Paediatrics

Emergency referrals

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.

It is proposed that the following conditions should be sent directly to emergency. This is not a list of all conditions that should be sent to the emergency department, it is intended as guidance for presentations that may otherwise have been directed to general paediatric outpatients:

  • Headaches
    • that wake at night or headaches immediately on wakening
    • new and severe headaches
    • associated with significant persisting change of personality or cognitive ability or deterioration in school performance
    • recent head injury or head trauma
    • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
    • sudden onset headache reaching maximum intensity within 5 minutes  ( = explosive onset)
    • presence of an intracranial csf shunt
    • hypertension above 95th centile by age for systolic or diastolic
  • Seizures
    • all children with new onset of clinically obvious epileptic seizures should be referred to emergency for initial assessment, observation and consideration of emergency investigation or management.
    • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
    • significant change in seizures for established epilepsy:
      • new onset of focal seizures or
      • a dramatic change in seizure frequency or duration
  • Faints syncope and funny turns
    • loss of consciousness in association with palpitations
    • sudden loss of consciousness during exercise
    • 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

  • Asthma, stridor and wheeze
    • infants who have apnoea or cyanosis during paroxysms of coughing
    • children with recurrent or persistent respiratory symptoms who have had an episode of choking
    • suggestive of a possible inhaled foreign body
    • recent onset or escalating stridor and respiratory distress
    • acute respiratory distress not responding to home management
    • acute respiratory symptoms causing inability to feed or sleep in an infant
  • Persistent and chronic cough
    • infants who have apnoea or cyanosis during paroxysms of coughing
    • children with recurrent or persistent respiratory symptoms who have had an episode of choking suggestive of a possible inhaled foreign body
    • prominent dyspnoea, especially at rest or at night
    • cough causing inability to feed or sleep in an infant

  • Jaundice
    • Jaundice in infants with elevated liver transaminases or conjugated (direct) bilirubin > 20 microMol per litre or >15% of total bilirubin.
    • Jaundice in ≥38 week infant ≥ 330 UMol/L
    • Jaundice in 35-37 week infant ≥ 280 UMol/L
    • Jaundice in <35 week infant ≥ 230 UMol/L
  • Chronic and Recurrent Abdominal Pain
    • severe pain not able to managed at home with simple analgesia
    • significant change in location or intensity of chronic abdominal pain suggestive of a new pathology
    • pain associated with vomiting where this has not occurred before
    • bile stained vomiting
  • Chronic Diarrhoea and/or Vomiting
    • vomiting or diarrhoea with weight loss in an infant <1 year
    • suspected pyloric stenosis
    • bile stained vomiting
    • acute onset abdominal distention
    • weight loss with cardiovascular instability, e.g. postural heart rate changes
    • new onset of blood in diarrhoea or vomitus
  • Constipation with or without soiling
    • severe abdominal pain or vomiting with pain

  • Urinary Incontinence and enuresis.
    • recent onset of polyuria/polydipsia that might suggest diabetes (mellitus or insipidus)
  • Recurrent Urinary Tract Infections (UTI)
    • acute infant  urinary tract infection presenting septicaemia or acutely unwell

  • Acute joint pain with fever
  • Acute joint pain unable to weight bear.

  • 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)

  • Anaphylaxis
  • Allergic reaction where there are any respiratory or cardiovascular symptoms or signs
  • Reaction to peanut or other nut should be referred to Emergency as these reactions can progress rapidly and should be observed and assessed in Emergency
  • Exposure to a known allergen with a previously identified potential for anaphylaxis in this patient even if the reaction appears currently mild
  • Severe angioedema of face

  • 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)

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

  • 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 months

  • 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)

  • New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
  • Ketoacidosis in a known diabetic with any of the following:
    • systemic symptoms (fever, lethargy)
    • vomiting
    • inability to eat (even if not vomiting)
    • abdominal pain
    • headache

Out of scope services

The following are not routinely provided in a public General Paediatrics service:

  • Educational assessment of school age children
  • Services that should be initially provided by primary care or community based allied health care for children, including well infant care and advice, parenting and behaviour management for young children, developmental services for children with mild developmental delay
  • Health screening assessments including on entry to foster care

Specialists list

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

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