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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 - June/July 2024
​​
Guidelines Coming Soon
​​
  • Obesity Safeguarding Strategy
  • Tics
  • Community Acquired Pneumonia​
  • Infantile Spasms
  • Micturating Cystograms in Children
  • Management of Significant Upper Gastrointestinal Bleeding in Secondary Care
  • Paediatric Urticaria
  • Asthma Pathways
  • Management of newborn infant where a parent has Hereditary Spherocytosis
  • Management of Paediatric Haemangiomas
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:
  1. Click the ⋮ or share icon in your browser
  2. Click 'Find on Page'
  3. ​Enter your search terms

A
Abdominal Pain Acute Kidney Injury - Prevention & Recognition  Adrenal Crisis (new presentation or pre-existing adrenal insufficiency) Ambiguous Genitalia (Initial Management of a Baby) Anaphylaxis ​​Anaesthesia for Emergencies Antibiotic Therapy for Specific Childhood Infections Anticonvulsant use when Nil by Mouth Antenatally Detected Uropathy Guidelines Arrhythmia - Tachyarrhythmia with a Pulse ​​Arrhythmia - Bradyarrhythmia with a pulse Asthma (Acute) ​​Asthma (Chronic) Autosomal Dominant Poly-cystic Kidney Disease

B
Blast Field Injury Blocked Ventricular Shunt/Hydrocephalus ​​​Brief Resolved Unexplained Event (BRUE) Burns ​​Bronchiolitis

C
​Care of the Ventilated Child Checklist (Awaiting SORT) ​Cardiac Arrest APLS Algorithm Ceftriaxone Administration in Children Central Venous Access Devices ​Cellulitis Chemotherapy Induced Nausea and Vomiting List of Approved Chemotherapy Regimes 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) Conjunctivitis in Children Constipation  Coughs and Colds Croup Cyanosed Infant with Systemic to Pulmonary Shunt (Blalock-Taussig or Sano shunt)

D
​​​​Debrief after a Difficult Event Decreased Conscious Level RCPCH Guidelines Dermatology
  • See Dermatology section
​​Dextrocardia
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Diabetes Diabetic Ketoacidosis ​​Diarrhoea and Vomiting Difficult Intravenous Access Pathway Drowning Drug Infusion Guideline for SORT ​Drug Calculator

E
​Eczema
Egg Allergy
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 ​​​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 Fever in babies less than 90 days old (The Hot Baby Pathway) First Afebrile Seizure ​​Foreign Body Ingestion ​​​Frameworks Explainer for Children and Young People with Mental Health Concerns

G
Gastroesophageal Reflux Gastrostomy Interactive Toolkit GCSF: The Use of Haematopoietic Growth Factors in Paediatric Oncology and Haematology PatientsGentamicin Dosing in Children​​ ​Genetics - Acutely Unwell ChildrenGenetics - Developmental Delay​​ Glucose Concentrations and Calculator

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. Hyperkalaemia Hyperthyroidism and Thyrotoxicosis Management
Hypoalbuminaemia Hypocalcaemia Hypoglycaemia Hypothyroidism (congenital) and raised neonatal bloodspot TSH

I
Ifosfamide Induced Encepahlopathy Infant Feeding Guidelines​ ​​Influenza Infectious Disease Screening for Refugees and Asylum-Seekers Intubation Checklist Assessment and Management of Acute Idiopathic Thrombocytopenia Purpura (ITP 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

L
Limp
Long Term Ventilation
Lymphadenopathy
​Lymphadenitis ​
Lyme Disease

M
Malaria in Children MART - Maintenance and Reliever Therapy for Chronic Asthma in Young People >12 years of age  Mastoiditis Meningitis Metabolic Emergencies Milk Re-introduction ​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. Nursing Care Plans 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  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 Paracetamol Overdose - SNAP Protocol Preorbital Cellulitis Perioperative Fasting Guidelines
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Peri-operative Management of Children and Young People taking regular corticosteroid therapy Pertussis - Acute Management Prophylaxis of Pneumocystis Jirovecii Pneumonia (PJP) in Children with Solid Tumours​ Pneumonia 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 Sedation Withdrawal and Weaning Sepsis Sickle Cell Crisis and Guideline ​​​Sick Day Steroid Doses Seizure SNAP Protocol Spinal Cord Compression ​Starting TPN (Oncology) Stones (Nephrolithiasis & Nephrocalcinosis)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. STOPP Form (Safe Transfer of the Paediatric Patient) Stroke Swollen Joints in Children ​Syphilis​ (Congenital)

