Guidelines endorsed by RCPCH - General paediatrics

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 general paediatrics.

On this page:

Endorsed guidelines

The following have been endorsed by the College. 

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

This guidance update is a joint venture between the Royal College of Ophthalmologists (RCOphth) 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 RCOphth. 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, 747KB, 2 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
 

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 here:

www.rcpch.ac.uk/allergy
 

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)
 

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)
 
Full Guideline (PDF, 172KB, 39 Pages)
 

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)
 

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 quality standards (PDF, 188KB, 40 Pages)
 

Atopic Eczema in Children (NICE CG)

The guideline covers the assessment, diagnosis and management of atopic eczema in children from birth until 12 years and provides information and education for children, parents and their carers. It is particularly relevant to all healthcare professionals who are involved in the care of children who have atopic eczema, those responsible for commissioning and planning healthcare services; and, children with atopic eczema and their families.

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

Date of Publication: December 2007
Date of Endorsement: April 2008

Full guideline (PDF, 2.37MB, 220 Pages)
NICE guideline (PDF, 190KB, 39 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 quality standards (PDF, 172KB, 46 Pages) 
 

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

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE QS)

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

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

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

Full quality standard (PDF, 257KB, 50 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE CG)

The guideline covers the diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people under 16 years in primary and secondary care.

The guideline is accompanied by a quick reference guide, parent/carer version, audit tools and algorithms.

RCPCH notes:

Please note that since publication of the guideline:

  • NICE have updated the quick reference guide to reflect the action required when meningococcal meningitis is confirmed in children older than 3 months. Please see the NICE website for further information.
     
  • Recommendation 1.4.45 has been amended from:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'

    To:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'

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

Full guideline (PDF, 5.75MB, 275 Pages)
NICE guideline (PDF,  293KB, 45 Pages)
Press release (PDF, 47KB, 6 Pages)
 

Blood transfusion (NICE)

Blood transfusions are common in clinical practice. In 2014/15 NHS Blood and Transplant issued 1.7 million units of red blood cells, 275,000 units of platelets, 215,000 units of fresh frozen plasma and 165,000 units of cryoprecipitate to hospitals in England and North Wales. 
 
An estimated 430,000 patients received a red blood cell transfusion in 2002; a further study has not been conducted, but given the reduction in blood use since 2002 the number of patients who have had a transfusion is likely to be 10–20% lower than this figure.
 
Despite considerable efforts to ensure the safety of blood transfusions, they are associated with significant risks.
 
This clinical guideline contains recommendations about general principles of blood transfusion, and applies to a range of conditions and different settings. 
 
Date of Publication: November 2015
Endorsed on: February 2016
 
NICE clinical guideline (PDF, 142KB, 26 Pages) 
NICE full clinical guideline (PDF, 3,531KB, 351 Pages)
 

Bronchiolitis in children (NICE QS)

This quality standard covers the assessment, diagnosis and management of bronchiolitis in children.

Bronchiolitis is a condition that affects the lower respiratory tract. It is caused by infection with one of several different viruses. At the start of the infection, symptoms are usually those of a common cold, including a blocked or stuffy nose, cough and sneezing. After several days, breathing and feeding difficulties develop. Until this point, it is not possible to tell that the infection will cause bronchiolitis. If there are wheeze and/or crackles heard on clinical examination, a diagnosis of bronchiolitis can be made.

The quality standard is expected to contribute to improvements in the following outcomes:

  • antibiotic use
  • parent and carer experience of primary and secondary care
  • hospital admissions.

RCPCH notes:

This quality standard is welcomed, however it does not provide a distinction between babies who need readmission and those who need reassurance. As noted in the standard, further guidance is needed on admission avoidance and early supported discharge of children with bronchiolitis.

Date of Publication: June 2016
Endorsed on: August 2016

Full Quality Standard (PDF, 133KB, 26 Pages) 
 

Bronchiolitis in children (NICE CG)

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. It usually presents with cough with increased work of breathing, and it often affects a child's ability to feed. In primary care, the condition may often be confused with a common cold, though the presence of lower respiratory tract signs (wheeze and/or crackles on auscultation) in an infant in mid‑winter would be consistent with this clinical diagnosis. The symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness.
 
