Guidelines
441 entriesNDoH Hospital-level paediatric STG
- Diabetes Mellitus, Type 1Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 Code: E10 DESCRIPTION Most diabetic children have type 1 diabetes, and: have auto-immune destruction of the pancreatic beta cells as the underlying cause, have an absolute requirement for insulin therapy, will develop diabetic ketoacidosis (DKA) if not given insulin. DIAGNOSTIC CRITERIA The followin→
- Diabetes Mellitus, Type 2Description Diagnostic criteria General and supportive measures Medicine treatment ICD-10 Code: E11 DESCRIPTION Type 2 diabetes develops when insulin secretion cannot meet the increased demand posed by insulin resistance. Type 2 diabetes may be associated with hyperlipidemia, hypertension, acanthosis nigricans, ovarian hyperandrogenism and non-alcoholic fatty liver disease (features of insulin re→
- Diabetic KetoacidosisDiabetic Ketoacidosis→
- Diabetic KetoacidosisSee: Diabetic ketoacidosis Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 23: Paediatric Intensive Care, 23.6 Electrolyte Abnormalities, 23.6.9 Diabetic Ketoacidosis→
- Diabetic NephropathyDiabetic Nephropathy→
- Diarrhoea, AcuteDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A09.0 DESCRIPTION Diarrhoea is a serious common childhood illness evidenced by the passing of frequent profuse loose watery stools. Vomiting may or may not be present. Diarrhoeal disease is often caused by viral infection but may be due to bacterial infection, dietary or other causes. De→
- Diarrhoea, Chronic Other Than Post InfectiousDescription Diagnostic criteria Referral ICD-10 code: K52.9 DESCRIPTION Chronic diarrhoea: diarrhoea for longer than two weeks. Chronic diarrhoea results in significant morbidity and mortality associated with poor nutrition. Chronic diarrhoea is most frequently due to: Temporary loss of disaccharidase activity in the intestinal microvillous brush border, e.g. lactase loss; or lu→
- Dilated CardiomyopathyDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: I42.0 DESCRIPTION Dilated cardiomyopathy is a clinical diagnosis characterised by dilation and impaired contraction of the left or both ventricles that is not explained by abnormal loading conditions. It is difficult and sometimes impossible to distinguish myocarditis from dilated cardio→
- DiphtheriaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A36.9 * Notifiable condition Telephone Hotline NICD hotline (24 hours) 082 883 9920 National Institute of Communicable Diseases 011 555 0327 or 011 555 0352 DESCRIPTION Diphtheria is an acute, communicable infection of the upper respiratory tract, caused by Corynebacterium diphtheriae .→
- Disorders of PubertyDisorders of Puberty→
- Disorders of Sex Development (DSD)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 Code: Q52.9/Q55.9 DESCRIPTION The current terminology for neonates or children presenting with incomplete differentiation of the external genitalia is “disorder of sexual development”. DIAGNOSTIC CRITERIA Clinical DSDs present with one or more of the following: varying degrees of hypospadias, maldes→
- Disruptive Mood Dysregulation Disorder (DMDD)Disruptive Mood Dysregulation Disorder (DMDD)→
- Disseminated Intravascular CoagulationDescription Diagnostic criteria Medicine management Referral ICD-10 code: D65 DESCRIPTION Complication of an underlying condition, e.g. severe sepsis that is characterized by widespread activation of the clotting cascade leading to consumption of platelets and clotting factors with generalized bleeding. DIAGNOSTIC CRITERIA Investigations Prolonged INR and PTT. Thrombocytopaenia. Decreased f→
- Drug AllergiesDescription Classification Diagnosis ICD-10 code: T88.7 DESCRIPTION Drug allergy is an immune-mediated reaction to the drug. Reactions are idiosyncratic and, unlike side effects, cannot be predicted by physiological action of the pharmaceutical agent. Common drugs involved include penicillin, sulphonamides, non-steroidal anti-inflammatory drugs, anticonvulsants, and chemotherapeutic agents. CLASS→
- Drug ReactionsGeneral and supportive measures Medicine treatment Referral ICD-10 code: L27.0 Commonly associated with: sulphur-containing agents, penicillin, antiepileptics (e.g. carbamazepine, lamotrigine), NSAIDs, anti-tuberculosis drugs, and non-nucleoside reverse transcriptase inhibitors. A variety of rashes may occur, including: erythema multiforme (see Erythema Multiforme ) urticarial eruptio→
- Drug Resistant TB (DR-TB)ICD-10 code: U84.3 See the National Department of Health Clinical Reference Guide: Management of Rifampicin-Resistant Tuberculosis , 2019. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 10: Tuberculosis, 10.7 Drug Resistant TB (DR-TB)→
- Drug-Related AnaphylaxisICD-10 code: L88.6 See: Emergencies and Trauma, Anaphylaxis/Anaphylactic reactions. Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 25: Drug Allergies, 24.2 Immediate Hypersensitivity Reactions, 24.2.1 Drug-Related Anaphylaxis→
