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.
New & Updated Guidelines - March/April 2023
​​
New and Updated Guidelines Coming Soon
​​
  • Paediatric Egg Allergy Guidelines
  • Fever in Babies less than 90 Days Old
  • Brief Resolved Unexplained Events (BRUEs)
  • Obesity Safeguarding Strategy
  • Tics
  • Community Acquired Pneumonia
  • SNAP Protocol

Current number of
​PIER Guidelines
A-Z
To search for a specific guideline:
On a computer:
  1. Click the Ctrl and F keys on your keyboard
  2. Enter your search terms in the search box​
On a phone or tablet:
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  3. ​Enter your search terms

A
Abdominal Pain Acute Kidney Injury - Prevention & Recognition 
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Adrenal Crisis (new presentation or pre-existing adrenal insufficiency) Ambiguous Genitalia (Initial Management of a Baby) Anaphylaxis ​​​Antibiotic Therapy for Specific Childhood Infections Anticonvulsant use when Nil by Mouth Antenatally Detected Uropathy Guidelines Arrhythmia - Tachyarrhythmia with a Pulse ​​Asthma (Acute) ​​Asthma (Chronic) Autosomal Dominant Poly-cystic Kidney Disease

C
Ceftriaxone Administration in Children Central Venous Access Devices ​Cellulitis Chemotherapy Induced Nausea and Vomiting Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids Child Protection Policies and Procedures (Hampshire, Isle of Wight, Portsmouth and Southampton)
  • Hampshire, IoW, Portsmouth and Southampton (HIPS) Guideline
​Child Protection Companion ​​Child Death CMV (Congenital)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Conjunctivitis in Children Constipation  Coughs and Colds Croup Cyanosed Infant with Systemic to Pulmonary Shunt (Blalock-Taussig or Sano shunt)

D
​​Decreased Conscious Level RCPCH Guidelines Dermatology
  • See Dermatology section
​​Dextrocardia Diabetes Diabetic Ketoacidosis ​​Diarrhoea and Vomiting Drowning

E
​Eczema Electrolyte Replacement Empyema Encephalitis
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Extravasation

F
Fabricated and Induced Illness
  • Hampshire, IoW, Portsmouth and Southampton (HIPS) Protocol
​​​Facial Nerve Palsy Febrile Neutropaenia
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Femoral Fracture Fever First Afebrile Seizure​​Foreign Body Ingestion

G
Gastroesophageal Reflux Gastrostomy Interactive Toolkit Gentamicin Dosing in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​GCSF: The Use of Haematopoietic Growth Factors in Paediatric Oncology and Haematology Patients
​This guideline is due for review. Please check national guidance and use at your own clinical discretion.

H
Haematuria in Children Head Injury HSP in Children
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. HSV (Neonatal)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Humidified High Flow Hydrocephalus/Blocked Ventricular Shunt Hypercyanotic Spells in Tetralogy of Fallot ​​Hyperglycaemia (Steroid, Chemotherapy or Transplant Induced)Hyperinsulinaemic Hypoglycaemia in Neonates Hypertension (Oncology)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Hypertension (Non-Oncology)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. HypoalbuminaemiaHypocalcaemia Hypoglycaemia Hypothyroidism (congenital) and raised neonatal bloodspot TSH

I
Ifosfamide Induced Encepahlopathy Infant Feeding Guidelines​ ​​Influenza Infectious Disease Screening for Refugees and Asylum-Seekers Investigation of New Oncology Patients
​This guideline is due for review. Please check national guidance and use at your own clinical discretion.

K
Kawasaki Disease

M
Malaria in Children Mastoiditis Meningitis Metabolic Emergencies Mucositis
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.

N
Nasal Bridle Insertion and Management Nasojejunal Tube Placement and Basic Care​ ​Nausea and Vomiting Management (Oncology) Neonatal Collapse ​Neonatal Guidelines Nephrotic Syndrome
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Nutrition (Oncology)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion.

O
Obesity Off Treatment Oncology Surveillance 
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Oncology Emergencies Oral Steroids - Sick Day Telephone Advice Otitis Media ​Pharmacological Management of Non-Neuropathic Overactive Bladder

P
​​​Paediatric Inflammatory Multisystem Syndrome - Temporarily Associated with SARS-CoV2 (PIMS-TS) Parent Held Oncology Records Palliative Care and Symptom Management
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Preorbital Cellulitis Perioperative Fasting Guidelines
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Prophylaxis of Pneumocystis Jirovecii Pneumonia (PJP) in Children with Solid TumoursPneumonia Post-exposure prophylaxis (PEP) guidelines for children and adolescents potentially exposed to blood-borne viruses ​​Pseudomonas Treatment
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Pyelonephritis Pyloric Stenosis

R
​​Rapid Tranquilisation of Paediatric Patients Rash with a Fever Return of Spontaneous Circulation (ROSC) Management in Children

S
Sedation (Procedural) in the Emergency Department Sepsis Sickle Cell Crisis
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Sickle Cell Disease ​​​Seizure Spinal Cord Compression
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Starting TPN (Oncology) ​​​Steroids in Surgery for Children with Adrenal Suppression Stones (Nephrolithiasis & Nephrocalcinosis)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Stroke Swollen Joints in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Syphilis​ (Congenital)

T
​​TB Testing in Children on Biologics Tonsillitis Neonates Born to Mothers with Thyroid Disease Transfusion and Coagulation (Oncology)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Trauma Guideline Traumatic Brain Injury ​Raised TSH on Neonatal Bloodspot (and initial management of congenital hypothyroidism) Typhilitis (Oncology)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.

