Behavioural problem in a child < 6 years

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Suicidal or immediate danger of self-harm
    • Aggressive behaviour with immediate threatening risk to vulnerable family members
    • Refer to local HealthPathways or local guidelines
    • 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
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient 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
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system

    Patient resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Child in out of home care, where there is imminent threat of breakdown of current foster placement due to behaviour
Category 2
(appointment within 90 calendar days)
  • Sudden change in behaviour with suspected medical or underlying co-existent neurodevelopmental or developmental diagnoses as a possible cause
  • Child with associated moderate-severe developmental concerns (either across domains or within a single developmental domain)
  • Child excluded from childcare or school due to behaviour
  • Child whose behaviour is putting self or others at high risk of significant harm (details must be provided)
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age)

    • where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 3
(appointment within 365 calendar days)
  • Children > 4 years with oppositional or hyperactive behaviours
  • Children > 4 with moderate behavioural concerns who have had prior parenting support where service provider is requesting paediatrician (health) review.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Nature of parent concerns
  • Families of children not yet attending school must have been seen by community child and family health nurse or an equivalent primary care service for parental support to manage behaviour and must have been referred to some form of targeted more intensive support (either a psychologist or individual positive parenting program counsellor) and determined as requiring a specialist paediatrician behaviour assessment.
  • 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 Child Safety, Seniors and Disability Services for more than 6 months?
    • If so, do you consider that the child's foster placement is at risk of breaking down due to the child's behaviour?
  • Confirmation of OOHC (where appropriate)

3. 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 Child Safety, Seniors and Disability Services 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

4. Request

  • Patient's Demographic Details

    • 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • 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

    Reason for request

    • 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 modifiers

    • 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

    Other relevant information

    • 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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 4 December 2024

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