HNY Policy and Pathway Repository - Humber
Community Children's Nursing Service
Definition/Description
The Community Children’s Nursing Continence service is a level 2 (Bladder & Bowel UK) nurse-led service (non-prescribers). We follow NICE guidance and pathways and offer conservative advice and recommendations. If medication is recommended, we will refer to the GP to review for prescribing options.
Services are delivered in clinic settings across the city, as well as in the home or other community venues as appropriate. We aim to deliver a child-centred service which is accessible and family-friendly, and we actively encourage patient/family engagement in the planning and delivery of care wherever possible.
The service works in collaboration with a range of other services including Community Children's Nursing Services, General Practitioners, Therapists, Child and Adolescent Mental Health services and 0-19 ISPHNS colleagues in the acute setting. The service works closely with other providers, and liaises with Local Authorities, Education and Social Care in both Hull and the East Riding to ensure that the needs of children, young people and their families are appropriately met.
Children’s Continence Care Pathways Levels 1-2, Bladder & Bowel UK.
Red Flag Symptoms
Constipation
Constipation reported from birth or first few weeks of life. Meconium not passed within 48 hours of birth. 'Ribbon stools' (more likely in a child younger than 1 year). Previously unknown or undiagnosed weakness in legs, locomotor delay. Abdominal distension with vomiting.
Abnormal appearance/position/patency of anus: fistulae, bruising, multiple fissures, tight or patulous anus, anteriorly placed anus, absent anal wink. Gross abdominal distension. Abnormal: asymmetry or flattening of the gluteal muscles, evidence of sacral agenesis, discoloured skin, naevi or sinus, hairy patch, lipoma, central pit (dimple that you can't see the bottom of), scoliosis. Deformity in lower limbs such as talipes. Abnormal neuromuscular signs unexplained by any existing condition, such as cerebral palsy. Abnormal reflexes
Do a physical examination. Use table 3 to establish a positive diagnosis of idiopathic constipation by excluding underlying causes. If a child or young person has any 'red flag' symptoms do not treat them for constipation. Instead, refer them urgently to a healthcare professional with experience in the specific aspect of child health that is causing concern.
(Table 2 and Table 3, NICE Clinical guideline [CG99] Constipation in children and young people: diagnosis and management, 2010). https://www.nice.org.uk/guidance/cg99.
Enuresis
Assess whether the child or young person has any comorbidities or there are other factors to consider, in particular:
- constipation and/or soiling
- developmental, attention or learning difficulties
- diabetes mellitus
- behavioural or emotional problems
- family problems or a vulnerable child or young person or family.
Practitioners should be alert to signs of polydipsia and polyuria, and sign/symptoms indication possible infection (NICE Clinical guideline [CG111] Bedwetting in under 19s). https://www.nice.org.uk/guidance/cg111.
EXCLUDE RED FLAG SYMPTOMS
The Community Children’s Nursing Continence Service is not an emergency service and therefore has no facilities to see urgent referrals. Where the nature of the concern suggests an immediate response is required or where the condition is deteriorating or escalating rapidly the appropriate acute services should be considered.
Guidelines on Management
The ISPHNS 0-19 Service have responsibility for ensuring that level 1 support is provided across all areas of continence. Children should be seen, in the first instance, by the appropriate 0-19 Public Health Nursing team who will offer advice and support and follow the referral pathway to the continence service as necessary.
East Riding ISPHNS e-mail hnf-tr.isphnspoc@nhs.net
Hull ISPHNS e-mail hull.cypcommunityservices@nhs.net
Constipation: Constipation should be managed with reference to the Bladder and Bowel UK Children’s Continence Care Pathways Levels 1-2, along with NICE Guideline Childhood Constipation - Constipation in Children and Young People: diagnosis and management. NICE Clinical Guideline 99, (NICE, 2010). Published May 2010, revised July 2017.
https://www.nice.org.uk/guidance/cg99.
CG99 guideline covers diagnosing and managing constipation in children and young people up to 18. It provides strategies to support the early identification and timely, effective treatment of constipation which will help improve outcomes for patients. It does not cover constipation caused by a specific condition.
Enuresis: Enuresis should be managed with reference to the Bladder and Bowel UK Children’s Continence Care Pathways Levels 1-2, along with NICE guidance cg111.
https://www.nice.org.uk/guidance/cg111 Recommendations | Bedwetting in under 19s | Guidance | NICE
CG111 guideline covers assessing and treating bedwetting in people aged under 19. It aims to reduce bedwetting and the distress this causes by explaining what to ask in an assessment, what advice to provide, and which treatments are effective. Constipation should be addressed prior to any Enuresis issues being considered.
