Position Statements

These have been approved by the BSPED and reflect the Society's views on best practice for the average patient.

Each patient must be considered as an individual in the context of their condition and other medication, and whilst every effort has been made to ensure the factual accuracy of the contents no liability can be accepted for any litigation, claims or complaints arising from the use of the statements, which is solely at the discretion of the reader.

 

BSPED statement on Glucocorticoid replacement and COVID-19 infections

Children and young people who have hormone problems and in particular who are taking steroids (hydrocortisone, prednisolone, dexamethasone) because their adrenal glands do not work properly (steroid replacement therapy) are at no more risk of catching COVID-19 than other children.

However, it is very important that all medicines are given regularly and at the doses recommended by your doctor. Make sure you have got enough medicine at home, without stockpiling, and that you follow sick day rules if you /your child becomes unwell.

Further information is available at:

NHS: https://www.nhs.uk/conditions/coronavirus-covid-19/ 

RCPCH: https://www.rcpch.ac.uk/resources/covid-19-resources-general-public 

 

CAH/Adrenal Replacement Therapy & Monitoring (reviewed in 2020)

Whilst it is recognised that multiple daily hydrocortisone dosing and 24 hr cortisol profiling may be beneficial in some patients with adrenal insufficiency, including congenital adrenal hyperplasia, whose control is challenging, there is currently no evidence to support this practice in all patients. The BSPED is currently seeking evidence to inform the development of a more detailed position statement and its members are invited to contact the Chair of the Clinical Committee.

 

BSPED Position Statement on Choice of Delivery Device for Growth Hormone Prescribing
(reviewed in 2020)

The BSPED recommends the following:

  • In accordance with NICE guidance (see below), the BSPED recommends that "the choice of product is made on an individual basis and after informed discussion between the responsible clinician and the patient and/or their carer about the advantages and disadvantages of the products available, taking into consideration therapeutic need and the likelihood of adherence to treatment."
  • The NICE guidance on choice of product should run throughout an individual’s duration of treatment with growth hormone. Treatment may require re-assessment upon transition from paediatric to adulthood services.
  • Automatic substitution (dispensing one brand instead of another equivalent or interchangeable brand) by professionals other than the prescribing team, without consultation with the hospital consultant managing the growth disorder, is not appropriate.

NICE: National Institute for Health and Care Excellence Technology appraisal guidance, 26 May 2010

Guidance 1.2

"Treatment with somatropin should always be initiated and monitored by a paediatrician with specialist expertise in managing growth hormone disorders in children. The choice of product should be made on an individual basis after informed discussion between the responsible clinician and the patient and/or their carer about the advantages and disadvantages of the products available, taking into consideration therapeutic need and the likelihood of adherence to treatment. If, after that discussion, more than one product is suitable, the least costly product should be chosen."

 

BSPED Statement on Gender Identity (reviewed in 2020)

The BSPED wishes to highlight that the management of children with Gender Identity Dysphoria is a highly specialised area. All children and young people with this condition should only be managed by a specialized team of clinicians with expertise in this area.

In England and Wales these services are provided by the Gender Identity Development Service (GIDS) based in London and Leeds.

In Scotland the service is provided by Sandyford Clinic Glasgow, together with clinicians at the Glasgow Royal Children's Hospital.

In Northern Ireland the service is provided by the Royal Belfast Hospital for Sick Children.

All referrals should be directed to these institutions alone

 

BSPED Position Statement on Paediatric Age Assessment (reviewed in 2020)

The BSPED wishes to highlight that it is not possible to accurately assess a child’s age based on physical examination or bone age assessment. Children and young people mature at very different rates and an examination can only demonstrate the stage of physical development that child is at, on that day. For example, an 11 year old girl who had an early puberty and has started her periods will be physically indistinguishable from a 15 year old girl who is at the same stage of puberty. The converse is also true – it is not possible to physically differentiate a young person who has delayed puberty from a younger child who is at the same pubertal stage. Bone age X rays will only report the degree of maturity of the bones, which is highly dependent on the child or young person’s pubertal stage and physical development. For the same reasons as given above, they cannot be used to accurately age a child or young person. For these reasons, we do not support the use of physical examination or bone age X ray assessment as tools for age assessment in children and young people.

 

Use of Prenatal Dexamethasone in Congenital Adrenal Hyperplasia (reviewed in 2020)