Development delay in children < 6 years
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:
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
Category 2
Appointment within 90 days is desirable
- Severe developmental delays
- Developmental delay with related medical co morbidities
- Child not walking at 18 months
- Marked low tone or high tone
- Differences between right and left sides of body in strength, movement or tone
- 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)
Category 3
Appointment within 365 days is desirable
- Moderate developmental delay/ multiple domain concerns
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 local care pathway
- Developmental optometry and auditory processing assessments are not supported by evidence
- Delay across multiple developmental domains is more likely to be associated with significant impairment and require general 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)
- Red flag referral guide link: https://www.childrens.health.qld.gov.au/chq/our-services/community-health-services/child-development-program/
- 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. http://www.pedstest.com/default.aspx
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. http://www.rch.org.au/ccch/resources_and_publications/Monitoring_Child_Development/ - 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. http://agesandstages.com/products-services/asq3/ - 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.communities.qld.gov.au/
Referral requirements
A referral may be rejected without the following information.
- General referral information
- Provide sufficient information of screening of the developmental concern. 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
NB: See information in “other useful information”
- Report presence or absence of red flags
Presence or absence of red flags
- Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
- Is the child expected to be in out of home care supervised by the department of child safety for more than 6 months?
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
- 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
- Significant psychosocial risk factors (esp parents mental health, family violence, housing and financial stress, department of child safety involvement)
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
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
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
Login to Brisbane North Health Pathways:
brisbanenorth.