The guideline covers children with bronchiolitis but not those with other respiratory conditions, such as recurrent viral induced wheeze or asthma.
 
Date of Publication: May 2015
Endorsed on: June 2015
 
Full clinical guideline (PDF, 148KB, 29 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, 847KB, 317 Pages)
NICE guideline (PDF, 336KB, 52 Pages)
 

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

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

The guideline includes an executive summary and research priorities.

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

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

Further information can be found here
 

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 (NICE QS)

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 Publiction: May 2014
Date of Endorsement: December 2014

Full quality standard (PDF, 214KB, 38 Pages)
 

Constipation in Children and Young People (NICE/RCoG)

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, 2.48MB, 255 Pages)
 

Diabetes (type 1 and type 2) in children and young people: diagnosis and management (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, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.
 
This guideline is of relevance to those who work in or use the National Health Service (NHS) in England and Wales, in particular:
  • paediatric endocrinologists, paediatric dietitians, paediatric diabetes specialist nurses, general practitioners 
  • those responsible for commissioning and planning healthcare services, including primary care trust and local health board commissioners, Wales commissioners and public health and trust managers
  • children and young people with type 1 or type 2 diabetes and their families or carers.
Date of Publication: August 2015
Endorsed on: March 2016 
 
Full Clinical Guideline (PDF, 4,609KB, 517 Pages) 
NICE Clinical Guideline (PDF, 335KB, 92 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

Date of Publication: July 2016
Endorsed on: August 2016

Full Quality Standard (PDF, 194KB, 40 Pages) 
 

Diabetic foot problems - prevention and management (NICE)

Foot complications are common in adults with diabetes. It is estimated that 10% of adults with diabetes will have a diabetic foot ulcer at some point in their lives. A foot ulcer can be defined as a localised injury to the skin and/or underlying tissue, below the ankle, in a person with diabetes. 
 
This guideline covers preventing and managing foot problems in adults with diabetes, with an emphasis on the education of children and young people in foot care in preparation for transition to adulthood. The guideline aims to reduce variation in practice.
 
Date of Publication: August 2015
Endorsed on: January 2016
 
Full clinical guideline (PDF, 2802KB, 282 Pages) 
NICE guideline (PDF, 217KB, 46 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 (PDF, 245KB, 21 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)
 

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)
 

Drug allery: diagnosis and management (NICE)

This quality standard covers the diagnosis and management of drug allergy in adults, young people and children.

Diagnosing drug allergy can be challenging and there is considerable variation in management and in access to specialist drug allergy services. This can lead to under diagnosis, misdiagnosis and self-diagnosis. This variation may be caused by a lack of local drug allergy centres or awareness of available services. Some people are never offered a referral to specialist services and stay in primary care. Others have their drug allergy managed in other disciplines. Only a small proportion of people are treated in specialist allergy centres.

The quality standard is expected to contribute to improvements in the following outcomes:

  • patient experience of care
  • patient safety incidents reported
  • mortality from causes considered preventable
  • patient exposure to unnecessary broad-spectrum antibiotics antibiotic
  • prescribing and antimicrobial resistance rates

Date of Publication: July 2015
Endorsed on: September 2015

Full quality standard (PDF, 206KB, 40 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 quality standard (PDF, 235KB, 45 Pages)
 

Feverish illness in children (NICE QS)

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)
 

Fractures (complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected complex facture. 
 
Two of the five guidelines in the NICE Trauma Suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care.
 
The key clinical issues that are covered are as follows:
  • Initial triage by pre-hospital care provider
  • Initial assessment and management by pre-hospital care provider
  • Acute stage clinical assessment
  • Acute stage imaging assessment
  • Timing of referral and criteria for acceptance
  • Initial management and treatment plan
  • Ongoing management
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with complex fracture
  • Information and support needs of patients and their families and carers where appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,191KB, 278 Pages) 
NICE Clinical Guideline (PDF, 117KB, 18 Pages)
 

Fractures (non-complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected non-complex facture. 
 
Two of the five guidelines in the NICE trauma suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing non-complex fractures that can be treated in the emergency department or orthopaedic clinic. It aims to improve practice so that people with fractures receive the care that they need without unnecessary tests and treatments.
 
