One of the challenges of general practice is delivering optimal care in a limited consultation time. We recognise that this might be even more challenging when it comes to paediatric patients. Here you can find some useful information and guidelines that can assist you in your everyday practice. They are listed alphabetically as a quick reference.
Information also includes interpretation of abnormal results and urine tests.
We will continue to add to this list going forward. If you would like more topics to be covered, please contact our GP Liaison Officer team.
A:
- Abdominal pain
Acute Abdominal Pain – Primary Care Pathway
West Suffolk on chronic abdominal pain
Parental Advice Sheet
A framework at looking at acute abdominal pain- Don’t forget the bubbles - Allergic Rhinitis
RCPCH care pathway for managing children with allergic rhinitis
Paediatric Allergy Referral Pathways for Lister Hospital
Assessment of the sick child - Asthma
Acute Asthma/Wheeze primary care pathway (not for bronchiolitis)
Recurrent wheeze management in primary care (<5 years old)
Asthma diagnosis in 5-16 years old children
Managing asthma(chronic) in children 5-12 years
Managing asthma(chronic) in children>12 years
Asthma advice leaflet
My Asthma Plan - Attention, Deficit and Hyperactivity Disorder (ADHD)
Primary care pathway
Local referral criteria - Autism
Features of autism
Autism review in Hertfordshire
B:
- Blood pressure
Normal ranges of blood pressure - Organizing a 24h tape
- Some GP practices can organise 24h tapes in house.
- If you practice cannot organise a 24h tape, please refer to Royal Brompton Hospital, Paediatric Cardiology Team.
- Blood tests reference values
- Blurred vision
Local Ophthalmology Referral Pathway for GPs - Breastfeeding
Breastfeeding support groups in Hertfordshire
Parent’s guide to breastfeeding - Bronchiolitis
Bronchiolitis Primary Care Clinical Pathway
Local pathway
Parent information leaflet
Why bronchiolitis does not get better with inhalers?
The Decision Maker’s Guide to Bronchiolitis Assessment - BCG vaccine
Contact details for organizing a BCG vaccine
Contact hospital midwifery team (01438 286197)
C:
All referrals for Community Paediatrics are sent in via paper request to the contact centre with the associated questionnaires and these are then logged on Lorenzo.
The Community Paediatric service is only available for children who live within the East and North Hertfordshire catchment area.
- Constipation
Primary Care Pathway (Healthier Together)
Bristol Stool Chart
Patient Information Leaflet
Conversations with parents around constipation
5 Simple Strategies to manage constipation like a pro
Understanding Constipation
- Cow’s Milk Protein Allergy
Primary Care Pathway- Local pathway – Please see uploaded document
- List of EHF and Amino Based Formula milks Hertfordshire – document to be uploaded
- Chronic Fatigue Syndrome
Diagnostic Criteria and when to suspect Chronic Fatigue Syndrome- RCPCH(2014)
Primary care Pathway
Information leaflet for patients
Information and guidance for schools and families
D:
- Dermatological complaints
Viral exanthemas
Useful pictures of various dermatological conditions
Common rashes/educational module- Paediatric Dermatology Referrals
- Please use HCT trust – skin health for non-urgent, routine dermatology referrals.
- Children with moles should be referred directly to Pediatric Dermatology and not to Paediatrics.
- There is no 2-week wait referral pathway for paediatric dermatology. The rationale is the chances of melanoma in children is exceedingly low, apart from large congenital melanocytic naevi etc. If you have any concerns re: urgent dermatological problems, follow the pathway above and mark the referral as urgent. Alternative pathway is through A&G, which might be slightly quicker.
- Development
Developmental Milestones
Developmental Red Flags and when to refer
Referral Pathway to Hertfordshire Speech and Language Service
How to refer to local audiology department
- Diabetic ketoacidosis (DKA)
DKA prevention at diagnosis homepage.
Short eLearning tool for primary care
- Diarrhoea and Vomiting
Diarrhoea and vomiting primary care pathway
Worked examples for enteral rehydration of children with D&V
Gastroenteritis Parent information leaflet
Secondary lactulose intolerance
E:
- Eating Disorders
Primary care referral pathway
Eating disorder and when to suspect
Junior MARSIPAN risk assessment tool
- Empirical Antibiotic Guideline
Antibiotic Guidelines for Children
- Enuresis
Useful information regarding enuresis
ERIC website - Refer to paediatric enuresis service via ERS
- Conditions treated:
- Bed wetting
- Day time wetting
- Frequency
- Urgency
- Recurrent UTI’s
- Infrequent voiding
- Epilepsy
First seizure – patient information leaflet
Welcome Information Leaflet (Epilepsy service for children and young people)
Transition to Adult Neurology – patient information leaflet
Patient Information – Epilepsy Nursing Service
- Exclusion Period for infections
Exclusion period for viral illnesses
Public Health England information
- Eye problems
Pre septal and septal cellulitis
Sticky eyes newborn
Local Ophthalmology Referral Pathway for GPs
F:
- Faltering growth
Local Guidance on when to refer babies and children with faltering growth
Faltering growth in infants - Febrile convulsions
Parent information sheet re: febrile convulsions
Fever
Fits, faints and funny turns - Food allergies
Management of childhood food allergy
RCPCH allergy care pathways - Fussy eating
Information and tips for parents and healthcare professionals regarding fussy eaters
G:
- Gastro-oesophageal reflux
Local pathway for management of GORD - Growing pains
NICE guidelines for the diagnosis of growing pains
Parent information leaflet
H:
- Headache
Safety netting advice to parents after initial review
Headaches in children and young people information leaflet - Head Injury
Head Injury Pathway, Primary Care and Community settings.