- Drug-Related AngioedemaDescription General and Supportive Measures Medicine Treatment Referral ICD-10 code: T78.3 DESCRIPTION Local swelling of skin and/or mucosal tissue. May occur in isolation or together with urticaria or anaphylaxis. It must be distinguished from recurrent non-pruritic angioedema which has a hereditary component and does not respond to the treatment below. Complement C4 and C1 esterase inhibi→
- Drug-Related UrticariaICD-10 code: L50.9 See: Dermatology, Urticaria . Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 25: Drug Allergies, 24.2 Immediate Hypersensitivity Reactions, 24.2.2 Drug-Related Urticaria→
- Duchenne Muscular Dystrophy (DMD)Duchenne Muscular Dystrophy (DMD)→
- DysenteryDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A03.9 DESCRIPTION Passage of blood and mucus in the stools. Shigella infection is the most common serious cause in children in South Africa. Complications include: dehydration, convulsions, shock, toxic megacolon, acidosis, rectal prolapse, renal failure, haemolytic uraemic syndrome. DIA→
- Dysfunctional BladderDescription Diagnostic criteria General and supportive measures Referral ICD-10 code: N31 DESCRIPTION Abnormalities of filling or emptying of the bladder, i.e. underactive or overactive bladder. Aetiology may be neurogenic, anatomical or functional. DIAGNOSTIC CRITERIA Clinical features include: Daytime frequency Incontinence Urgency Nocturia Hesitancy Straining Weak stream Dysuria Holding→
- DyslipidaemiaICD-10 code: E78.9 See: Dyslipidaemia Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 4: Cardiovascular System , 4.10 Dyslipidaemia→
- DyslipidaemiaDyslipidaemia (E78.9)→
- Dysnatraemias In ICURapid changes in serum sodium are more likely to be symptomatic. Slow changes should be corrected slowly: Hypernatremia – risk of cerebral oedema. Hyponatremia – risk of central pontine myelinolysis. Hyponatraemia Defined as serum Na < 135 mmol/L Disorder of water balance, excess total body water relative to electrolytes. Caused by increased renal water reabsorption in response to ADH, along w→
- Dyspnoea - Paediatric Palliative CareDescription General and supportive measures Medicine treatment ICD-10 code: R06.0 DESCRIPTION A subjective feeling of breathlessness, when breathing becomes unpleasant, difficult and tiresome. GENERAL AND SUPPORTIVE MEASURES Find the position in which the patient is most comfortable: upright, semifowlers or prone. In patients with large effusions: position with the bad lung down to allow fo→
- Dystonia/ Muscle Spasms/ Spasticity - Paediatric Palliative CareDescription General and supportive treatment Medication and treatment Referral DESCRIPTION Dystonia A movement disorder caused by diseases of the basal ganglia, in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements as well as abnormal posturing that is often painful. Dystonia can be a primary disorder (e.g. brain tumours, metabolic conditions,→
- EczemaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: L20.9 DESCRIPTION An inflammatory itchy skin condition characterised by: Vesicles, weeping and crusting during the acute stage. Scaling and lichenification during the chronic stage. DIAGNOSTIC CRITERIA Intractable itch. Family history of allergies. Onset under the→
- Effusion and EmpyemaDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J90 DESCRIPTION A pleural effusion is an accumulation of fluid between the visceral and parietal pleura. The fluid can be an exudate or a transudate (see Lights criteria: https://www.mdcalc.com/lights-criteria-exudative-effusions ). Common causes for exudates are infections, inflammation→
- Elimination DisordersElimination Disorders→
- EncopresisEncopresis→
- End Of Life And Terminal CareDescription General and supportive measures Terminal Care Medicine treatment Referral ICD-10 code: Z51.1 DESCRIPTION The end of life phase is defined as that stage where it is recognized that the child’s health is in a state of steady decline, whereas the terminal stage is the last few hours of life. Although prognostication is more difficult in children compared to adults especially when i→
- Endocarditis, InfectiveDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: I33.0 DESCRIPTION Infection of the endothelial surface of the heart. Suspect infective endocarditis in all children with fever and underlying heart disease. Antibiotic therapy in these children is highly dependent on the results of microbiology. DIAGNOSTIC CRITERIA Clinical An underlying→
- Enterocolitis, NecrotisingDescription Diagnostic criteria General and supportive measures Medicine treatment Surgical treatment Referral ICD-10 code: P77 DESCRIPTION Neonate presenting with the consequences of bowel wall injury or necrosis. Risk factors include: prematurity, hypotension/shock, sepsis, early formula feedings, high feeding volumes, perinatal asphyxia (hypoxia), patent ductus arteriosus, and polycythae→
