Development delay in children < 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.

Non-verbal child with acute distress and unable to examine adequately for medical conditions causing pain e.g. tooth abscess, bone infections or osteopaenic fractures
Suicidal or immediate danger of self-harm
Aggressive behaviour with immediate threatening risk to vulnerable family members

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

Definite history of developmental regression
Significant developmental delay in an infant less than 1 year
Suspicion of weakness in a child <1 year old
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 days is desirable

Child with evidence of severe delay in one or more developmental domains (see CHQ Red 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 days is desirable

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

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
Referrals for Developmental delay in children <6 may be redirected or concurrently referred to local Child Development Service (CDS) depending on local HHS procedures. You may be requested to refer directly to CDS
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
Developmental optometry and auditory processing assessments are not supported by evidence and are not recommended
Delay across multiple developmental domains is more likely to be associated with significant impairment and require 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)
Concerning features referral 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
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: Department of Children, Youth Justice and Multicultural Affairs
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.

Essential referral information

History and Examination

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 absence 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.
  NB: See information in “other useful information”
Confirmation of OOHC (where appropriate)

Additional referral information, Useful for processing the referral

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.
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
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)

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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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

Clinical Information (essential)

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