Behavioural problem in a child < 6 years
Emergency department referrals
All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.
Contact through:
- Caboolture Hospital (07) 5433 8888
- Redcliffe Hospital (07) 3883 7777
- Royal Brisbane and Women's Hospital (07) 3646 8111
Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- Suicidal or immediate danger to self-harm
- Aggressive behaviour with immediate threatening risk to self or others
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- Child in out of home care supervised by the Department of Children, Youth Justice and Multicultural Affairs where there is imminent threat of breakdown of current foster placement due to behaviour.
Category 2
Appointment within 90 days is desirable
- Sudden change in behaviour with a suspected medical or underlying developmental co-morbidity as a possible cause
- Child with severe behavioural concerns, who has been seen by mental health / psychology service or parenting support programme where service provider is requesting paediatrician (health) review.
- Child with associated moderate-severe developmental concerns (either across domains or within a single developmental domain)
- Child unable to attend childcare / school due to severe behaviour and is already accessing support services i.e psychology or child health behavioural service
- Severe behaviour that puts child at risk of physical harm (or others) and is accessing support services i.e. psychology or child health behavioural service
Category 3
Appointment within 365 days is desirable
- Children > 5 years with oppositional or hyperactive behaviours
- Child with mild-moderate behavioural concerns, who has been seen by mental health / psychology or parenting support program where service provider is requesting paediatrician (health) review.
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- 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
Other important information for referring practitioners
Not an exhaustive list
- Refer to HealthPathways for assessment and management information if available
- Behavioural problems in children < 6 years of age are best managed by family support services and behaviour specialists rather than being referred to general paediatrics in the first instance. Children referred under 5 years of age may be redirected to Primary Care community child and family support services.
- Consider the potential impact of parental mental health on the child’s behaviour. If this is an issue, then referral for the parent to address their own wellbeing may be more appropriate in the first instance
- In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
- 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 (https://www.cyjma.qld.gov.au/)
- 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.
Referral requirements
A referral may be rejected without the following information.
History and Examination
- Description of the behaviours of concern
- Nature of parent concerns
- Families of children not yet attending school must have been seen by community child health nurse or an equivalent primary care service for parental support to manage behaviour and must have seen a behaviour specialist (either a psychologist or individual positive parenting program counsellor) and determined as requiring a specialist paediatrician behaviour assessment. The service or practitioner they have seen should be identified in the referral. The specialist assessing this referral may waive this requirement in circumstances where primary care services are inaccessible.
- If educational setting concerns are present, then a letter from the educational setting must be included in a GP referral. In the absence of a letter from the educational institution provided with the referral, the referral will be categorised Cat 3 unless they meet other non-educational criteria.
- Report presence or absence of concerning features
- 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?
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- If so, do you consider that the child’s foster placement is at risk of breaking down due to the child’s behaviour?
- Information on family violence / exposure to adverse childhood events (psycho-social trauma)
- Confirmation of OOHC (where appropriate)
Additional referral information (useful for processing the referral)
Highly desirable information — may change triage category
- GP impression of current developmental status (may be parental assessment) (= age appropriate, some delays, significant delays). PEDs and/or ages and stages screening.
- PEDS is available in the “red book”
- Guidance officer assessment or other information from the school.
- Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness.
- Audiometry
- Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available.
- Previous services accessed (other paediatricians, mental health services, developmental therapists, etc)
- Previous medications or therapies used.
- 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)
- School history –exclusions or suspensions.
Desirable information — will assist at consultation
- Pregnancy and birth history
- Other past medical history
- 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
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- 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
- 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
- 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
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- 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.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
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