Physical finding of concern in an infant <1 year

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.

    • Inguinal hernia that cannot be reduced.
    • Painless firm neck swelling that is increasing in size.
    • White pupil or white instead of red reflex on eye examination.
    • Previously unrecognised intersex genitals (ambiguous as either virilised female or incomplete formation male e.g. bilateral absent testes).
    • Possible Infantile Spasms. This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old.
    • Absent femoral pulses.
    • Infant <3 months with newly noted murmur and any of the following:
      • poor feeding
      • slow weight gain
      • weak or absent femoral pulses
      • post ductal (foot) oxygen saturation < 95%
      • respiratory signs (wheeze, recession or tachypnoea)
    • Refer to local HealthPathways or local guidelines
    • Umbilical Hernia does not require referral unless child is > 3 years
    • Most general paediatricians will not perform frenulotomies for tongue tie in infants. Check with your local hospital general paediatric service. Usually, infants with tongue tie will need to be referred to paediatric surgery.
    • Scrotal swellings and herniae should be referred to paediatric surgery.
    • Possible developmental dysplasia of the Hip (DDH) should be referred to Orthopaedics.
    • In some health services children with plagiocephaly may be directed to Child Health or allied health services
    • 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
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Skin haemangioma of concern on head or neck or large haemangioma in any location
  • Small or large head or rapidly growing head circumference in infant < 6 months
  • Significant or rapidly progressing plagiocephaly or other cranial asymmetry
  • Neck mass or lump
  • Eye abnormality (colobomas, abnormal fixation or pupil appearance)
  • Any abdominal organomegaly
  • Growth asymmetry (hemihypertrophy or limb inequality)
  • Most physical findings of concern in an infant < 1 year that are not likely to be cosmetic significance only
  • 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 2
(appointment within 90 calendar days)
  • Finding likely to be of cosmetic significance only
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

  • Describe the physical finding of concern
  • Age when the finding was first noted by any observer
  • If concern about head size is the reason for referral, then head circumference, weight and height should be provided.
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • Detailed description of physical finding.
  • Change in the finding over time (e.g. serial head circumferences)
  • Family history of related problems
  • Presence of any congenital abnormalities or birthmarks

Desirable information- will assist at consultation

  • Other past medical history
  • Birth and pregnancy history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Child Safety, Seniors and Disability Services involvement)
  • 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 results or medical imaging reports

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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