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NICE CG99 recommends diet, laxatives and lifestyle advice in combination. The major change is the off license use of macrogol as first line treatment. Do not use flavoured macrogol preparations for children under 12 years of age.
A local specialist nurse-led children's continence service is available for children and young people who do not respond to primary treatment regimens. Specialist nurses are not able to prescribe but can give advice on treatments and liaise with the GP.
Specialist referral is appropriate
Children will normally be able to access the specialist service at level 3, although the specialist paediatric bowel and bladder service can provide specialist training, education and support to primary and community care staff delivering services at levels 1 and 2.
Level 1: A universal service delivered by health visitors, school health nurses or children's centres. This is for giving basic advice and information, e.g. signposting to ERIC (www.eric.org.uk), advice on fluids, and toileting
Level 2: For active treatment and intervention, preferably in a clinic setting. This is delivered by health visitors and school health nurses following treatment pathways and NICE Guidelines, for at least 6 months
Level 3: Referral to Paediatric Bladder and Bowel Care Team after initial failure or non-response to treatment, this is delivered by specialist paediatric bladder and bowel care nurses.
Level 4: Onward referral to Consultant Paediatrician/ Consultant Paediatric Urologist if red flags are present and/or a medical review is required.
Paediatric Bladder & Bowel Care Service
Tel: 01392 208044
Mob: 07792 829 438