Growth Failure (Diabetes and Endocrinology)
Paediatric

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Emergency Referrals

Useful Management Information

Correct for prematurity (<37 weeks) until 24 months of age
There are growth charts available for specific conditions including down syndrome, turner syndrome and williams syndrome and these should be used
The frequency of follow up depends on the child’s weight, age and psychosocial circumstances
- Younger infants need more frequent follow up
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
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.

Clinician Resources

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Possible CNS signs (visual disturbance, morning headaches etc) Hypoglycaemia Untreated hypothyroidism Cushing’s syndrome (not iatrogenic) Signs and symptoms suggestive of IBD, renal failure other serious intercurrent illness or significant medical problems Pubertal arrest
Category 2 (appointment within 90 calendar days)	Constitutional delay of growth and puberty Delayed puberty >12y females and 13y males Primary or secondary amenorrhoea Small for gestational age with no catch-up growth Abnormal coeliac serology Hypothyroidism started on treatment Syndrome associated short stature Documented channel crossing due to poor height velocity Iatrogenic Cushing’s syndrome Skeletal dysplasias Short stature with increased fracturing Short stature with relative obesity
Category 3 (appointment within 365 calendar days)	If there is parental concern Variants of normal growth including familial short stature
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

Current height and weight, including head circumference for children less than 2 years
Report presence or absence of concerning features
- Presence of chronic respiratory or bowel symptoms
- Recurrent infectious illness
- Juvenile arthritis (as this may be a marker of inflammatory disease e.g. inflammatory bowel disease)
- Unexplained sudden growth arrest in a previously well-growing child
- Visual field defects, eye movement disorders, morning headaches or other neurological signs

Additional Referral Information

Highly desirable Information – may change triage category

Height/weight/head circumference/percentile charts (measured serially and plotted to note trend, if available). It is recommended that WHO growth standards be used for children under 2 years of age and CDC growth charts for children over 2 years of age
Delayed pubertal development (no signs by 12 years in girls or 13 years in boys)
Early signs of pubertal development (signs prior to 8 years in girls and 9 years in boys)
Accurate parental heights obtained

Desirable Information - will assist at consultation

Other past medical history
Immunisation history
Developmental history
Medication history
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
Other physical examination findings inclusive of CNS, birth marks or dysmorphology

Investigations to consider if clinically indicated

FBC ESR/CRP results
Urea electrolytes and LFT results
Bone chemistry results (calcium, phosphate and alkaline phosphatase)
Coeliac serology (TTG & IgA) results
TSH & FT4 results–to exclude hypothyroidism (peripheral or central)
IGF1 results – to exclude GH deficiency
Karyotype results in girls - to exclude Turner syndrome. May also request CGH microarray however a karytoype should be requested if mosaic Turner syndrome is suspected. https://www.acmg.net/StaticContent/SGs/Laboratory_guideline_for_Turner_syndrome.8.pdf
Urinalysis– to exclude renal disease
Bone age XR of wrist
FSH/LH results - if concerns about puberty
Faecal calprotectin

Send Referrals To

Smart Referrals

Not Available

Secure Web Transfer

Not Available

Internal Referrals

Paediatric Endocrinology qhRefer

Fax

Internal Referrals only

Post

Not Available

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Diane Jensen

Medical Director Paediatric Endocrinology

Facilities

Gold Coast University Hospital

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.

Growth Failure (Diabetes and Endocrinology)Paediatric

Useful Management Information

Minimum Referral Criteria

Essential Referral Information

Additional Referral Information

Send Referrals To

Smart Referrals

Secure Web Transfer

Internal Referrals

Fax

Post

Enquiries

Related HealthPathways

Service Availability

Facilities

Child Safety

Growth Failure (Diabetes and Endocrinology)
Paediatric