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.
- aggressive behaviour with immediate threatening risk to vulnerable family members suicidal or immediate danger of self-harm
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
- 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
Inclusions
- ongoing management of a child with complex presentation:
- autism spectrum disorder (ASD)
- fetal alcohol spectrum disorder (FASD)
- attention deficit hyperactive disorder (ADHD)
- global developmental delay
Exclusions
- assessment for suspected autism spectrum disorder (ASD)/fetal Alcohol spectrum disorder (FASD) 'Diagnostic assessment for Developmental Concerns (Developmental Assessment Services) Paediatric CPC'
- auditory processing disorder, refer to audiology +/- occupational therapy
- oppositional defiance disorder, refer to child and adolescent mental health services (CAMHS)
- primary mental health presentations
- aggressive behaviour with high risk of significant injury to vulnerable family members/children who may be at risk of self-harm, refer to CAMHS
- specific learning difficulties including dyslexia/reading
- stuttering without associated speech and language disorder
- severe behavioural concerns without possible medical concerns, unable to attend childcare/school, refer to CAMHS
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- child aged < 6 years with any of the following
- new onset or unstable physiological concerns such as
- abnormal neurological features
- seizures
- developmental regression
- new onset or unstable physiological concerns such as
Category 2 (appointment clinically indicated within 90 days)
- child aged < 6 years with any of the following:
- physiological concerns
- premature birth (< 32 weeks gestation)
- significant unmanaged co-morbidities which could affect behaviour
- psychosocial concerns
- acute behaviour changes in known developmental disorder
- investigated by child protective services/under the custody or guardianship of the Chief Executive
- physiological concerns
Category 3 (appointment clinically indicated within 365 days)
- ongoing management of a child with complex presentation:
- autism spectrum disorder (ASD)
- fetal alcohol spectrum disorder (FASD)
- global developmental delay
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
- previous management trialled and outcomes
- height/weight
- physical examination findings
- neurological examination findings
Concerning features including
- developmental regression
- significant physical illness
- unintentional weight loss
- seizure or neurological features
- functional impairment including feeding, toileting or sleep issues
- behaviours of concern including:
- features of autism spectrum disorder (ASD)
- features of attention deficit hyperactive disorder (ADHD)
- potential for aggression
Additional information to assist triage categorisation
- family history, including family members affected with ASD, ADHD, learning difficulties or mental illness
- psychosocial factors including parental relationship issues, mental illness, substance abuse, parental disability, family in crisis, or child protection involvement
- body mass index (BMI) if child is aged ≥ 16 years
- growth chart trends
- visual acuity examination within last 6 months – can be performed by GP or local optometrist where available
- audiometry examination findings
- investigations if appropriate
- genetic test screening
- speech assessment
- occupational assessment
- physiotherapy assessment
- psychology assessment
- relevant allied health, diagnostic, imaging reports including location of company and accession number
Clinical management advice
Behavioural disorders in children encompass a range of conditions characterised by persistent patterns of disruptive or problematic behaviours. Recognising and understanding symptoms is crucial for commencement of early intervention approaches with parents, educators, and mental health professionals to improve outcomes for children and their families.
The National Disability Insurance Scheme early childhood approach can facilitate and expedite community allied health involvement in children with suspected developmental disorders that are likely to require longer term input. Patients can self-refer or be referred by clinicians.
Clinical resources
- Emerging Minds
- HealthPathways SA – Faltering Growth, log in required
- Parenting SA – Milestones: Children 0 to 4 years – Parent Easy Guide, log in required
- Royal Australian College of General Practitioners – Problem behaviour in children (an approach for general practice)
- Autism CRC - National Guideline for supporting the learning, participation, and wellbeing of autistic children and their families in Australia
- Therapeutic Guidelines – Assessing developmental delay and disability
Consumer resources
- ADHD Foundation Australia - ADHD and the facts
- Emerging Minds
- FASD HUB Australia – For People with FASD, Parents and Carers
- Global Developmental Delay – Understanding Global Developmental Delay
- Language Disorder Australia - Developmental Language Disorder
- Parental SA – Children with disability - Parent Easy Guide
- Parental SA – Developmental delay - Parent Easy Guide
- Raising Children Network - Suitable for 5-18 years Conduct disorder: children and teenagers
- Raising Children Network – Suitable for 3-5 years Preschoolers: development
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.