Head injury remote assessment
Patient Information Leaflet
Head injury don’t forget the bubbles
Safety netting and patient information
- Healthy Lifestyle
Staying Healthy for young children - Henoch-Schonlein purpura(HSP)
Paediatrics for Primary Care (and anyone else): HSP (gppaedstips.blogspot.com)
How to monitor a patient diagnosed with HSP in the community
Information to parents and careers about HSP
Skin deep HSP
HSP, infokid.org
- Hypermobility
Physiotherapy referrals pathway
- Hand Foot and Mouth
Skin deep(useful pictures)
L:
- Laryngomalacia
REFERRAL PATHWAY FOR PRIMARY CARE:
- If there are any acute concerns about the child such as desaturations, increased work of breathing or poor feeding/failure to thrive, the child to be referred urgently to the Paediatric team for assessment in children’s assessment unit and then referred to ENT team as an inpatient.
- If the child is not showing any of the acute symptoms and signs mentioned above, to be referred as an outpatient to ENT within 2-4 weeks-time.
- Limping child
Primary Care Pathway
Parent Information Leaflet
Differential diagnosis of a limping child
Limping Remote assessment
- Liver Function Test Abnormal Results
Interpretation of LFT’s (Pediatric liver function test: smarter interpretation • Critical Pediatrics)
- Lymphadenopathy
Primary care pathway
Safety netting and parent information
Advice for parents
Choice of antibiotics
N:
- Neonatal presentations
Sticky eyes
Safety netting and parent info
Antibiotics choice
Red umbilicus
Umbilical conditions
Erythema toxicum
Skin Deep erythema toxicum
Excessive crying
Crying baby under 3 months
Infant crying and how to cope
Clinical support tool for remote clinical assessment
Colic
Unsettled baby
Pathway for primary care professionals
Constipation (please Refer to constipation)
Reflux (please refer to Gasto-oesophageal reflux)
- Nephrotic Syndrome:
Infokid.org
Frequently relapsing nephrotic syndrome
Notifiable diseases
O:
- Obesity
Paediatric Obesity Guidelines
Beezee bodies -helping you making healthier habits
Talking about obesity for health care professionals
- Otitis Media
NICE Guidance
Choice of antibiotics
Don’t Forget the bubbles
Primary care and safety netting info
- Otitis Externa
Choice of antibiotics
Don’t Forget the bubble, diagnosis and management of otitis externa
Otitis externa safety netting and parent info
Clinical support tool for remote assessment
P:
- Palpitations
Palpitations management in primary setting
Information leaflet on palpitations and ectopic beats- British Heart Foundation - Pneumonia (community acquired)
BTS guidelines on community acquired pneumonia
Safety Netting and patient information
Choice of antibiotics - Precocious Puberty
Disordered Puberty simply explained - Prolonged jaundice
Primary care pathway for neonatal jaundice
Advice for parents
GP/Primary care safety netting
Management of prolonged Jaundice in Primary care
R:
S:
- Safeguarding referral pathways
Useful links and information for professionals
NHS safeguarding App
Roles of safeguarding professionals and organizations
Safeguarding clinical pathways
Information leaflet for parents - Syncope
What is syncope? - Scarlet Fever
Pictures of scarlet fever rash- Skindeep
Diagnosis and management of scarlet fever– Don’t forget the bubbles
Antibiotic choice for scarlet fever - Scabies
Skin deep scabies
Antibiotic choice - Sepsis
Assessment and management of sepsis out of the hospital pathway
T:
- Tonsillitis
Sore throat clinical support tool for remote assessment
Tonsillitis and criteria for referring to ENT for tonsillectomy – East and North Hertfordshire CCG
Safety netting and patient information
Choice of antibiotics - Thyroid
Thyroid disorders- information for GPs and parents - Threadworms
Parent information leaflet
How to investigate and treat
U:
- Undescended Testes pathway
If undescended testis was picked up during the 6 weeks check:- If the child is already under Paediatrics for any reason, then please review at 6 months and refer to Urology if still undescended. If there is no further paediatric problem, they can be referred directly to Urology once it has been confirmed that the child has an undescended testis.
- Is an USS needed before referring?
- No need for imaging, in-fact the new trust guidelines will reject any request for US unless they have been seen by urology.
- When to Refer?
Refer as soon as they have been diagnosed as they will need an operation at age 1.
- How is the referral done?
Please refer via ERS. If the child is close to 1 year, please email urology secretaries as well as the child will need a more urgent review.
If you pick up any child with diagnosis of Antenatal Hydronephrosis, VUR or Hypospadias not already under paediatric team please refer to urology. Local team at Lister will operate on children from 1 year of age if needed. If under 1 year of age, urology team will arrange the necessary as not all of them will need surgery. Lister Hospital has a very good Paediatric Nephrology and Urology joint clinic set up, 4 times a year for some children who need this approach.
- Urine
Primary Care Management Pathway for suspected Urinary Tract Infection
Choice of antibiotics for UTI
Urine Dipstick interpretation
Safety Netting regarding UTI
Urinary Tract Infection – parent information leaflet
Pyelonephritis – parents information leaflet
- Urticarial rash
Differential Diagnosis and Management of urticarial rash
Primary care pathway for the management of urticaria-mastocytosis-angioedema
V:
- Vitamin D Deficiency
When to test and how to treat Vitamin D deficiency
W:
- Weight loss in neonates
Infant feeding and weight loss