Faltering growth (failure to thrive) 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.

  • Faltering growth (failure to thrive in children < 6 years)
    • dehydration
    • severe malnutrition or significant illness
    • Signs of abuse, neglect or poor attachment
    • temperature instability
    • cardiovascular instability – postural heart rate change
  • Short stature
    • possible CNS signs (visual disturbance, morning headaches)
  • Confirmation of OOHC (where appropriate)

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

  • Infants < 1 year with faltering growth
  • Significant weight loss/failure to gain in a child up to 6 years
  • 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 2

Appointment within 90 days is desirable

  • Most other referrals with faltering growth in children < 6 years

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

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
  • If breast-fed baby, offer advice about technique – lactation consultant or child health nurse (weekly until seen)
  • Prematurity needs to be corrected on growth charts
  • Severe acute malnutrition is defined by more than 10% recent acute weight loss or crossing two major centiles or visible severe wasting or nutritional odema: http://www.who.int/childgrowth/standards/en/
  • Royal Children’s Melbourne Growth charts and calculators: RCH Growth Charts
  • 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.

History and Examination

  • For infants less than 12 months must provide gestational age at birth (or weeks of prematurity)
  • Details of concern about growth
    • current height and weight *(at least two weights (one of which may be birth weight)), and include date of measurement
    • if under 2 years include head circumference and development
  • Confirmation of OOHC (where appropriate)

*It is important to note the trend, 1 week apart

Additional referral information (useful for processing the referral)

  • 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
  • Feeding history:
    • infants – breast or formula, volumes or effectiveness of feeding, parental vegan diet
    • older children – feeding refusal, restrictive food choices
  • Gestational age at birth and birth weight.
  • Bowel habit and any history of vomiting
  • GP impression of current developmental status (may be parental assessment) (= age appropriate, some delays, significant delays).
  • Family history (family history with short stature)
  • Social history
    • parental mental health problems
    • lack of financial resources for food requirement
    • lack of suitable housing
    • lack of family/community supports
    • refugee or recent immigrant background
    • failure to attend/engage hospital or community services appointments
    • previous history of child protection involvement

Desirable information — will assist at consultation

  • Other past medical history
  • Immunisation history
  • Medication history
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology

Investigations that may be considered with referral

  • Urinalysis
  • Consider B12 and Iron studies
  • Stool PCR or M/C/S for infections, calprotectin, elastase
  • FBC with differential, LFTs U&Es TFT
  • If gluten in diet: coeliac serology, total IgA

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

Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

Health pathways

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

For login details email:

Login to Brisbane North Health Pathways:

Back to top