​Regional Guidelines

The PIER tools and guidelines have been created to reduce the variation of care for paediatric conditions throughout the region. They have been created by multidisciplinary clinicians from throughout the region, with input from tertiary consultants, regional speciality networks and accepted national guidance. Our resources also include useful signposting websites for children and young people with chronic health conditions.
Search all the PIER, SORT and Healthier Together Guidelines
New & Updated Guidelines - Jan 2026
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Important
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​New STOPP form now available from the Paediatric Critical Care Network
Guidelines Coming Soon
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  • ​Chronic Childhood Constipation
  • Tics
  • Community Acquired Pneumonia​
  • Infantile Spasms​​
  • ​​​Diagnosis of Coeliac Disease​
  • Management of Capillary Haemangiomas
Allergy
Anaphylaxis Management
IgE Home Milk Introduction
Paediatric Allergic Rhinitis
Paediatric Egg Allergy
Penicillin Allergy and De-Labelling
Urticaria
Cardiology
Acute Management of a Cyanosed Infant with Systemic to Pulmonary Shunt (Black-Taussig or Sano Shunt)
Dextrocardia
Hyper-cyanotic spells in Tetralogy of Fallots
Perinatal Ectopic Beats
Child Death
Hampshire and Isle of Wight Child Death Overview Panel Notification Form (CEDOP Form)
Diabetes
Diabetic Ketoacidosis (DKA)
Treatment of Children with Diabetes Undergoing Surgery
Eating Disorders
Medical Assessment in Eating Disorders
Management of a Ward Admission
Emergency Medicine & Acute Paediatrics
Acute Non-Invasive Ventilation (CPAP/BiPAP)
​Bone and Joint Infections
Brief Resolved Unexplained Event (BRUE)
​Cellulitis
Fever in babies less than 90 days old (the 'hot baby' pathway)
​First Afebrile Seizure
​Foreign Body Ingestion
Henoch-Scholein Purpura (HSP)
​Lymphadenitis/Lymph Node Abscess
Lower Motor Neurone Facial Nerve Palsy ​​
Otitis Media/Mastoiditis
Paracetamol Overdose - 12hr SNAP Protocol
Petechial/Purpuric Rash
Pneumonia/Empyema
Preseptal Cellulitis/Orbital Cellulitis
Procedural Sedation in the Emergency Department
Pyelonephritis
Swollen Joints in Children
Trauma
Tonsillitis/Quinsy
Toxic Shock Syndrome in Paediatric Burns
Use of Inhaled Methoxyflurane (Penthrox) as an Analgesic Agent for Acute Traumatic Pain and Painful Procedures
Endocrine
Adrenal Crisis (New Presentation or Pre-existing adrenal insufficiency)
Ambiguous Genitalia (Initial Management of a Baby)
Congenital Hyperinsulinism in Neonates
Electrolyte Management
​Hyperthyroidism and Thyrotoxicosis
Acute Hypocalcaemia
Investigations and Initial Management of Hypoglycaemia
Management of Neonates Born to Mothers with Thyroid Disease
Management of Raised Neonatal Bloodspot TSH and Initial Management of Congenital Hypothyroidism
Sick Day Steroids Guideline
Peri-operative Steroid Management
Obesity
Genetics
Wessex Paediatric Whole Genome Sequencing Guide: for well child with developmental delays or well young person with learning disability (LD)
How to Request Urgent Whole Genome Sequencing for Acutely Unwell Children
Gastroenterology
Bedside Placement and Care of a Nasojejunal Tube
Gastrostomy Toolkit
Nasal Bridle in Children
Prescribing and Monitoring of Biologics in IBD
Management of Significant Upper GI Bleed
Haematology
Assessment and Management of Idiopathic Thrombocytopaenic Purpura (ITP)
Management of Newborn infant where a parent has Hereditary Spherocytosis
Sickle Cell​
Infectious Diseases
Bone and Joint Infections
Cellulitis
Lymphadenitis/Lymph Node Abscess
Congenital Cytomegalovirus (CMV)
​Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids
​Fever in babies less than 90 days old (the 'hot baby' pathway)
Gentamicin Dosing in Children
Kawasaki Disease
Lyme Disease
Management of Infants at Risk of Congenital Syphilis
Malaria
Suspected Meningitis
Neonatal HSV
Otitis Media/Mastoiditis
Paediatric Inflammatory Multisystem Syndrome - Temporarily Associated with SARS-CoV2 (PIMS-TS)
Paediatric Influenza
Petechial/Purpuric Rash
Pneumonia/Empyema
Preseptal Cellulitis/Orbital Cellulitis
Pyelonephritis
TB Testing in Children on Biologics ​
Tonsillitis/Quinsy
Vancomycin Guideline
Non-Tuberculous Myobacterial Cervical Lymphadenitis
Acute Management of Pertussis
Position Statement on Respiratory PCR Testing in Children
Infant Feeding
IgE Home Milk Introduction
Mental Health & Eating Disorders
Medical Assessment in Eating Disorders
Management of a Ward Admission in Eating Disorders