U
​Undescended Testes
  • ​Full Guideline - Temporarily Unavailable pending review
Unsettled Baby Urinary Incontinence Uropathy (Antenatally Detected) GuidelinesUTI

V
Vaccinations For Paediatric Patients Treated With Standard-Dose Chemotherapy And Haemopoietic Stem Cell Transplantation Recipients Re-Vaccination Schedule for Patients After Completion of Standard Dose Chemotherapy Vancomycin Dosing in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Veno-Occlusive Disease (Oncology)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Ventricular Shunt Problems Viral Infections, Viral Prophylaxis and Vaccinations (Oncology)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Vitamin D

W
Viral Induced Wheeze and Acute Asthma Treatment ​Recurrent Wheeze in <5 year old
Child Death
Emergency Medicine
​Burns ​Drowning Extravasation ​​Femoral Fracture Foreign Body Ingestion Head Injury Humidified High Flow in Children Procedural Sedation Return of Spontaneous Circulation (ROSC) Management in Children Traumatic Brain Injury Wessex Children's Major Trauma Guideline National Links
Endocrinology
Steroids in Surgery for Children with Adrenal Suppression Adrenal Crisis (new presentation or pre-existing adrenal insufficiency) Acute Hypocalcaemia Atypical or Ambiguous Genitalia Congenital Hypothyroidism (and raised neonatal bloodspot TSH) ​Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Hypoglycaemia ​Hyperinsulinaemic/ Hypoglycaemia in Neonates Low Vitamin D Obesity in Children and Young People Sick Day Telephone Advice for Children Taking Regular Oral Steroids
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​​Management of Neonates Born to Mothers with Thyroid Disease
​National Links
Gastroenterology
Constipation  ​​​Diarrhoea and Vomiting Gastroesophageal Reflux Gastrostomy Interactive Toolkit Nasal Bridle Insertion and Management Nasojejunal Tube Placement and Basic Care​​National Links
Haematology
Sickle Cell Crisis
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Sickle Cell Disease
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​
​National Links
Infectious Disease
Antibiotic Therapy for Specific Childhood Infections Ceftriaxone Administration in Children Management of Congenital CMV
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids Gentamicin Dosing in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Infectious Disease Screening for Refugees and Asylum-Seekers Kawasaki Disease ​​​Management of Neonatal HSV
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Management of Paediatric Influenza Malaria in Children ​Management of Suspected Meningitis ​Management of Infants at Risk of Congenital Syphilis
Management of Sepsis ​​​Paediatric Inflammatory Multisystem Syndrome - Temporarily Associated with SARS-CoV2 (PIMS-TS) Post-exposure prophylaxis (PEP) guidelines for children and adolescents potentially exposed to blood-borne viruses TB Testing in Children on Biologics Vancomycin Dosing in Children
​This guideline is due for review. Please check national guidance and use at your own clinical discretion.
British Society for Antimicrobial Chemotherapy (BSAC) Paediatric Pathways
​​National Links​
LTV
Guides to LTV Ventilators
Stellar 150
Nippy 4
Trilogy
Mental Health
Paediatric Rapid Tranquilisation Policy​ ​​​
​National Links
Metabolic Disorders
Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Metabolic Emergencies ​
​National Links
Neonatology
Neonatal Collapse ​Nursing Guidelines (from Neonatal ODN website)
​​Clinical Guidelines (from Neonatal ODN website)
​Congenital Hypothyroidism (and raised neonatal bloodspot TSH) ​Initial Management of a Baby with Atypical or Ambiguous Genitalia ​Management of Congenital CMV
  • See Infectious Disease
Nephrology
Acute Kidney Injury - Prevention & Recognition
This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​​Antenatally Detected Uropathy Guidelines Autosomal Dominant Poly Cystic Kidney Disease Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Haematuria in Children Management of HSP in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Nephrotic Syndrome
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Pharmacological Management of Non-Neuropathic Overactive Bladder Pyelonephritis Recognition & Follow up of Hypertension
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Stones (Nephrolithiasis & Nephrocalcinosis)
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Assessment of Daytime Urinary Incontinence UTI
​National Links
Neurology & Neurosurgery
Anticonvulsant use when Nil by MouthFacial Nerve Palsy First Afebrile Seizure The Management of Children & Young People with Acute Decreased Conscious Level RCPCH Guidelines Management of Hydrocephalus or Blocked Ventricular Shunt ​Management of Suspected Encephalitis
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Prolonged Seizure ​Stroke
​National Links
Oncology
COVID-19 Specialty Information
​Care and Management of Central Venous Access Devices ​Chemotherapy Induced Nausea and Vomiting Electrolyte Replacement Extravasation of Chemotherapy Febrile Neutropaenia
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​GCSF: The Use of Haematopoietic Growth Factors in Paediatric Oncology and Haematology Patients
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Hyperglycaemia (Steroid, Chemotherapy or Transplant Induced) Hypertension
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Hypoalbuminaemia Ifosfamide Induced Encepahlopathy Investigation of New Patients
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Mucositis
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Nausea and Vomiting Management Nutrition
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Off Treatment Surveillance
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Oncology Emergencies Parent Held Oncology Records Palliative Care and Symptom Management
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Prophylaxis of Pneumocystis Jirovecii Pneumonia (PJP) in Children with Solid Tumours Spinal Cord Compression
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Starting TPN Transfusion and Coagulation
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Typhilitis
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Vaccinations For Paediatric Patients Treated With Standard-Dose Chemotherapy And Haemopoietic Stem Cell Transplantation Recipients Viral Infections, Viral Prophylaxis and Vaccinations
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Veno-Occlusive Disease
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​
​National Links