The key clinical issues that are covered are as follows:
  • Assessment tools for initial triage
  • Acute-stage imaging assessment
  • Initial management and treatment plan
  • Ongoing management
  • Follow-up clinics
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with fractures
  • Information and support needs of patients and their families and carers when appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,577KB, 295 Pages) 
NICE Clinical Guideline (PDF, 111KB, 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 clinical guideline (PDF, 165KB, 34 Pages)
Full clinical guideline (PDF, 3,089KB, 218 Pages)
 

Haematological cancers (NICE QS)

This quality standard covers diagnostic reporting and the organisation of haematological cancer services for people of all ages (children, adults and young people) and managing haematological cancers in adults and young people (aged 16 and over). It describes high-quality care in priority areas for improvement.

Date of Publication: June 2017
Endorsed on: June 2017

Full quality standard(PDF, 111KB, 19 Pages)
 

Head injury (NICE)

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)
 

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 quality standards (PDF, 155KB, 31 Pages)
 

Heavy Menstrual Bleeding (NICE)

This guideline covers advice on the diagnosis and management of women with heavy menstrual bleeding (HMB) as a result of cyclical ovarian activity.

The guideline is accompanied by a quick reference guide, slides highlighting the key messages, costing tools and implementation advice and include audit criteria and key priorities for implementation.

Date of Publication: January 2005
Date of Endorsement: September 2008

Full guideline (PDF, 1.25MB, 192 Pages)
NICE guideline (PDF, 185KB, 30 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

RCPCH guideline (PDF, 1017KB, 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)
 

Major trauma: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected major traumatic injury. 
 
This guideline covers the rapid identification and early management of major trauma in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns.
 
The key clinical areas covered are as follows:
  • Airway management
  • Pre-hospital management of chest trauma
  • Hospital management of chest trauma
  • Management of haemorrhage
  • Management of shock
  • Heat loss
  • Pain management
  • Documentation and transfer of information
  • Information and support
  • Skills to be present in the multidisciplinary team. 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,829KB, 330 Pages) 
NICE Clinical Guideline (PDF, 127KB, 21 Pages)


Major trauma: service delivery (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a major traumatic injury or a suspected major traumatic injury. 
 
This guideline covers the organisation and provision of major trauma services in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by providing a systematic approach to the delivery of major trauma care. It does not cover services for people with burns.
 
The key service areas are:
  • Access to services
  • Appropriate destination
  • Continuity of care
  • Documentation and transfer of information
  • Audit
  • Provision of information
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 2,361KB, 203 Pages) 
NICE Clinical Guideline (PDF, 147KB, 20 Pages)
 

Management of Invasive Meningococcal Disease in Children and Young People (SIGN)

This guideline covers best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age.

The guideline is accompanied by a quick reference guide and information for parents and carers and includes key audit criteria.

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

  • The recommendation that "parenteral antibiotics (either benzylpenicillin or cefotaximine) should be administered in children as soon as IMD is suspected and not delayed pending investigations" is a Grade D recommendation and based upon expert opinion. Evidence from a systematic review by Hahne et al suggested that the use of parenteral antibiotics is inconsistent and that results are inconclusive. SIGN have amended the guideline to include this reference; however, the grading has not been altered as the recommendation is in line with advice from the Health Protection Agency.

Date of Publication: May 2008
Date of Endorsement: April 2009

Full guideline (PDF, 527KB, 53 Pages)
Quick reference guide (PDF, 181KB, 2 Pages)
Key messages (PDF, 537KB, 25 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, 1.61MB, 96 Pages)
Quick reference guide (PDF, 1.08MB, 20 Pages)
 

Management of Palliative Care on Neonatal Units

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
 

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 QS)

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 CG)

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)
 

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 plan for individuals prescribed Jext
 

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 & 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)
 

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 quality standards (PDF, 244KB, 64 Pages)
 

Pressure ulcers (NICE QS)

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 CG)

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) 
 

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.
  • Please note that since publication of the guideline, marketing authorisation of Subratamine (Reductil) has been suspended. The guideline previously recommended use of this drug for treatment of obesity in some circumstances and these recommendations have now been withdrawn. Prescribers should follow advice given by the MHRA.

