Advice & Guidance

Overview - Paediatric A&G

Emergency Department

Please see the Guidance for Parents and Carers produced by NHSE which advises on when to present to ED, GP or call NHS111 if a child is unwell.

For further information on obtaining same day/urgent advice please see the paediatric Urgent Care Referrals page.

Out Patient Referrals

Please consider the following before making a referral:

• Use Remedy guidelines or the Bristol Royal Hospital for Children guidelines prior to making referrals.
• If more specific advice is required, consider using advice and guidance services. The Bristol Royal Hospital for Children (BRHC) has set up several routes to access advice if needed (see sections below).
• Referrals to Paediatrics will only be accepted if the child is aged 15 years or under at time of referral.

Selection of most appropriate Advice and Guidance Service

Below are the various options for advice and guidance in paediatrics. Please choose the service that is most appropriate for your patient rather than always choosing the general service. A and G requests cannot be moved between specialties within paediatrics, so if a request is sent to the incorrect service it may be returned to you.

General Advice and Guidance

Paediatric Guidelines

Before requesting advice please check the Bristol Royal Hospital for Children guidelines  or the relevant section of Remedy as these may help to support you in making management decisions.

If the paediatric guidelines have been checked and more specific advice is required, then please consider using one of the relevant paediatric sub-specialty A&G services below, or the general paediatric advice and guidance services listed in this section as appropriate.

Please note that at present, requests cannot be moved between A&G services at the trust, so it is important to send requests to the correct paediatric service (speciality or general) in the first place, in order to avoid declined or returned queries. 

General Paediatric advice and guidance - UHBW

Requests can be submitted directly to the General Paediatric Advice & Guidance Service using e-Referral (they do not need to be sent via the Referral Service). This should include name of patient, date of birth, NHS number, brief clinical history, name of requesting GP. If inadequate information is supplied the request will either be returned to the GP or a request for the patient to be referred to outpatients will be made.

Requests will be  viewed at least once every 24 hours Monday to Friday by the nominated consultant.  Advice will be returned online, with a reply provided within two working days for 80% of requests (minimum target).

The service will advise on general paediatric medical cases only (NOT surgical, ENT, dermatology, allergy, etc which can be found in the list of paediatric sub-specialty services below).

Although not an exhaustive list, the following are some examples of areas covered:

• Abnormal blood results
• Management of recurrent UTIs +/- daytime urinary continence difficulties
• Constipation
• Infant/toddler (pre-school) wheezing
• Investigation of fatigue
• Abnormal shaped heads
• Suspected Cow’s Milk Protein Intolerance
• Feeding difficulties and suspected gastro-oesophageal reflux
• Abdominal pain
• Concerns about growth and puberty
• Headaches
• Common neonatal problems
• Which paediatric service to refer to if GP unsure

Please see the Paediatric A&G Steps - UHB (word doc) for instructions on how to complete a request through e-Referral.

Please see the General Paediatrics A&G Standard Operating Procedure for further details.

Paediatric A&G - North Somerset

Paediatric advice and guidance is provided by WGH to North Somerset GPs via e-Referral. Advice & Guidance requests are not processed by the Referral Service. All requests should be submitted directly to the Paediatric Advice & Guidance Service using e-Referral.

Please see the Paediatric A&G Steps - WGH (word doc) for instructions on how to complete a request through e-Referral.

All requests for blood tests in children under 5 should be submitted to the service initially. 

Allergy Advice & Guidance

Please see the Advice & guidance information in the Allergy Section

Asthma Advice & Guidance

Please see the Advice & guidance information in the Respiratory Section

Dermatology Advice & Guidance

The advice and guidance service (via e-RS) can be used for routine and urgent requests for advice during the COVID outbreak. If there is a need to see patients urgently face to face this will be used to identify those who need urgent referral via e-RS.

Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

There is an option to include photos and this is mandatory for lesions and rashes where the clinical question is about the diagnosis. If the diagnosis is already known and general management advice only is required (eg eczema) then photographs are optional but always desirable to guide the advice. If inadequate information is supplied the request will be returned to the GP.

The requests will be viewed most working days if possible. Advice will be submitted online with a reply provided within 7 working days for 80% of requests. There are only 2 part time paediatric dermatology consultants and this is likely to reduce to one during the pandemic period if one is also occupied on the medical wards as is likely.

The advice and guidance service is intended to cover all paediatric dermatology presentations that are significantly impacting on patients’ lives or are thought to have possible serious underlying associations that cannot be managed in primary care.

Benign Skin Lesions

Please note that referrals requesting removal of benign skin lesions will still need prior approval.

ENT Advice & Guidance

Paediatric ENT Advice and Guidance is available by emailing: paediatricentoutpatients@uhbw.nhs.uk

General Surgery and Urology Advice & Guidance

Advice & Guidance is not available.

Please consider the following guideline options:

• See the Remedy page paediatric surgery including urology guidelines.
• Continence – including Enuresis
• Constipation
• Urinary Tract Infections

The following Remedy pages may also be useful:

• Circumcision in children
• Hernias in children
• Suspected cancer referrals in children
• List of Funding policies

Infectious diseases and immunology Advice & Guidance

The advice and guidance service set up in eRS has now closed (20/10/22)

Mental Health CAMHS A&G

Please see the Advice & guidance information in the Mental Health (CAMHS) section

Neurosurgery Advice & Guidance

Please note that Paediatric Neurology advice needs to be requested through general paediatrics not paediatric neurosurgery

Urgent Referrals

When urgent advice is needed, but when a child is not acutely unwell, or at risk of neurological deterioration then enquiries can be made via the on call paediatric neurosurgery Registrar. UHB switchboard has this number. These referrals may be triaged into either an urgent telephone consultation or a face to face appointment when necessary.

Examples of suitable requests for urgent referral would include:

• Infant with increasing head circumference, crossing centiles with full fontanelle but no neurological symptoms.
• New significant neurological symptoms of acute onset that arise in a patient known to the neurosurgical service.

Advice and Guidance

For children known to the neurosurgery service - When non-urgent advice is needed for known patients please contact the relevant neurosurgical secretary who will relay a message to either the child’s usual consultant or the on call consultant should the former not be available within a reasonable timeframe (1 week).

For children not previously known to the neurosurgery service - non-urgent requests for A and G can be processed via eRS.

Requests should include contact details of the child (including telephone number for the parents/carer) and clinical history. Name and contact details (including mobile phone if possible) of requesting GP should also be included.

Examples of suitable requests for advice and guidance would include:

• New minor neurological symptoms that are slowly progressive

Ophthalmology Advice & Guidance

Paediatric Ophthalmology Advice & Guidance is available at UHBW via eRS. Advice requests should ideally be typed into the free text window of the advice request body on e-RS rather than attaching a separate letter or Word document.  If you attach a Clinical Information Summary, please ensure it is named this, so that clinicians at secondary care can opt to look at it if they wish to turn the request into a referral.

Paediatric Ophthalmology Advice - University Hospitals Bristol - RA7. (Priority - URGENT, Specialty - Children's & Adolescent Services, Clinic - Ophthal - Not Otherwise Specified)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.