Continence Products: Provision of containment products should be managed with reference to the Bladder and Bowel UK Children’s Continence Care Pathways Levels 1-2. Following key recommendations from Bladder and Bowel UK all children and young people (CYP) should receive a toilet training programme for at least six months to help them achieve their potential for the attainment of continence, regardless of their age, culture, ability, medical condition or diagnosis prior to referral for containment products. If a child/young person then still requires containment products a full assessment will be completed and the Guidance for the provision of continence containment products to children and young people - A consensus document will be referred to prior to the child being issued with continence products.
General – ERIC and Bladder and Bowel UK provide a comprehensive continence support information website for parents and professionals.
The Children’s Bowel and Bladder Charity ERIC Website https://www.eric.org.uk/
Bladder and Bowel UK https://www.bbuk.org.uk/
Referral Criteria/Information
Do Not Refer
Constipation
Do not refer under 2 years of age.
Do not refer without confirmed diagnosis of idiopathic constipation.
Do not refer if not examined by GP or Consultant to initially rule out any organic cause for constipation.
Enuresis
Do not refer under 5 years of age.
Do not refer if not registered with HULL GP.
Do not refer if not been examined by a GP or consultant to initially rule out any organic cause for the wetting.
Continence Products
Child/family should receive a toilet training programme to help them achieve their potential for the attainment of continence, regardless of their age, culture, ability, medical condition or diagnosis prior to referral for containment products.
Referral Criteria
The Community Children’s Continence Service accepts referrals for:
- Constipation: Children and Young People over the age of 2 years with a Hull or East Riding GP with a diagnosis of idiopathic constipation. They must have been examined by a GP/Consultant (or other suitably qualified health professional as determined by the practice) to initially rule out any organic cause for constipation and be commenced on Movicol Paediatric Plain on a maintenance dose and taken regularly. Please refer to the Consitpation checklist prior to making the referral.
- Enuresis (Nighttime and Daytime Wetting): Children and Young people aged 5 and over with a HULL GP only. They must have been examined by a GP/Consultant (or other suitably qualified health professional as determined by the practice) to initially rule out any organic cause for the wetting. Please refer to the Enuresis checklist prior to making the referral.
- Continence product assessment: Children and Young People aged 5 and over with a Hull or East Riding GP.
A requirement for specialist nursing interventions and support for children and young people with continence needs, e.g. Catheterisation, Antegrade Colonic Enema (ACE), Stoma, Cystostomy, Mitroffanof, Trans anal irrigation.
The service also offers:
- Toileting support: Children’s Community Nursing Team (CCN) internal referral only for Children and Young People on existing continence caseload.
- Training – Parents and carers – tailored training support for parents and carers to enable delivery of care across settings for continence management
- Transition planning – Support for young people aged 14 and above with long term continence needs to facilitate movement into adult services.
Referral is via Electronic referral to Community Children’s Nursing CHCP.CIC: chcp.communitychildrensnursing@nhs.net
All referrals are inputted onto SystmOne by the Children’s Community Nursing Administration Team and triaged by an experienced clinician. Any inappropriate referrals are rejected and returned to the referrer with reasons stated.
We accept referrals from health care professionals including GPs, therapy services, and Community Children's Nurses. We do not accept referrals from parents/carers or children. Referrals should be accompanied by the appropriate checklist (Enuresis/Constipation).
Referrers will be notified if the referral is declined, and a letter of explanation will be provided.
The parent/child will then be offered a Triage/Initial assessment. This may be via Telephone or Clinic appointment.
Additional Resources & Reference
Children’s Continence Care Pathways Levels 1-2, Bladder & Bowel UK -
NICE Guideline Childhood Constipation - Constipation in Children and Young People: diagnosis and management. NICE Clinical Guideline 99, (NICE, 2010). Published May 2010, revised July 2017 -
https://www.nice.org.uk/guidance/cg99.
https://www.nice.org.uk/guidance/cg111 Recommendations | Bedwetting in under 19s | Guidance | NICE
Guidance for the provision of continence containment products to children and young people - A consensus document -
The Children’s Bowel and Bladder Charity ERIC Website - https://www.eric.org.uk/
Bladder and Bowel UK - https://www.bbuk.org.uk/
EXCELLENCE in Continence Care Practical guidance for commissioners, and leaders in health and social care - https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf
Local Offer Hull - https://hullsendlocaloffer.org.uk/
Local Offer East Riding - https://www.eastridinglocaloffer.org.uk/
Any Other Information
Referrals into this service should be made on the designated referral form. Please complete as much of the form as possible. It is important that the referrer indicates Reason for Referral, includes reports from other services involved and completes required checklists as appropriate. E-mail is the preferred format for receiving referrals. Email: chcp.communitychildrensnursing@nhs.net
The postal address is:
Community Children’s Nursing,
Marfleet Primary Healthcare Centre
Preston Road
Kingston upon Hull
HU9 5HH
Associated Policies
Specialties
Places covered by
- Hull