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Monthly BNFc updates

posted : 17/02/20

Monthly updates are provided online via PCO UK's BNFc lookup tool. The changes listed below are cumulative (from one print edition to the next).

Significant changes

Significant changes made since the release of data for the print edition of BNF for Children 2019 - 2020:

  • Adrenaline / epinephrine auto-injectors: recent action taken to support safety [MHRA/CHM advice]
  • Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents [MHRA/CHM advice]
  • Flutiform® 50 microgram / 5 microgram inhaler (fluticasone with formoterol): age range extension to include children aged 5 to 12 years for the prophylaxis of asthma
  • Fingolimod) (Gilenya®): increased risk of congenital malformations; new contraindication during pregnancy and in women of childbearing potential not using effective contraception [MHRA/CHM advice]
  • Lanadelumab for preventing recurrent attacks of hereditary angioedema [NICE guidance]
  • Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy [MHRA/CHM advice]
  • Montelukast (Singulair®): reminder of the risk of neuropsychiatric reactions [MHRA/CHM advice]
  • Nusinersen for treating spinal muscular atrophy [NICE guidance]
  • Oral retinoid medicines (acitretin, isotretinoin, and tretinoin): revised and simplified pregnancy prevention educational materials for healthcare professionals and women [MHRA/CHM advice]
  • Parenteral nutrition supplements (RoActemra®): light protection required to reduce the risk of serious adverse effects in premature neonates [MHRA/CHM advice]
  • Tocilizumab (RoActemra®): rare risk of serious liver injury including cases requiring transplantation [MHRA/CHM advice]
  • Yellow fever vaccine, live: stronger precautions in people with weakened immunity and in those aged 60 years or older [MHRA/CHM advice]

Dose changes

Changes in dose statements made since the release of data for the print edition of BNF for Children 2019 - 2020:

New preparations

New preparations included since the release of data for the print edition of BNF for Children 2019 - 2020:

Related drugs


RCPCH 2020 Annual Conference

posted : 04/02/20

28 April 2020 - 30 April 2020 | ACC Liverpool

The theme for the RCPCH's big event is ‘Innovating for child health’, and delegates can look forward to a packed programme with some influential figures lined up to deliver keynote talks, plus a range of sessions will explore the latest innovations in child health.

Don’t miss out on early bird booking for conference. Be quick - this specially discounted rate closes at 23:59 on Thursday, 27 February.

Find out more and book your place


Children's Mental Health Week: 3-9 February 2020

posted : 13/02/20

This week we celebrate Children's Mental Health Week, which is run by children's mental health charity Place2Be. This week is dedicated to focussing on the importance of looking after our emotional wellbeing from an early age. The theme of this year’s Children’s Mental Health Week is Find your Brave.

Life often throws challenges our way. Bravery isn’t about coping alone or holding things in. It’s about finding positive ways to deal with things that might be difficult, overcoming physical and mental challenges and looking after yourself.

Did you know that more than 4,000 children in Scotland contacted Childline about poor mental health last year. They talked about feeling depressed, anxious, stressed and isolated. While some spoke of self-harming and suicidal thoughts, NHS figures show that more than 200 children in Scotland had to wait over 12 months for mental health support last year.

PCO UK provides comprehensive child health and safeguarding decision support resources for both the common and not so common paediatric signs and symptoms, including topics to support Children's Mental Health Week. Read relevant topics today, including depressed mood, self-harm, psychotic behavior and anxiety, and explore the 'Red Flag' signs and symptoms, treatment approaches, information on when to refer, safety netting advice as well as links out to parent / carer information and further reading. 

Find our supportive resources here.


MenB vaccine: poster available for healthcare professionals

posted : 23/01/20

The new MenB vaccine (Bexsero®) protects against meningococcal disease capsular group B. The vaccine was added to the childhood immunisation programme as part of the routine schedule in England from 1 September 2015.

Public Health England has revised their 2015 poster to promote the availability of the vaccine for use in clinics, GP surgeries and other healthcare settings aiming to encourage parents to have their baby vaccinated against meningococcal capsular group B disease.

