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 - March 2025
​​​
Guidelines Coming Soon
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  • ​Tics
  • Community Acquired Pneumonia​
  • Infantile Spasms​​
  • Management of Paediatric Haemangiomas
  • Pineal Cyst Pathway​
  • Use of Intravenous Iron in the Treatment of Iron Deficiency Anaemia in Children
  • Use of Inhaled Methoxyflurane (Penthrox®) as an Analgesic for Acute Traumatic Pain and Painful Procedures
A-Z

A
Abdominal Pain Acute Kidney Injury - Prevention & Recognition  Adrenal Crisis (new presentation or pre-existing adrenal insufficiency) Allergic Rhinitis Guideline 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
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Arrhythmia - Tachyarrhythmia with a Pulse ​​Arrhythmia - Bradyarrhythmia with a pulse Asthma ​​ 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 Chest Drain Insertion in a DGH Setting Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ 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) Micturating Cystograms in Children

D
​​​​Debrief after a Difficult Event Decreased Conscious Level RCPCH Guidelines Dermatology
  • See Dermatology section
​​Dextrocardia
 Diabetes Diabetic Ketoacidosis ​​Diarrhoea and Vomiting Difficult Intravenous Access Pathway Drowning Drug Infusion Guideline for SORT ​Drug Calculator

E
Eating Disorders Medical Emergencies (MEED)​ EczemaEgg AllergyElectrolyte 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
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Fever Fever in babies less than 90 days old (The Hot Baby Pathway) First Afebrile Seizure ​​Foreign Body Ingestion
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ ​​​Frameworks Explainer for Children and Young People with Mental Health Concerns

G
Gastroesophageal Reflux Gastrostomy Interactive Toolkit
​​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 Gentamicin Dosing in Children​​ ​Genetics - Acutely Unwell Children Genetics - Developmental Delay ​Genetics - General ​​ Glucose Concentrations and Calculator ​Upper Gastrointestinal Bleeding

H
Haematuria in Children
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Head Injury Hereditary Spherocytosis 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
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Hydrocephalus/Blocked Ventricular Shunt Hypercyanotic Spells in Tetralogy of Fallot ​​Hyperglycaemia (Steroid, Chemotherapy or Transplant Induced) Initial Assessment and Management of Congenital Hyperinsulinism 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
Prescribing, Monitoring and Therapeutic drug monitoring of biologic therapies in IBD​ Idiopathic Intracranial Hypertension in Children Ifosfamide Induced Encepahlopathy Infant Feeding Guidelines​ ​​Influenza
​​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 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

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 Micturating Cystograms in Children ​Mpox Royal College of Paediatrics & Child Health Guidance

N
Nasal Bridle Insertion and Management
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ 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
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​

P
​​​Paediatric Inflammatory Multisystem Syndrome - Temporarily Associated with SARS-CoV2 (PIMS-TS)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ Parent Held Oncology Records Palliative Care and Symptom Management Paracetamol Overdose - SNAP Protocol Preorbital Cellulitis Perinatal Ectopic Beats 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 Petechial/Purpuric RashesProphylaxis 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 ChildrenAllergic Rhinitis Guideline

S
Sedation (Procedural) in the Emergency Department
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ 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)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​

T
TB in Children - Managing Active and Latent Infection ​​TB Testing in Children on Biologics Hyperthyroidism and Thyrotoxicosis Management Tonsillitis 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
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ 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 Urticaria Pathways and Patient Information LeafletsUTI

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 & Asthma Pathways
​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 FallotKawasaki DiseasePerinatal Ectopic Beats
​National Links


