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 malnutrition
  • temperature instability
  • postural heart rate changes

Please contact the paediatric 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

Southern Adelaide Local Health Network

Women's and Children's Health Network

Regional Health Networks 

Eyre and Far North Local Health Network

Flinders and Upper North Local Health Network

Limestone Coast Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • child has crossed two percentile curves
  • infants older than 12 months old with faltering growth
  • children older than 6 years of age and any concerning features:
    • flat or lethargic
    • vomiting
    • chronic diarrhoea
    • sudden or significant weight loss
    • hypoglycaemia/hyperglycaemia
    • suspected eating disorder
    • suspected mental illness in parents
    • parental concern

Category 2 (appointment clinically indicated within 90 days)

  • children > 6 years of age 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, provide any relevant features as relating triage categories
  • medications and allergies
  • dietary history
  • presenting symptoms including:
    • dates and frequency of symptoms
    • associated symptoms including dysphagia, eczema, asthma, prolonged illness/infection
    • previous management trialled/response
    • presence of concerning features
  • weight/height trends
  • body mass index (BMI) if child is ≥ 16 years
  • growth chart trends
  • blood pressure trends
  • full examination findings

Additional information to assist triage categorisation

  • psychosocial history including family support, siblings, stressors
  • dietitian summary/report
  • 3-day food chart
  • presenting symptoms including:
    • sensory and texture issues with food if any
    • food avoidance/restricted eating patterns if any
  • pathology:
    • complete blood examination (CBE)
    • urea, electrolytes, creatinine (UEC)
    • liver function tests (LFTs)
    • random blood glucose level 
    • iron (Fe) studies
    • thyroid function tests 
    • folate level
    • vitamin B12 level
    • c-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • coeliac serology
    • urinalysis
    • faecal calprotectin
    • faecal multiplex polymerase chain reaction (PCR)
    • stool microculture and sensitivities (M/C/S)
  • relevant diagnostic/imaging reports including location of company and accession number

Clinical management advice

Slow weight gain refers to a child or infant whose present weight or rate of weight increase falls noticeably below what is typically anticipated based on their age and gender, or if their weight has declined by two or more major percentile lines.

Slow weight gain can be indicative of insufficient growth for the child’s overall health and development and should prompt a thorough medical and psychosocial evaluation. In cases of slow weight gain, the child’s length and head circumference often remain relatively stable initially, but if inadequate nutrition persists severely or for an extended period, these measurements may also be affected. It’s important to note that slow weight gain doesn’t always have an underlying pathological cause.

Referrals to allied health clinicians, such as speech pathologists (for swallowing assessment) and dietitian’s (for consideration of additional caloric supplementation) are advised. Exclusion diets should only be initiated under the guidance and supervision of a qualified dietitian or paediatric specialist. It’s not recommended to remove gluten from the diet without proper professional oversight, as early cessation may cause a false negative reading in diagnosis confirmation.

Provide guidance on breastfeeding techniques and milk supply for breastfed babies and refer to a lactation consultant where possible.

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.