children and young people. 
  • Parent or carer satisfaction with information and advice. 
Children and young people who are able to manage their constipation to their satisfaction.
 
These standards therefore draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.
 
Date of publication: May 2014
Date of endorsement: December 2014
 
Full quality standard (PDF, 217KB, 38 Pages)
 

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.

RCPCH notes:

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)
 

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)
 

Diarrhoea and Vomiting In Children Under 5 (NICE)

This guideline covers the management of young children under 5 years of age with acute diarrhoea, with or without vomiting, due to gastroenteritis.

The guideline is accompanied by a quick reference guide, a parent/carer advice sheet to support consultations, costing tools, a slide set, audit support, and a chart to facilitate assessment of dehydration. It also includes key priorities for implementation.

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

  • The guideline recommends that IV fluids should only be given if the child is in shock or is deteriorating despite ORS. It should be noted that NICE state that this recommendation has been made to prevent unnecessary IVT.
  • This guideline supersedes the Paediatric A&E Research Group guideline Children Presenting to Hospital with Diarrhoea, with or without Vomiting published in 2002.

Date of Publication: April 2009
Date of Endorsement: August 2009

Full guideline (PDF, 3.18MB, 200 Pages)
NICE guideline (PDF, 2.65KB, 33 Pages)
Key messages presentation (PDF, 245KB, 21 Pages)
 

Donor Breast Milk Banks (NICE)

The guideline covers the operation of donor breast milk services, including the recruitment of donors, expressing and handling on donor breast milk and testing and treating donor breast milk. The guideline does not make recommendations relating to the configuration of donor breast milk services.

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

RCPCH notes:

The RCPCH welcomes the publication of this guideline which focuses on the operation of donor milk banks (that is, the handling of milk).

  • The College would like to emphasise that siting donor breast milk in one site within a neonatal network would avoid duplication of resources.

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

Full guideline (PDF, 950KB, 132 Pages)
Quick reference guide (PDF, 99KB, 16 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

NICE clinicl guideline (PDF, 165KB, 34 Pages)
Full clinical guideline (PDF, 3,089KB, 218 Pages)
 

Intravenous fluid therapy in children and young people in hospital (NICE QS)

This quality standard covers the management of intravenous (IV) fluids in term neonates (babies born at term or born prematurely with a corrected age of term or more), children and young people under 16 years. 

 
It covers IV fluids used for a range of conditions and in different hospital settings. It does not cover term neonates, children and young people with condition-specific IV fluid needs, because they are under the care of specialists due to their specific needs.
 
The quality standard is expected to contribute to improvements in the following outcomes: 
  • patient safety incidents resulting from errors in IV fluid therapy. 
  • length of hospital stay. 
  • children’s and young peoples’ experience of inpatient services. 
  • mortality resulting from errors in IV fluid therapy. 
 
Date of Publication: September 2016
Endorsed on: October 2016
 
Full Quality Standard (PDF, 162KB, 34 Pages)
 

Intravenous fluid therapy in children and young people in hospital (NICE CG)

Correct fluid and electrolyte balance is essential to maintain normal physiological function in humans. Normally, children are able to maintain their fluid requirements through drinking. However, many children admitted to hospital may be too ill to drink and may require intravenous (IV) fluid therapy to maintain correct fluid and electrolyte balance. 
 
Children may need IV fluids to account for losses of red blood cells, plasma, water or electrolytes, beyond the usual losses in urine, stools and sweat. These losses can occur via the loss of blood, plasma and other fluids resulting from burns, diarrhoea, vomiting or leakage of fluid from the circulation into the interstitial space. In these situations, the aim is to replace any depleted fluids and restore associated electrolyte imbalances. 
 
This clinical guideline contains recommendations about general principles for managing intravenous (IV) fluids in children and young people under 16 years, and aims to help prescribers understand the:
  • indications for IV fluid therapy
  • reasons for the choice of the various fluids available
  • prevention and treatment of sodium imbalance
  • principles of assessing fluid balance
  • training and education needs of those prescribing IV fluids.
Date of Publication: December 2015
Endorsed on: February 2016
 
NICE clinical guideline (PDF, 142KB, 33 Pages) 
NICE full clinical guideline (PDF, 1,421KB, 33 Pages)
 

Investigations in Hypernatraemia (RCPCH)

This guideline is based on a systematic review of the literature relating to hypernatraemia and salt poisoning. It will provide evidence-based guidance on the differential diagnoses for hypernatraemia in children and on what investigations should be undertaken when children present, and the interpretation of the results of investigations.

The guideline is accompanied by an executive summary.

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

Full guideline (PDF, 0.99KB, 114 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, 1.6MB, 96 Pages)
Quick reference guide (PDF, 1.1MB, 20 Pages)
 

Neonatal Jaundice (NICE) 

The guideline covers the recognition, assessment and treatment of neonatal jaundice as well as the prediction of later significant hyperbilirubinaemia and adverse sequelae in babies from birth until 28 days of age.

The guideline is accompanied by a quick reference guide, guidance for parents and carers, audit support tools, costing tools, a factsheet, treatment threshold graphs, a slide set and a baseline assessment tool.

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

  • The scope of the guideline does not cover infants with jaundice lasting beyond the first 28 days.

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

Full guideline (PDF, 7.64MB, 252 Pages)
NICE guideline (PDF, 1.21MB, 54 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.

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, 198 Pages)
NICE guideline (PDFm 997KB, 84 Pages)
 

Organ Donation for Transplantation (NICE)

This guideline recognises the complexities that arise owing to the majority of potential adult and paediatric organ donors lacking the capacity to be directly involved in decision making at the time of their death. It covers strategies for improving donor identification and consent rates for deceased organ donation.

RCPCH notes:

The College asks members to note that:

  • There are few data on the validity of trigger tools in paediatric practice. NICE’s response to this comment is as follows: ‘The GDG made their decisions using the best available evidence, and where this was not available or lacking, the GDG based their recommendations on their clinical experience.’ It should be noted that NICE has deemed the best evidence from studies investigating conversion of patients displaying clinical triggers into organ donors is of very low quality.
  • Explicit reference to contraindications to donation from a paediatric perspective is not covered by the guideline.  This is because the GDG agreed that contraindications should not be included due to the rapid pace at which changes to contraindications occur particularly in paediatric patients.

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

Full guideline (PDF, 168KB, 26 Pages)
Appendices
 

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 guidelines

The Management of Inflammatory Bowel Disease in Children (BSPGHN)

This guideline covers good practice in the investigation of Inflammatory Bowel Disease in children and management of Crohn's Disease, Ulcerative colitis and Indeterminate colitis.  It makes recommendations for associated aspects of IBD, including nutrition, growth and pain management as well as recommendations on service delivery.  Sources of information for parents and carers are presented.  The guideline does not cover second line treatment, duration of treatment or advice regarding tapering of Azothioprine.

The guideline includes recommendations on service delivery and sources of information for parents and carers.

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

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

Date of Publication: October 2008
Date of College Support: June 2009

Full guideline (PDF, 569KB, Pages)