Development delay in children < 6 years
Paediatric

Child Development Service

Useful Management Information

  • Developmental optometry and auditory processing assessments are not supported by evidence
  • Delay across multiple developmental domains is more likely to be associated with significant impairment and require general paediatric review
  • The chronological age versus the “developmental age” (which should be available through screening) can be used as a gauge of functional severity. Considering a 4 year old child:
    • MILD – 6 months delayed
    • MODERATE – 12 months delayed (i.e. a 4 year old who acts more like a three year old re abilities)
    • SEVERE – 18-24 months delayed (i.e. a 4 year old who has the abilities of a 2-21/2 year old child)
  • Refer to allied health professional for an assessment and/or intervention and review within a pre-determined period of time (e.g. 3-6 months)
  • Children with developmental delays should concurrently be referred to local Early Childhood Early Intervention – ECEI Partners (NDIS for children < 7 years) as may be eligible for ongoing allied health and other community supports through NDIS or other local services
  • Concerning features referral guide: Red Flags Early Identification Guide
  • Mild or unspecified developmental concerns, including isolated speech delay, should be initially referred to community child health nurse or to a community allied health provider rather than to general paediatric outpatients
  • Refer for hearing/vision testing as part of differential diagnosis and co- morbidities.
  • Parents’ evaluation of developmental status (PEDS) screening tool - is an evidence based screening tool that elicits and addresses parental concerns about children’s development, health and wellbeing. PEDS  is a simple, 10-item questionnaire that is completed by the parent.
    PEDS is available in the “red book” (hand held child health record) and can be used informally to ascertain concern across single domain or multiple domains. Child Health Nurses are able to formally administer this.
  • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
  • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

Clinical Resources

  • Ages and stages questionnaires are available online and can be completed by practice nurse in conversation with parent or formally by Child Health Nurse. Ages and stages questionnaires  are not free but may be purchased on line.
  • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
  • Statement of intent – the prioritisation of health services for children and young people in the child protection system

Patient Resources

  • Parents' evaluation of developmental status (PEDS) screening tool - is an evidence based screening tool that elicits and addresses parental concerns about children's development, health and wellbeing. PEDS is a simple, 10-item questionnaire that is completed by the parent.
    PEDS is available in the “red book” (hand held child health record) and can be used informally to ascertain concern across single domain or multiple domains. Child Health Nurses are able to formally administer this.

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?
Category 1 (appointment within 30 calendar days)
  • Definite history of developmental regression
  • Significant developmental delay in an infant less than 1 year
  • Children in out of home care supervised by the Department of Child Safety, Youth and Women (CSYW) where there is imminent threat of breakdown of current foster placement due to the complexity of the child's developmental concern
Category 2 (appointment within 90 calendar days)
  • Child with evidence of severe delay in one or more developmental domains (see CHQ Red flags Flags Early Identification Guide )
  • Developmental screening provides significant detailed history that is strongly suggestive of a significant or severe underlying developmental disorder
  • Developmental delay with related medical co morbidities
  • Abnormalities in neurological examination
    • Marked low tone or high tone
    • Muscle weakness / floppy child
    • Differences between right and left sides of body in strength, movement or tone
    • Microcephaly or increasing head circumference
  • Child at risk of losing existing resources i.e. ECEI / NDIS without paediatric diagnostic review.
  • Child unable to attend or is at risk of suspension / expulsion from childcare / school due to behaviour or developmental concerns
  • Child expected to be in out of home care supervised by the department of child safety for more than 6 months (only those with developmental delay)
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, 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 presenting with mild to moderate developmental delays that are impacting on their day to day functioning or participation
  • Child with developmental concerns, linked into external services, requiring ongoing specialist Paediatrician management

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

Essential Referral Information

  • Provide sufficient information of screening of the developmental concern. Greater detailed information will allow more accurate categorisation. This may be any of the following:
    • a developmental screening tool
    • a community child health nurse or health worker developmental Assessment
    • an allied health Assessment
    • sufficiently detailed developmental milestone history

See CHQ Red Flag Early Identification Guide and report any developmental Red Flags child is not meeting

  • Report presence or abscence of concerning features
    • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
    • Are there any associated abnormalities on neurological or physical examination?
    • Is the child expected to be in out of home care supervised by the Department of Children, Youth Justice and Multicultural Affairs for more than 6 months?
    • Is there any risk of child's current placement breaking down?
    • Is the child unable to attend childcare / school, or at risk of expulsions or repeated suspensions to due behaviour or developmental concern
    • Is child engaging in physical aggression or other behaviours that place themselves or others at risk
    • Confirmation of OOHC (where appropriate)

Additional Referral Information

Highly desirable Information – may change triage category

  • Birth history
  • Other past medical history
  • School or Child Care Centre observations / reports
  • Family history (parental consanguinity, history of neurological disorders, learning or developmental problems)
  • Visual acuity and audiometry (developmental optometry and auditory processing assessments are not recommended – see other useful information)
  • Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available
  • If the child is in foster care please provide the name and regional office for the Child Safety Officer who is the responsible case manager
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
  • Has the child been referred / are they accessing disability supports through ECEI / NDIS

Desirable information- will assist at consultation

  • Immunisation history
  • Developmental history
  • Medication history
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory tests or medical imaging results
Last updated 18 July 2024

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

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

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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