Faltering growth (failure to thrive) 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.

    • Dehydration
    • Severe malnutrition or significant illness
    • Signs of abuse, neglect, or poor attachment
    • Temperature instability
    • Cardiovascular instability – postural heart rate change
    • Refer to local HealthPathways or local guidelines
    • 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
    • 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
    • Allergy action plans and patient information is available at (Australian Society for Clinical Immunology and Allergy)

    Clinician resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Infants < 1 year with faltering growth
  • Significant weight loss /failure to gain in a child up to 6 years
  • 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 2
(appointment within 90 calendar days)
  • Most other referrals with faltering growth in children < 6 years
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

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

  • 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, development
  • Confirmation of OOHC (where appropriate)

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

3. Additional referral information Useful for processing the referral

Highly Desirable Information – may change triage category.

  • 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
    • 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 & 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

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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