Paediatrician only development clinic criteria
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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

A medical emergency requiring immediate provision of medical care including:
- Suicidal or immediate danger of self-harm
- Aggressive behaviour with immediate threatening risk to others
- Concerns around acute deterioration in function and/or significant loss of previously acquired skills that is suggestive of an underlying neurological deterioration/condition
- Sudden onset of neurological symptoms (i.e., sudden weakness, slurred speech, seizures)
- Non-verbal child with acute distress and possible acute pain where medical condition needs exclusion, e.g. tooth abscess, bone infections or osteopaenic fractures

Growth concerns

Faltering growth (failure to thrive in children < 6 years)
- severe malnutrition
- temperature instability
- cardiovascular instability – postural heart rate change
Short stature
- possible CNS signs (visual disturbance, morning headaches)

Developmental concerns

Nonverbal child with acute distress and unable to examine adequately for medical conditions causing pain eg tooth abscess, bone infections or osteopaenic fractures

Behavioural concerns

Suicidal or immediate danger of self-harm
Aggressive behaviour with immediate threatening risk to vulnerable family members

Irritable Infant

Fluctuating or altered conscious level – weak cry, not waking appropriately for feeds, lethargy, maternal concern of failure of normal interaction
Suspicion of harm or any unexplained bruising, especially in infant <3 months
Significant escalation in frequency or volume of vomiting
New onset of blood mixed in stool
Fever
Increased respiratory effort
Weak or absent femoral pulses in infant <3 months
Presence of newly noted heart murmur in infant <3 month

Physical findings od concern in an effort <1 year

Inguinal hernia that cannot be reduced
Painless firm neck swelling that is increasing in size.
White pupil or white instead of red reflex on eye examination.
Previously unrecognised intersex genitals (ambiguous as either virilised female or incomplete formation male eg bilateral absent testes).
Possible Infantile Spasms. This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old.
Absent femoral pulses.
Infant <3 months with newly noted murmur and any of the following:
- poor feeding
- slow weight gain
- weak or absent femoral pulses
- post ductal (foot) oxygen saturation < 95%
- respiratory signs (wheeze, recession or tachypnoea)

Useful Management Information

The following criteria should be used for any child referred to Child Development Service (CDS) Gold Coast where the primary concern is around developmental and/or behaviour concern, where input from a Developmental Paediatrician only is required. The decision around which CDS clinical pathway a child will be allocated to is at the discretion of the CDS Intake and Waiting List co-ordinators and will be based on information provided by referrer and during intake consultation with family.
The CDS Developmental Paediatrician Only Clinic provides tertiary level assessment, diagnostic formulation and development of management plans for children that present with complex developmental and / or behaviour concerns. The aim of the clinic is to provide specialist opinion and discharge back to GP / external agencies for ongoing management. Only those children with complex developmental concerns that require longer term Developmental Paediatric management will remain within the service in a co-share arrangement with their GP.
The CDS Developmental Paediatrician Only Clinic offers services for all children requiring specialist opinion around assessment / management of children with underlying developmental or behaviour issues as the primary concern, this includes children that are linked into NDIS / ECEI
As a public service, CDS cannot guarantee the consistency of the clinician involved in the child’s care. Clinical services may also be provided by a Paediatric Registrar under the supervision of a Consultant.
If clinically applicable, the child may be initially assessed and managed by other clinicians, i.e., clinical nurse within child development or another appropriate allied health therapist.
The CDS Developmental Paediatrician Only Clinic is focused on providing assessment, diagnostic formulation and development of management plans, with the aim of transitioning longer-term care back to the GP or other external stakeholders.
Children demonstrating mild-moderate behavioural problems without evidence of associated developmental delay should be referred to external parenting / psychology services. Behavioural problems of this nature are best managed by family support services and behavioural specialists in the community.
If a child is presenting with both developmental difficulties and associated behavioural challenges, categorisation will be based on the concern that warrants highest prioritisation (i.e., will receive the earliest review).
Other useful information for referring practitioners:
- Key Developmental Red Flags
- Children not walking at 18 months
- Children who are non-verbal at 12 months (minimal to no cooing / babbling)
- Children who have less than 3 words at 18 months
- Child attending school who is more than 2 years behind their peers in academic achievement and requires further developmental assessment by Paediatrician
  - Children under 5 years can be concurrently referred to Community Child Health Nurses and family support service (EIPS)
  - CDS Developmental Paediatricians are available for phone / telehealth consultations with GPs to support the management of a child’s developmental care (i.e., offering guidance around medication adjustments or linking in with external services whilst waiting for an appointment). Call CDS on 5687 9183 or Direct Developmental Paediatrician on-call number.

