Development delay in children < 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.

    • 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
    • Refer to local HealthPathways or local guidelines
    • 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.
    • Refer for hearing/vision testing as part of differential diagnosis and co- morbidities
    • 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: CHQ Early Identification Guide – note that trigger points for referral development assessment are not indicators of severity.
    • 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
    • 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

    Clinician resources

    • 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 online.
    • PEDS is available in the “red book” (handheld 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.

    Patient resources

    • 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.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Definite history of developmental regression
  • Significant developmental delay in an infant less than 1 year
  • Children in out of home care supervised by the Department of Child Safety, Seniors and Disability Services 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 calendar days)
  • Child with evidence of severe delay in one or more developmental domains
  • Developmental screening provides significant detailed history that is strongly suggestive of a significant or severe underlying developmental disorder.
  • 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 excluded from childcare or school due to developmental concern
  • 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), or

    • 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)
  • 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

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

  • 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
  • Include specific developmental attainments by domains:
    • Motor,
    • Cognitive / Learning,
    • Self-Care,
    • Social-emotional,
    • Language / Speech

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.
    • Confirmation of OOHC (where appropriate)

NB: See information in “other useful information”

3. 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.
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress involvement)
  • Has the child been referred / are they accessing disability supports through Early Childhood Australia (ECA) / National Disability Insurance Scheme (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

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: 24 January 2025

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