Child Death
Eating Disorders
Eating Disorders Medical Emergencies (MEED)​
Emergency Medicine
​​​Anaesthesia for Emergencies Brief Resolved Unexplained Event (BRUE) Burns ​​​Cardiac Arrest APLS Algorithm  Care of the Ventilated Child Checklist (Awaiting SORT) Chest Drain Insertion in a DGH Setting Debrief after a Difficult Event The Management of Children & Young People with Acute Decreased Conscious Level RCPCH Guidelines Difficult Intravenous Access Pathway Drowning ​Drug Calculator Extravasation ​​​Eating Disorders Medical Emergencies (MEED)​ 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 ​​​​Mpox Royal College of Paediatrics & Child Health Guidance 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)​ ​Electrolyte Replacement
  • SORT Guideline
  • ​Also see Electrolyte Replacement section of Oncology Guidelines
Glucose Concentrations and Calculator Hypoglycaemia Initial Assessment and Management of Congenital Hyperinsulinism in Neonates Hyperkalaemia Hyperthyroidism and Thyrotoxicosis Management Low Vitamin D Obesity in Children and Young People​ 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 IBD​Nasal Bridle Insertion and Management Nasojejunal Tube Placement and Basic Care​ Upper Gastrointestinal Bleeding
​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 ​​​​Mpox Royal College of Paediatrics & Child Health Guidance Paediatric Inflammatory Multisystem Syndrome - Temporarily Associated with SARS-CoV2 (PIMS-TS) Pertussis - Acute Management Petechial/Purpuric Rashes 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
Eating Disorders Medical Emergencies (MEED)​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
Perinatal Ectopic Beats
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. Micturating Cystograms in ChildrenNephrotic 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 Idiopathic Intracranial Hypertension in Children
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



Nursing Care Plans
Asthma Bronchiolitis  Fitting Child Nephrotic Syndrome Paracetamol Overdose  Pyloric Stenosis Sickle Cell Crisis  Wheeze
Oncology
​Care and Management of Central Venous Access Devices ​Chemotherapy Induced Nausea and Vomiting List of Approved Chemotherapy Regimes 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 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. 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​ Prophylaxis of Pneumocystis Jirovecii Pneumonia (PJP) in Children with Solid Tumours Spinal Cord Compression ​Starting TPN
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Transfusion and Coagulation
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion. Typhilitis 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












Ophthalmology
Preorbital Cellulitis
Orthopaedics
Limp ​Femoral Fracture ​Swollen Joints
Respiratory
Asthma & Viral Wheeze​​ Bronchiolitis Croup Empyema Nasal Humidified Oxygen (High Flow)
​​This guideline is due for review. Please check national guidance and use at your own clinical discretion.​ ​​ Pneumonia Pseudomonas Treatment Upper Airway Obstruction ​​
Recurrent Wheeze in <5 year old
​National Links



Rheumatology
Chicken Pox Contacts in Immunosuppressed Children on Methotrexate, Biologics or Steroids Kawasaki Disease  Swollen Joints in Children ​
​National Links
Surgery
Abdominal Pain Gastrostomy Interactive Toolkit Management of ​Pyloric Stenosis ​​​​Naso-jejunal Tube Placement and Basic Care​ Nasal Bridle Insertion and Management ​​Perioperative Fasting Guidelines ​​Peri-operative Management of Children and Young People taking regular corticosteroid therapy Undescended Testes​
  • ​Full Guideline - Temporarily Unavailable pending review
Nursing Care Plans
Asthma
Bronchiolitis
Fitting Child
Nephrotic Syndrome
​Paracetamol Overdose ​
Pyloric Stenosis
Sickle Cell Crisis
Wheeze
Healthier Together Pathways & Safety Netting Documents
Abdominal Pain Acute Asthma/Wheeze Bronchiolitis Cellulitis ​Conjunctivitis in Children Constipation Coughs and Colds Cow's Milk Protein Allergy Croup Diarrhoea & Vomiting ​Eczema ​Faltering Growth in Infants Fever Fits, Faints and Funny Turns Gastroesophageal Reflux Head Injury ​Jaundice In Babies
Limp Lymphadenopathy Lymphadenitis Mastoiditis ​ Otitis Media Periorbital Cellulitis Pneumonia Preterm Infant Feeding Pyelonephritis Rash ​with a Fever ​Rhinosinusitis Secondary Lactose Intolerance Seizure Sepsis ​​Tonsilitis ​Unsettled Baby UTI
Archives of Disease in Childhood Fifteen Minute Consultations
These useful resources from ADC have been collated by Olivia Falconer and will continue to be updated as new guides become available. Please note that the information contained in these resources has not been ratified by the PIER governance process and should be used at the clinicians discretion.
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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.

​Resources contained within the Resource Hub as provided from Trusts within the Wessex and Thames Valley region for free use within the Network's Trusts. These resources are available for local adaptation and are not checked of ratified using the Guidelines governance procedures. Please use these resources at your discretion and with local governance protocols.