Guidance
Update information
October 2023: We updated recommendations 1.3.1, 1.4.2 and 1.7.4 in line with NHS England's standard on faster diagnosis of cancer.
July 2019: We changed the timing of referral from urgent to immediate for adults with sudden-onset speech or language disturbance and for children under 4 years with a change in head circumference and signs or symptoms of raised intracranial pressure (see recommendations 1.13.1 and 1.22.3).
Minor changes since publication
March 2024: In recommendation 1.30.1 and the related rationale, we changed red reflex to fundal ('red') reflex. See the surveillance report for more information. We also updated links to our guidance on bacterial meningitis and meningococcal disease following the launch of NICE's guideline on meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management.
October 2021: In recommendation 1.30.1, we added a cross-reference to NICE's guideline on suspected cancer. We also updated the rationale for this recommendation to clarify that new-onset squint with loss of fundal 'red' reflex may indicate a neurological condition associated with raised intracranial pressure or a brain tumour. See the surveillance report for more information.
In recommendation 1.16.1, we added a link to NICE's guideline on shared decision making.
ISBN: 978-1-4731-5439-1