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.

  • nil

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

Inclusions

The following disorders are common and can generally be managed by reassurance from primary care providers, but can be referred to paediatric medicine if complex.

  • rapid eye movement (REM) parasomnias — nightmares, REM sleep behaviour disorder
  • non-REM parasomnias —  sleep terrors, confusional arousals, and sleepwalking
  • parasomnias occurring in either and/or both non-REM or REM sleep — sleep-related eating disorder, sleep-related enuresis, parasomnia disorders

Exclusions

Refer to Sleep Disordered Breathing (including Respiratory and Sleep Medicine - Sleep Apnoea, Sleep Difficulties) - Paediatric CPC

  • infant with observed prolonged apnoeas
  • recurrent snoring with associated symptoms such as apnoeas, restless sleep, mouth breathing, daytime tiredness or headaches, poor concentration requiring objective evaluation to confirm the evidence of obstructive sleep apnoea
  • recurrent snoring in children with risk factors for obstructive sleep apnoea — obesity, hypotonia, facial dysmorphology, specific syndromes like Trisomy 21

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • rapid eye movement (REM) parasomnias — nightmares, REM sleep behaviour disorder
  • non-REM parasomnias — sleep terrors, confusional arousals, and sleepwalking
  • parasomnias occurring in either and/or both non-REM or REM sleep — sleep-related eating disorder, sleep-related enuresis, parasomnia disorders

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
  • onset, duration, and progression of symptoms, including:
    • parental observations and description of sleep patterns
      • snoring
      • restlessness
      • snorting arousals or apnoeic episodes
      • disturbed sleep, night terrors
      • enuresis, bruxism
    • daytime symptoms
      • hypersomnolence
      • irritability
      • hyperactivity
      • poor school performance
  • management history including treatments trialled/implemented prior to referral
  • current medication list including non-prescription medication, herbs and supplements
  • examination:
    • body mass index (BMI) if child is aged ≥ 16 years
    • large tonsils
    • nasal obstruction
    • craniofacial abnormality
    • consider six-week trial of nasal steroids

Additional information to assist triage categorisation

  • relevant allied health, diagnostic, imaging reports including location of company and accession number
  • tonsillar hypertrophy grading scale

Clinical management advice

Childhood behavioural sleep problems manifest across age groups as various forms of difficulty initiating and/or maintaining sleep. These difficulties are often amenable to home-based behavioural interventions, which can be taught to parents and, de-pending on their developmental stage, the child or adolescent. Sustaining the intervention for sufficient sleep duration can be challenging for families.

Allied health practitioners play a central role in tailoring the explanation of management strategies to families and children or adolescents. Sleep diaries and education materials from evidence-based websites can assist the practitioner and family in achieving successful diagnosis and treatment.

Clinical resources

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.