Download the poster for your clinic here


New Key Practice Point topics published

posted : 01/01/20

We are pleased to announce the launch of our newest Key Practice Point (KPP) topics, covering the signs, symptoms and care situations for Projectile Vomiting (with an emphasis on pyloric stenosis), Self-Harm and Rashes (Viral).

The editorial team worked with a number of healthcare professionals and paediatric specialty groups to produce these topics in line with our robust editorial process

KPPs continue to provide concise, easy-to-use decision support tools to assist healthcare professionals with diagnosis and treatment management at the point of care. We will continue to update and provide new content to ensure PCO UK remains a valuable source of support and information.


Integrated care – what is it & what does it mean?

posted : 20/01/20

According to Health Education England:

"Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care reforms and new organisational arrangements focusing on more coordinated and integrated forms of care provision”

But, what is integrated care in relation to children and young people, and how can it benefit them and their workforce? In a recent RCPCH article, three topic experts outline different aspects of integrated care related to paediatrics, the workforce and community child health.

Vice President for Policy Dr Simon Clark looks at the NHS Long Term Plan, what integrated care is and describes the structure of NHS England and the policy shifts of the last five years, including the move towards integrated models of care.

Officer for Workforce Dr Nicola Jay outlines the shape of the paediatric workforce in the UK and looks to the future, as an uncertain political environment impacts the front line of the health service.

Dr Lisa Kauffmann, Chair of the British Association of Community Child Health (BACCH) outlines the role of community paediatricians and explains why their work with agencies across child health is crucial to delivering integrated care.

Read the full article here


New Key Practice Point topics published

posted : 01/01/20

We are pleased to announce the launch of our newest Key Practice Point (KPP) topics, covering the signs, symptoms and care situations for Projectile Vomiting (with an emphasis on pyloric stenosis), Self-Harm and Rashes (Viral).

The editorial team worked with a number of healthcare professionals and paediatric specialty groups to produce these topics in line with our robust editorial process

KPPs continue to provide concise, easy-to-use decision support tools to assist healthcare professionals with diagnosis and treatment management at the point of care. We will continue to update and provide new content to ensure PCO UK remains a valuable source of support and information.


2019 / 2020 flu season and reports (updated)

posted : 05/12/19

Flu can be a very unpleasant illness causing fever, stuffy nose, dry cough, sore throat, aching muscles and joints, and extreme tiredness. To help prevent spreading flu, it is important to have the flu vaccine which can offer the best protection.

Annual flu programme

The flu programme is a coordinated and evidence-based approach to planning for the demands of flu across England. Each year the NHS prepares for the unpredictability of flu. For most people, flu is an unpleasant but usually self-limiting disease; however, there is a particular risk of severe illness from catching flu for:

  • the very young
  • pregnant women
  • older people
  • those with underlying disease, particularly chronic respiratory or cardiac disease
  • those who are immunosuppressed.

In the 2019 / 2020 flu season, the flu vaccine should be offered to all children aged two to ten years old on 31 August 2019. All primary school-aged children are now eligible for vaccination, and the vaccine should also be offered to children from six months of age in clinical risk groups.

There are several important resources for the flu season available to healthcare professionals including:

A freely available e-learning resource, consisting of three knowledge sessions and three assessment sessions, is also available to support the flu Immunisation programme, describing the national flu programme for England for the 2019 / 2020 flu season.

National influenza reports

Public Health England offer week on week National influenza reports, which track seasonal flu and other seasonal respiratory illnesses within the UK. 

These reports summarise UK surveillance of influenza and other seasonal respiratory illnesses for the 2019 to 2020 season. A weekly report is published during the influenza season (October to May) and a fortnightly summary report is published during summer months (June to September).

Reports from present day (2020) back to 2013 can be access here.


New ‘Quick Reference Guides’ to accompany Key Practice Points

posted : 04/11/19

Clinic times are precious and we understand that sometimes it is hard to find all the information you need to advise and treat a patient during an appointment. Based on current KPP topics, our new Quick Reference Guides (QRGs) aim to provide information to busy General Practitioners and those working in primary care on a wide range of commonly encountered conditions and problems in an easy to use format and at one’s fingertips.

Topics will eventually accompany relevant KPPs; however, to start off we are trialling QRGs covering common medical emergency admissions and primary care / out patient referrals including:

Watch this space for further topics coming soon!



