Children's Bladder and Bowel Pathway & service

Children’s Bladder and Bowel Service and Pathway

 

A new Children’s Bladder and Bowel Pathway for 2-18 year olds was approved by the CCG Clinical Ratification Group in August 2021. The pathway describes three levels of service provision; Level 1 (GPs, Heath Visitors and School Health Nurses), Level 2 (Children’s Bladder and Bowel Service) and Level 3 (Secondary Care).

 

Pathway Principles:

 

  • Children who are being successfully supported by HVs or SHNs do not need to be referred to a GP unless no improvement is made after 3 months.
  • Referral to level 2 or 3 services will only be accepted once a medical assessment has been carried out by a GP.
  • If no red flags are identified, children and young people must first be given Level 1 first line advice and support before progressing through the pathway.
  • Children should only be referred to one service at a time. The correct service can be identified through the GP referral form (currently being produced)

 

The agreed pathway document including an explanatory pathway map can be found below.

 

 

 

Children’s Bladder and Bowel Service (CBABS)

 

CBABS undertakes comprehensive bladder and bowel assessments and treats children and young people from 2-18yrs years with bladder and/or bowel problems and/or delayed toilet training, where universal Level 1 interventions have not resolved the issues.

 

Children and young people’s care will be shared between CBABS and the GP while undergoing treatment for bladder and bowel dysfunction. CBABS Nurses will communicate any adjustments made to the child/young person’s management plan, requesting adjustments to medication in line with current NICE guidance.

 

When appropriate, CBABS Nurses will work under an agreed Patient Service Agreement (PSD) with the GPs and Consultant Paediatricians in secondary care, in relation to anti-cholinergic medication for day-time wetting.

 

Children and young people who are on anti-cholinergic medication will be followed up at 3mths, then 6 months and remain on the CBABS caseload until their continence has been achieved. If there is no improvement the service will refer to the GP for further investigation or referral to secondary care.

 

 

Dis-impaction for soiling and constipation

 

CBABS will only accept referrals for constipation and soiling after they have been seen by a GP for initial treatment (minimum of 4 weeks) as per NICE Guidance.

 

The ERIC website has a useful ‘Parent’s Guide to disimpaction’.

ERIC leaflet on disimpaction

 

 

Fluid and Stool Charts

Please encourage your patients to record their fluid intake and toileting using the charts below. A helpful guide for parents is also included in the links below.

 

 

Useful Resources for Professionals

www.eric.org.uk ERIC charity

www.bbuk.org.uk Bladder and Bowel UK

http://i-c-c-s.org International Children’s Continence Society

 

 

Children with special needs;

Bladder and Bowel UK have a really helpful website offering information about building toileting skills and use of strategies specifically for children with ASD:

 

Information-for-parents-re-toilet-training-children-with-ASD.pdf (bbuk.org.uk)

 

Toilet and Potty Training Resources - Bladder & Bowel UK (bbuk.org.uk)

 

https://www.thepoonurses.uk Tackling childhood constipation and soiling with a macrogol laxative

Do you want to add this to your CPD record?

Did you find this page helpful?