Clinician and Patient Resources:

Raising Children Network - The Australian Parenting Website

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Child in out-of-home care, known to Child Safety Services, where there is imminent threat of breakdown of current foster placement due to the complexity of their developmental/behavioural concerns. These children will receive priority initial clinical contact, however full developmental assessment is likely to be deferred until a more clinically appropriate time.
Category 2 (appointment within 90 calendar days)	Evidence of severe developmental delay (either across domains or within a single developmental domain), or underlying severe learning disability Child where developmental screening is strongly suggestive of a significant developmental disorder Child with developmental delay and related medical co-morbidities (nature of medical co-morbidity will determine if the child is better seen within the acute paediatric service) Abnormalities in neurological examination Marked low tone / high tone Differences between right / left sides in strength movement or tone Acute severe deteriorating function in a child diagnosed with ASD, learning disability or other developmental diagnosis (formally diagnosed or presumed) Child demonstrating a recent change in behaviour or mood (internalising and externalising behaviours) with suspected underlying developmental disability as a possible cause Child at imminent risk of losing existing resources or not able to access appropriate external resources, i.e., ECEI / NDIS without diagnostic review Child known to ECEI / NDIS where additional developmental diagnostic formulation may give a more complete explanation/add to the understanding of their presentation Child at risk of expulsion, repeated suspensions, or is unable to attend childcare/ school due to behaviour or developmental concerns Child with developmental delay expected to be in out of home care supervised by Child Safety Services for more than 6 months A child in out of home care where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 3 (appointment within 365 calendar days)	Child with mild-moderate developmental delays / learning concerns that impact on their day to day function or participation Child with developmental concerns, linked into external services, requiring ongoing specialist Developmental Paediatrician opinion
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

If the child meets Category 2 criteria, they may be referred immediately to CDS, but should also be concurrently referred to the following services to start accessing developmental assessment(s)/therapy:
- Relevant private allied health provider(s) if appropriate/financially viable. For example:
- Speech Pathologist to assess speech/language delay via the Chronic Disease Management Plan
- Psychologist to assess cognition/learning difficulties via Mental Health Care Plan or Psychology Service Programme
- A referral to the NDIS under the ECEI (Early Childhood Early Intervention: 0-6 yrs) pathway.
- If childcare or school-related developmental delays/learning difficulties are the primary reason for the referral, then a letter from the education facility outlining the developmental/learning areas of concern is required.

Additional Referral Information

Desirable information – will assist at consultation
Pregnancy information (including maternal medications, alcohol and illicit drug intake during the pregnancy)

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Child Community Health MO Account: GQ4215000TL HL EDI: qldcomch

Internal Referrals

Child Development Services qhRefer

Fax

(07) 5687 4497

Post

Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 9141

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Francoise Butel

Medical Director Children's Community Health

Facilities

Gold Coast University Hospital

Southport Health Precinct

Palm Beach Community Health Centre

Helensvale Community Health Centre

Upper Coomera Child Health

Early Years Centre Coomera Springs

Norfolk Village State School Health & Education Hub

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Child Safety

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, contact Department of Children, Youth Justice and Multicultural Services . Please consider if mandatory reporting applies.

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