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

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

Recognition and Assessment of Acute Pain in Children (RCN)

This guideline updates the Royal College of Nursing (RCN) guideline 'Assessment of Acute Pain in Children' (2001). The guideline covers the recognition of acute pain in children, as well as the assessment of acute pain using scales and other tools in children with and without cognitive impairment. It provides recommendations based upon the best available evidence.

The guideline is accompanied by a quick reference guide and poster, and includes implementation advice.

The RCPCH believes that the update of this guideline is extremely valuable. However, the College believes that it would be worthwhile to consider cross-cultural and ethnicity issues in a future update of the guideline.

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

Full guideline (PDF, 3.06MB, 74 Pages)
 

Respiratory Tract Infections (NICE)

This guideline covers the treatment of adults and children, 3 months or older, with respiratory tract infections (RTIs) for which immediate antibiotic prescribing is not indicated.

The guideline is accompanied by a quick reference guide, information for patients, slides highlighting the key messages and audit tools and includes care pathways, audit criteria and key priorities for implementation.

Date of Publication: July 2008
Date of Endorsement: January 2009

Full guideline (PDF, 628KB, 121 Pages)
Quick reference guide (PDF, 150KB, 2 Pages)
Key messages (PDF, 28.1KB, 20 Pages)
 

Spinal injury: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with suspected spinal column or spinal cord injury secondary to a traumatic event. 
 
This guideline covers the assessment and early management of spinal column and spinal cord injury in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It covers traumatic injuries to the spine but does not cover spinal injury caused by a disease.It aims to reduce death and disability by improving the quality of emergency and urgent care.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,363KB, 247 Pages) 
NICE Clinical Guideline (PDF, 120KB, 22 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) 
 

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)
 

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

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

Urinary Tract Infection in Children (NICE)

The guideline covers the investigations and treatment for children younger than 16 years who have a urinary tract infection (UTI) and the information that should be offered to their families. Urine testing strategies are provided. The guideline is particularly relevant to all healthcare professionals who are involved in providing care for children who have a UTI, those responsible for commissioning and planning healthcare services and children who have a UTI and their families.

The guideline includes key priorities for implementation, a quick reference guide, information for parents/carers, slides highlighting the key messages, audit criteria, costing tools, implementation advice, and an online educational tool.

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

Full guideline (PDF, 5.56MB, 178 Pages)
NICE guideline (PDF, 252KB, 30 Pages)
 

Urinary Tract Infection in Febrile Infants and Young Children (AAP)

The aim of the guideline was to formulate recommendations for health care professionals about the diagnosis, treatment, and evaluation of an initial urinary tract infection (UTI) in febrile infants and young children ages 2 months to 2 years.

The guideline includes an algorithm.

Date of Publication: April 1999
Date of Endorsement: April 1999

Technical report (PDF, 990KB, 60 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 quality standards (PDF, 170KB, 31 Pages)
 

Vaccine uptake 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, 1.45MB, 156 Pages)
NICE guideline (PDF, 371KB, 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)
 

Late Intrauterine Fetal Death and Stillbirth (RCOG)

This guideline identifies evidence-based options for women (and their relatives) who have a late intrauterine fetal death (IUFD: after 24 completed weeks of pregnancy) of a singleton fetus. It includes information on general care before, during and after birth, and care in future pregnancies.

Date of publication: October 2010
Date of College support: 2011

Full guideline (PDF, 460KB, 33 Pages)
 

Management of Children Referred for Dental Extractions Under General Anaesthesia (APA)

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 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)
 

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)
 

Surgical Site Infection (NICE)

This guideline covers the prevention and treatment of surgical site infection in adults and children undergoing surgical incisions through the skin, including minimal invasive surgery.
 
The guideline is accompanied by a costing report, slide set, quick reference guide, parent/carer version and audit support and includes audit criteria.
 
Date of publication: October 2008
Date affirmed: September 2009
 
Full guideline (PDF, 5.9 MB, 168 Pages)
NICE guideline (PDF, 213 KB, 28 Pages)
 
RCPCH Comments:
The RCPCH welcomes the publication of this guideline but asks Members to note the following:
  • The guideline presents recommendations relating to the prevention and treatment of surgical site infection, however the Guideline Development Group did not include paediatric representation