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.
- 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?
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.
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
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.
A referral may be rejected without the following 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.
- 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
- 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.)
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
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