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The British National Formulary for Children (BNFC) addresses day-to-day prescribing information needs of healthcare professionals treating children. The BNFC brings together authoritative independent guidance on best practice, validating information with a standardised process. Careful consideration is given to establishing the clinical need for unlicensed interventions. It remains the main stay of reliable prescribing information alongside NICE guidance outlined below for the most common conditions, but is not an exhaustive list.

Please expand the topics below for more information and useful links.

The information and links provided are for guidance, clinical decisions remain the responsibility of the practitioner; the intention is to help prescribers find evidence based information and does not replace input from appropriate professionals or constitute medical advice for individual patients.

Asthma

NG80 Asthma: diagnosis, monitoring and chronic asthma management, noting the Treatment pathway for children under 5.

BTS/SIGN guideline for the management of asthma.

See the formulary link for the Respiratory System.

Balanitis

Most pre-pubertal boys only experience a single episode of balanitis.

See CKS Balanitis for further guidance on treatment.

Constipation

CG99 Constipation in children and young people: diagnosis and management. See point 1.4 for clinical management including disimpaction and maintenance therapy.

ERIC (the Children’s Bladder and Bowel Charity) have some useful resources for children and teens, parents/carers and education and health professionals.

Eczema

CG57 Atopic eczema in under 12s: diagnosis and management

See our dermatology webpage and formulary for guidance and formulary choices.

Infections

NICE [NG194] Neonatal infection: Risk factors for and clinical indicators of possible late-onset neonatal infection discusses risk factors for clinical indicators of possible late-onset neonatal infection.

Refer to the Somerset CCG Infection Management page for GP paediatric Sepsis decision support tools and prescribing advice.

Reflux and Food Allergies

NG1 Gastro-oesophageal reflux disease in children and young people: diagnosis and management, including ‘silent reflux’ also known as occult reflux.

Be aware that some symptoms of a non‑IgE‑mediated cows’ milk protein allergy can be similar to the symptoms of GORD, especially in infants with atopic symptoms, signs and/or a family history. If a non‑IgE‑mediated cows’ milk protein allergy is suspected, see the NICE guideline on CG116 Food allergy in under 19s: assessment and diagnosis.

See our infant feeding page and formulary links to suspected cow’s milk protein allergy for breastfed infants and formula fed infants.

Cow’s milk protein allergy should not be confused with Lactose intolerance.

Oral Thrush

CKS Oral Candidiasis, see also Somerset CCG infection page.

Remember to treat the breastfeeding mum as well as baby when the child is diagnosed with oral candidiasis.

See the Breastfeeding Network factsheet on Thrush and Breastfeeding.

Sleep hygiene resources for children

Babies, children, and teenagers need significantly more sleep than adults to support their rapid mental and physical development.

Sometimes sleep can be difficult to initiate or maintain and parents or carers will ask for advice.

Listed below are some Somerset based resources which may be helpful.

Somerset Children and Young People Health and Wellbeing

Special Educational Needs. Somerset Expertise (sen.se)

Please see the Traffic Light System for prescribing status of individual medications – Currently none are suitable for primary care prescribing.

Specials

Medicines are not always available in formulations that are suitable for patients, the alteration of medication formulations may therefore be necessary, such as crushing tablets or prescribing a ‘special’ liquid formulation. Access the specials guide for information and to avoid delay in treatment and unnecessary use of unlicensed options for children. See Somerset CCG formulary for further information. Medications should only be given in an unlicensed manner when a licensed alternative is not available. Licensed routes of administration should be sought first. When prescribing alternatives (licensed/ unlicensed) it is important to consider:

  • Dose adjustments that need to be made with alternative liquid/ injection preparations.
  • Full dose directions need to be included on the prescription (if applicable) e.g. ’take one tablet, disperse in water and take once in the morning’.

Before accepting a request for prescribing (including specials) from secondary care, a prescriber should consider if the condition is suitable for taking on in primary care, for example complex paediatrics under the care of a consultant.

Vitamin D

The Department of Health recommends that:

  • Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms (µg) of vitamin D to make sure they get enough. This is whether or not you’re taking a supplement containing vitamin D yourself.
  • Babies fed infant formula shouldn’t be given a vitamin D supplement if they’re having more than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D and other nutrients.
  • Children aged 1 to 4 years old should be given a daily supplement containing 10µg of vitamin D.

Healthy Start vitamins are available for families who qualify for free, see how to apply. Healthy Start women’s vitamin tablets contain folic acid and vitamins C and D (Children’s drops also available). FAQs. The application form must be signed by a midwife, health visitor, doctor or nurse.

Medicines for Children provide some practical guidance and leaflets for children.