Topic suggestions welcome

posted : 29/10/19

General practice can vary significantly from day to day; on occasions you may be challenged and need to broaden / develop your knowledge. 

While PCO UK try to provide a thorough online resource for healthcare professionals, who see children and young people at the point of care, we sometimes need suggestions on content from the end user. 

If you have a suggestion for a new topic on our A-Z list which will help primary care & general practice, please contact



Key Practice Point Updates - trainee volunteers needed

posted : 20/08/19

Are you interested in helping the editorial team to update the Key Practice Points?

We are keen to hear from any trainees interested in assisting us in this work. This will involve reviewing KPP content to determine what updates are required - on the basis of appropriate national guidance - and then completing the update (this applies to trainee's working in the relevant specialty). Take a look at our Fever KPP as a example of what will be updated.

All update work can be completed remotely, and reviewers will receive detailed instructions and guidance from the PCO UK team and Lead Editor. Upon completion of the work, each individual reviewer will be acknowledged, and receive a letter confirming their contribution to the update work. 

If you are interested in contributing please contact to express your interest.



PCO UK's first webinar

posted : 25/07/19

We are excited to announce that this month PCO UK hosted its first live webinar.

During the webinar, Drs Arindam Das and Job Cyriac provided a basic overview and background to urinary tract infection (UTIs) in infants, children and young people, as well as drilled down to specific topics such as dysuria  and enuresis.

These two topics are featured in the A-Z list of Key Practice Points (KPPs), and provide all healthcare professionals who see children and young people at the point of care with detailed, yet comprehensive, guide to the signs, symptoms and critical care situations of these conditions.

The webinar is aimed at both the paediatrician and non-paediatrician (eg, pharmacists, GPs, nurses, health visitors).

You can re-watch the webinar here (or below)


Undetected button / coin cell battery ingestion in children

posted : 11/07/19

In a recent investigation by the Healthcare Safety Investigation Branch (HSIB), on undetected button battery ingestion in children, a safety recommendation was made to the RCPCH:

In light of this recommendation, PCO UK will shortly be developing a Key Practice Point (KPP) on button battery ingestion in children, which will provide a comprehensive guide that covers the Red Flag signs & symptoms, investigations to be considered, as well as treatment approach / options and when to refer to a wide range of healthcare professions.

To read the full HSIB report, visit their summary page.


Important updates to RCPCH Child Protection Companion

posted : 19/06/19

We are pleased to announce recent updates to the RCPCH Child Protection Companion (CPC). 

Working alongside members of the RCPCH Child Protection Standing Committee and Research & Publications Sub-Committee significant updates have been made over the past two months, including:

Chapter 6 (The Medical Assessment and Admission to Hospital)

  • While the chapter is pending a complete update, in the interim two new paragraphs (6.5.4 & 6.6.7) have been added

Chapter 9 (Recognition of Physical Abuse) > section 8 (Abusive abdominal and visceral injuries)

  • Updated in line with the RCPCH Child Protection Systematic Review on visceral injuries

Chapter 10 (Child Sexual Abuse)

  • Revised definitions & ‘Good Practice Recommendations’
  • New sections on Accidental anogenital injuries and Genital bleeding in prepubertal girls to reflect to reflect latest edition of RCPCH Physical Signs of Child Sexual Abuse publication
  • Revised ‘timings for forensic samples’
  • Child Exploitation relocated from Ch14 

Chapter 11 (Neglect)

  • Revised definition
  • Implications for Practice section
  • New faltering growth section
  • New section on ‘indicators of neglect’ and tables linking to the Child Protection Evidence systematic reviews 

The CPC continues to be your go-to resource on child protection and safeguarding. Covering all forms of abuse and the spectrum of medical and social involvement, it focuses on all aspects from examination, to identification, to referral, to court. 

Remember: Safeguarding children is everyone's business, and as doctors and other healthcare professionals working in paediatrics and child health in the community we strive to improve outcomes for children and young people. 

To view the updated chapters visit the Child Protection Companion contents page.