T
TB in Children - Managing Active and Latent Infection ​​TB Testing in Children on Biologics Hyperthyroidism and Thyrotoxicosis ManagementTonsillitis Toxic Shock Syndrome Neonates Born to Mothers with Thyroid Disease Time Critical Transfer Checklist 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)

U
​Undescended Testes
  • ​Full Guideline - Temporarily Unavailable pending review
Unsettled Baby Upper Airway Obstruction Urinary Incontinence
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Uropathy (Antenatally Detected) Guidelines UTI

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 Ventilation Initiation During StabilisationViral 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
​This guideline is due for review. Please check national guidance and use at your own clinical discretion. ​Recurrent Wheeze in <5 year old
Cardiology
​​Arrhythmia - Bradyarrhythmia with a pulse Arrhythmia - Tachyarrhythmia with a Pulse Dextrocardia
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Acute Management of a cyanosed Infant with systemic- to- pulmonary shunt (Blalock-Taussig or Sano shunt) presenting to primary care or ED/ Acute Paediatrics Hypercyanotic Spells in Tetralogy of Fallot
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Kawasaki Disease
​National Links


Child Death
Emergency Medicine
​​​Anaesthesia for Emergencies Brief Resolved Unexplained Event (BRUE) Burns ​​​Cardiac Arrest APLS Algorithm  Care of the Ventilated Child Checklist (Awaiting SORT) Debrief after a Difficult Event The Management of Children & Young People with Acute Decreased Conscious Level RCPCH Guidelines Difficult Intravenous Access PathwayDrowning ​Drug Calculator Extravasation ​​Femoral Fracture Fever in babies less than 90 days old (The Hot Baby Pathway) Foreign Body Ingestion Head Injury Humidified High Flow in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Intubation Checklist Paracetamol Overdose - SNAP Protocol Procedural Sedation Return of Spontaneous Circulation (ROSC) Management in Children Traumatic Brain Injury Toxic Shock Syndrome Ventilation Initiation During Stabilisation Wessex Children's Major Trauma Guideline
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ National Links


Endocrinology
Adrenal Crisis (new presentation or pre-existing adrenal insufficiency) Acute Hypocalcaemia Atypical or Ambiguous Genitalia Congenital Hypothyroidism (and raised neonatal bloodspot TSH)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ ​Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Glucose Concentrations and Calculator Hypoglycaemia ​Hyperinsulinaemic/ Hypoglycaemia in Neonates Hyperkalaemia Hyperthyroidism and Thyrotoxicosis Management
Low Vitamin D Obesity in Children and Young People
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Management of Sick Day Episodes in Children and Young People Treated with Regular Glucocorticoids ​​Management of Neonates Born to Mothers with Thyroid Disease Peri-operative Management of Children and Young People taking regular corticosteroid therapy
​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 and GuidelineAssessment and Management of Acute Idiopathic Thrombocytopenia Purpura (ITP
​​National Links
Infectious Disease
Antibiotic Therapy for Specific Childhood Infections Ceftriaxone Administration in Children Management of Congenital CMV Cervical Lymphadenitis (Non-Tuberculous Mycobacterial) 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​ Infectious Disease Screening for Refugees and Asylum-Seekers Kawasaki Disease ​​​Lyme 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) Pertussis - Acute Management Post-exposure prophylaxis (PEP) guidelines for children and adolescents potentially exposed to blood-borne viruses TB in Children - Managing Active and Latent Infection TB Testing in Children on Biologics Toxic Shock Syndrome 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​
Mental Health
Paediatric Rapid Tranquilisation Policy​ ​​Frameworks Explainer for Children and Young People with Mental Health Concerns ​National Links
Metabolic Disorders
Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Metabolic Emergencies ​
​National Links
Neonatal
Neonatal Collapse Nursing and Clinical Guidelines ​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
​​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
 ​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 and Neurosurgery
Anticonvulsant use when Nil by Mouth Facial Nerve Palsy
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ 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