Upper Gastrointestinal Dysfunction - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Exclusions

• < 4 weeks of vomiting
  
• infantile reflux or colic — refer to Paediatric Medicine, see Neonatal or Infant Presentation - Paediatric Medicine CPC

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• recurrent dysphagia with previous food bolus obstruction and/or decrease of > 2 weight percentiles
  
• persistent or recurrent vomiting with small volume haematemesis

Category 2 (appointment clinically indicated within 90 days)

• aged > 2 years with reflux and recurrent or persistent dyspepsia despite 2-month trial of proton pump inhibitors
  
• failure to progress to solid foods, after speech pathology and/or dietetics review
  
• lack of progression to harder food textures due to swallowing difficulties, after speech pathology and/or dietetics review
  
• dysphagia without faltering growth and/or weight loss
  
• persistent or recurrent vomiting (≥ 4 weeks) without small volume haematemesis
  
• positive Helicobacter pylori (H. pylori) testing (stool antigen or urea breath test) in the presence of refractory upper gastrointestinal symptoms and associated with iron deficiency anaemia and/or family history of gastrointestinal cancer. H. pylori testing not indicated in the absence of above features.

Category 3 (appointment clinically indicated within 365 days)

• nausea with associated weight loss ≥ 2 weight percentiles with or without vomiting
  
• aged > 2 years with painless, effortless regurgitation

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

• details of presenting condition including:
  
  • onset and duration of symptoms
    
  • frequency and severity of symptoms
    
• medical management to date / treatment trialled and response, e.g. proton pump inhibitors, Helicobacter pylori (H. pylori) treatment
  
• clinical history including:
  
  • current weight and length or height, with percentiles
    
  • growth chart trends including at least two weight measurements, with percentiles
    
  • any weight loss, including amount and timeframe
    
  • medical history, medications, allergies, immunisations

Additional information to assist triage categorisation

• previous endoscopy or histopathology results, if available
  
• recent pathology reports
  
• H. pylori results, including urea breath tests
  
• relevant imaging reports, including date and location of imaging
  

Clinical management advice

Proton pump inhibitors are safe to use in children; if responsive to a trial for 6 to 8 weeks and able to be weaned off without a recurrence of symptoms, review by Gastroenterology is not required.

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient 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

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.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• 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 pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.