Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- severe/uncontrollable abdominal pain
- severe diarrhoea/vomiting with symptoms of dehydration
- acute abdominal distention
- bilious (green) vomiting
- inguinal/scrotal pain or swelling
- focal tenderness/guarding/peritonism
- overt rectal bleeding
- foreign substance/body ingestion
- ingested caustic and acid substances
- haemodynamic instability — symptomatic haemoglobin < 85g/L
- suspected appendicitis
- suspected intussusception
- suspected gastric outlet obstruction
Please contact the pediatric medicine on-call registrar (or relevant surgical or medical subspecialty) to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant specialty service.
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Regional Health Networks
Eyre and Far North Local Health Network
- Port Lincoln Hospital (08) 8682 5831
Flinders and Upper North Local Health Network
- Port Augusta Hospital (08) 8668 7500
Limestone Coast Local Health Network
- Mount Gambier District Hospital (08) 8721 1200
Category 1 (appointment clinically indicated within 30 days)
- recurrent/chronic abdominal pain with concerning features such as:
- bloody stools
- clubbing of fingers or toes
- dysphagia
- faltering growth / failure to thrive
- persistent fever
- joint pain
- mouth ulcers
- persistent vomiting
- skin rash
- unexplained anaemia – asymptomatic haemoglobin < 85g/L
- unintentional weight loss
- suspected malignancy — please contact paediatric medicine registrar on-call to discuss your concerns prior to referral
- significant impact on school, work, extracurricular activities (at least 50% non-attendanc)
Category 2 (appointment clinically indicated within 90 days)
- recurrent/chronic abdominal pain without concerning features
Category 3 (appointment clinically indicated within 365 days)
- nil
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.
- past medical history – please provide any relevant features as relating triage categories
- medications and allergies
- presenting symptoms including:
- dates and frequency of symptoms
- duration and severity of episodes
- treatment trialled and response
- current management regime including medications, and allied health input
- medical specialist involvement if previous medical consultation completed
Additional information to assist triage categorisation
- fructose/lactose breath hydrogen testing
- abdominal ultrasound
- blood pressure trends
- family history of autoimmune disease, inflammatory bowel disease, immunodeficiency syndromes
- menstrual history, if relevant
- sexual history, if relevant
- toileting history including stool chart
- abdominal examination findings
- height/weight
- body mass index (BMI) if child is aged ≥ 16 years of age
- growth chart trends
- pathology — referrer to consider if clinically relevant:
- complete blood examination (CBE)
- urea, electrolytes, creatinine (UEC)
- liver function tests (LFTs)
- c-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- iron (Fe) studies
- coeliac serology
- faecal calprotectin
- urinalysis
- faecal multiplex polymerase chain reaction (PCR)
- stool microculture and sensitivities (M/C/S)
- blood glucose levels (BGL)
- allied health reports and summaries
- relevant diagnostic and imaging reports including location of company and accession number
Clinical management advice
In many cases, more serious causes of abdominal pain can be reasonably excluded by a thorough history and examination, without the need for extensive investigation.
Clinical resources
- HealthPathways SA – Chronic recurrent abdominal pain in children, log in required
- RACGP – Chronic abdominal pain in children
- RACGP – Mind-body therapies use in chronic pain management
- RACGP – The role of food intolerance in functional gastrointestinal disorders in children
- Rome IV criteria for functional gastrointestinal disorders
- Royal Children’s Hospital Melbourne – Chronic abdominal pain
- Women’s & Children’s Hospital – Breath hydrogen test
Consumer resources
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 General Practitioners role 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 General Practitioner once the transfer of care has occurred.