Rapid Tranquilisation Policy
Mental Health Act Frameworks Explainer
Neonatal Guidelines
Thames Valley and Wessex Neonatal Network
​Congenital Hyperinsulinism in Neonates
​Ambiguous Genitalia (Initial Management of a Baby)
​Congenital Cytomegalovirus (CMV)
​Neonatal HSV
​Management of Infants at Risk of Congenital Syphilis
​Management of Neonates Born to Mothers with Thyroid Disease
​​Antenatally Detected Uropathy - Investigations and Management
Nephrology & Urology
Acute Kidney Injury Prevention and Recognition
Antenatally Detected Uropathy - Investigations and Management
Haematuria in Children
Assessment of Childhood Daytime Urinary Incontinence
Micturating Cystograms in Children
Nephrolithiasis and Nephrocalcinosis (Stones)
Nephrotic Syndrome
Pharmacological Management of Non-Neuropathic Overactive Bladder (Wetting)
Paediatric Hypertension
Neurology & Neurosurgery
Anticonvulsant Medications when the Oral Route is Unavailable
Assessment of Childhood Daytime Urinary Incontinence
Care for Children with Hydrocephalus or a Blocked Ventricular Shunt
Encephalitis
First Afebrile Seizure
Idiopathic Intracranial Hypertension in Children aged 1-18 years
Lower Motor Neurone Facial Nerve Palsy
Management of Children and Young People with Acute Decrease in Conscious Level (RCPCH DeCon Guidelines)
Pineal Cyst Pathway
Arterial Ischaemic Stroke
Oncology
Management of Chemotherapy Induced Nausea and Vomiting (CCLG Guideline)
Electrolyte Management
Infections
Guidelines for the Prophylaxis of Pneumocystis Jirovecii Pneumonia (PJP) in Children with Solid Tumours
Hypoalbuminaemia in Paediatric Oncology
Investigation of New Patients in Oncology
Blocked Central Venous Devices and Lines
Hyperleucocytosis
Hypertension in Oncology
Ifosfamide Induced Encephalopathy
Varicella Contact in Oncology
Veno-occlusive Disease in Paediatric Oncology Patients
Viral Infections, Viral Prophylaxis and Vaccination Guidance
Off Treatment Follow Up for Acute Lymphoblastic Leukaemia (ALL)
Systemic Anti Cancer Therapy Extravasation Guideline
Children’s Cancer Referral Pathway into Southampton Principle Treatment Centre (PTC) V1.0
Re-Vaccination Schedule for Patients Beginning 3 months After Completion of Standard Dose Chemotherapy
Recognition and Management of Tumour Lysis
Spinal Cord Compression (SCC)
Starting Parenteral Nutrition (PN) in Paediatric Oncology
Symptom Management and Palliative Care in Oncology
The Use of Haemopoietic Growth Factors in Paediatric Oncology and Haematology Patients
Transfusion and Coagulation in Paediatric Oncology
Typhilitis
Vaccinations For Paediatric Patients Treated With Standard-Dose Chemotherapy and Haemopoietic Stem Cell transplantation Recipients
Supportive Care Guidelines: Management of Nutrition
Steroid, Chemotherapy or Transplant Induced Hyperglycaemia
Recommendations for the Prevention and Management of Oral Complications in Children and Young People with Cancer (CCLG)
List of Approved Chemotherapy Regimes
Parent Held Oncology Records
Orthopaedics
Femoral Fracture Transfer Guideline
Respiratory
​Acute Non-Invasive Ventilation (CPAP/BiPAP)
Asthma
Use of Heated, Humidified High Flow for Children and Young People
​Chest Drain Insertion in a DGH
Long Term Ventilation Quick Links
Rheumatology
Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids
Swollen Joints in Children
Surgery
Perioperative Fasting Guidelines
Pre-Operative Care of Infants with Pyloric Stenosis

Disclaimer

The PIER guidelines have been created collaboratively with ratification through the relevant regional speciality clinical network. They represent the views of the relevant speciality clinical network and have been produced after consideration of the available evidence in conjunction with local expertise.

Guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the individual circumstances of their patients.

Governance and ratification of the PIER Guidelines is kindly performed by the Child Health Governance group at University Hospital Southampton. Overall management of the guidelines is performed by the PIER team.

PIER guidelines are subject to a 3 year review process which takes into account any changes in management or new research. Some guidelines may have reached or passed this review date. These guidelines are still available for use in clinical practice but should be used at the clinicians discretion with appropriate review of any new national guidelines that may be available. PIER does not hold any responsibility for the outcomes of the use for guidelines used outside of their review process.