- EnuresisEnuresis→
- EnuresisICD-10 code: R32 See: Child and Adolescent Psychiatry, Enuresis . Click here for the pdf . Click here for the Erratum-3 notice . Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _Chapter 6: Nephrological/Urological Disorders; 2023, 5th edition→
- EnvenomationThe management of severe envenomation, particularly by snakes and scorpions, is complex. Please contact the Poisons Information Helpline for advice. 0861 555 777 Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 18: Poisoning, 18.2 Envenomation Click here for Insect Bites and Stings Click here for Scorpi→
- Epidermolysis BullosaDescription General and supportive measures Referral ICD-10 Code: Q81.9 DESCRIPTION Congenital, hereditary blistering skin lesions with onset in the newborn. Lesions have an erythematous base. Involvement of the mucous membranes as well as loss of nails may occur. GENERAL AND SUPPORTIVE MEASURES May require monitoring in a high or intensive care unit. Aseptic aspiration of bullae on th→
- EpiglottitisDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J05.1 DESCRIPTION Life-threatening upper airway obstruction at the level of the supraglottic structures (epiglottis and arytenoids). The condition is rare since H. influenzae Type b vaccination has been introduced. DIAGNOSTIC CRITERIA Acute onset, high fever, sore throat, dysphagia,→
- EpilepsyDescription Epilepsy types Investigations G40.0-9 DESCRIPTION Epilepsy is a disease of the brain defined by any of the following conditions: At least two unprovoked (or reflex) seizures occurring >24 hours apart, or One unprovoked (or reflex) seizure if there is a high risk (60% or more) of having recurrent seizures within the next 10 years (i.e., if the person is vulnerable to having another→
- Epilepsy SyndromesDescription Medicine treatment Referral G40.3-5 DESCRIPTION An epilepsy syndrome is a specific seizure type associated with characteristic EEG and imaging features, natural history, age-dependent features, triggers, response to ASM, and prognosis. For classification of seizure types, see Figure 1 in Epileptic seizures . Pointers for the identification of an epilepsy syndrome: Early-onset se→
- Epilepsy in Adolescents (13-18 Years)G40.0-9 See Adult Hospital Level STGs and EML, Central Nervous System, Epilepsy in adolescents and adults. Click here to access the pdf . Click here to access NEMLC Report . Standard Treatment Guidelines and Essential Medicines List for South Africa, Paediatric Hospital Level_Updated May 2025 Chapter 13: The Nervous System_13.4 Epilepsy_13.4.2 Epilepsy in Adolescents (13 – 18 years)→
- Epilepsy in Children <13 Years of AgeSpecial considerations General and supportive measures Medicine treatment Referral A child may be diagnosed with focal, generalised, combined generalised and focal, or unknown epilepsy types. Special considerations Seizures in neonates Seizures in the neonatal period seldom confer a diagnosis of epilepsy. For management of seizures, see Seizures, neonatal . Underlying conditions and co-morbiditie→
- Epileptic SeizuresStatus Epilepticus (Convulsive)→
- Epileptic Seizures and Status Epilepticus in Adolescents (13-18 Years)See Adult Hospital Level STGs and EML, Epileptic Seizures and Status Epilepticus in Adolescents (13 – 18 Years) And Adults in Status Epilepticus . Click here to access the pdf . Click here to access NEMLC Report . Standard Treatment Guidelines and Essential Medicines List for South Africa, Paediatric Hospital Level_Updated May 2025 Chapter 13: The Nervous System_13.2 Status Epilepticus_13.2.2. Ep→
- Epileptic Seizures and Status Epilepticus in Children <13 Years of AgeStatus Epilepticus (Convulsive)→
- Epistaxis (Nose Bleed)Epistaxis (nose bleed)→
- Erythema MultiformeDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: L51.9 DESCRIPTION An acute, self-limiting and commonly recurrent inflammatory eruption of the skin with variable involvement of the mucous membranes and without systemic symptoms. Symmetrically distributed crops of target lesions, (dark centre, an inner, pale ring surrounded by an→
- Ethanol PoisoningDescription Diagnostic criteria Medicine treatment Referral ICD-10 code: T51.0 DESCRIPTION Ethanol is a selective CNS depressant at low concentrations, and a generalised depressant at high concentrations. DIAGNOSTIC CRITERIA Clinical lack of co-ordination, stupor, ataxia, coma, slurred speech, hypoglycaemia, gait disturbances, convulsions, drowsiness. Investigations Monitor bl→
- Exposure To Poisonous SubstancesSee section: Poisoning Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition Chapter 1: Emergencies and Trauma, 1.1 Paediatric Emergencies, 1.1.11 Exposure To Poisonous Substances→