UK-WHO Growth Charts added

posted : 27/11/18

Growth is an important indicator of child health. By using growth charts to compare height and weight, child health professionals can tell whether a child is growing as expected.

As of today you can now access and download the UK-WHO Growth Charts from the dedicated PCO UK page.


Self-accreditation for CPD through use of PCO UK

posted : 11/10/18

While preparing for appraisal or re-validation with your personal development plans (PDP), you can trust PCO UK to help show that you are keeping your knowledge up to date and learning about the latest, evidence-based developments in your specialty.

We are pleased to announce that after discussions with the RCPCH Education & Professional Development team we have been granted use of the below statement:

By using the RCPCH CPD scheme, and online CPD diary, you have the tools at your fingertips to support in planning, reflecting on and recording your learning and creating PDPs.

The RCPCH CPD scheme provides a framework to assess your educational needs and to identify and plan appropriate learning activities on a continuous basis within the context of your Professional Development Plan. The scheme is consistent with Academy of Medical Royal Colleges CPD guidance, and can help you to ensure you are meeting GMC requirements for re-validation and CPD.

Paediatric doctors should refer to the RCPCH CPD scheme guidance for more information or contact the team at


PCO UK is evolving and we need your help!

posted : 27/06/18

Are you a keen photographer, work in a busy clinical environment and would like to contribute images to the forthcoming Image Library?

We are currently updating the resources within PCO UK to enhance and evolve this online decision support system. 

The Image Library resource will host a variety of online-exclusive clinical photographs to accompany conditions covered within the Key Practice Points (KPP). Soon healthcare professionals will be able to browse images to aid diagnosis and presentations, including clinical manifestations and aetiology. 

However, in order to build a successful Image Library we need help from our clinical colleagues to obtain quality photographs and images of condition presentations. 

What topics will be covered? 

Understandably, not all KPPs will qualify for images; however, the intention is to provide a resource for healthcare professionals to refer to for examples of clinical manifestations (where applicable). For example, conditions like rash or alopecia can present across a wide spectrum. 

Current KPP topics can be found here, with a further 10 new topics planned for publication shortly covering topics such as Attachment Difficulties, Clubbing, Depressed Mood, Hyperglycaemia, Neonatal Sepsis, Pyrexia of Unknown Origin, Psychotic Behaviour, Spasticity, Stroke and Traumatic Injury.

How can I get involved? 

If you would like to get involved, please contact for more information and / or to request the patient consent form.



Risks of Valproate Medicines in Female Patients

posted : 26/01/18

Babies born to mothers who take valproate medicines (Epilim and Depakote) during pregnancy have a 30–40% risk of developmental disability and a 10% risk of birth defects. Despite communications to prescribers in January 2015 and February 2016 on the magnitude of this risk and the actions to take, there is evidence that women are still not being informed of the risk. Patient Safety Alerts were issued in 2017 asking all organisations to systematically identify women and girls taking valproate. A European review is considering whether further regulatory action is necessary and is due to complete in Spring 2018.

The Paediatric Care Online UK website features warnings where valproate is recommended as a medication, within the following Key Practice Points:

This warning will prompt clinicians to speak to the patient about the risks associate with the medicine during a pregnancy.



Key Practice Point on Fever endorsed by NICE

posted : 02/08/17

As the Key Practice Points on Paediatric Care Online (PCO UK) continue to develop, it has been announced that our Fever (Pyrexia) KPP has now been endorsed by the National Institute for Health and Care Excellence (NICE).

The endorsement recognises that the KPP supports implementation of the recommendations in the NICE Fever in under 5s clinical guideline (CG160).

The PCO UK team plan to continue this endorsement process, demonstrating the high-quality of information available in the wide range of KPPs.

For more information on how we develop our Key Practice Points, please visit our About page.


Download our new mobile app today!

posted : 23/05/17

To respond to user demand, the PCO UK app has been created to provide all users with quick and easy access to this powerful resource whether online or offline, from your tablet or mobile phone.

The app makes it even easier to access the decision support information you need, when you need it, and includes access to Key Practice Points, the Green Book and the Child Protection Companion.

The app has been optimised for use on both Apple and Android devices, and is available to download from the iTunes and Google Play stores.

For more information on how to download the app, visit our information page

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