Community Paediatrics (Community Child Health) Referral Criteria (Out Patients only)
Community paediatricians are developmental paediatricians seeing children and young people in Out Patients. They do not manage medical difficulties where there are no developmental concerns (e.g. Faltering growth, reflux and simple epilepsy). Medical conditions should always be referred direct to the general paediatricians.
Physical Disabilities – from birth, evolving or secondary to illness /injury
Children at high risk of developmental problems (premature births/ acquired brain injury)
Children with delayed milestones (speech, motor, social communication, play) who are not yet at school
Diagnosis of Developmental co-ordination disorder (dyspraxia) where the child or young person has already had a Movement ABC suggestive of diagnosis (under 5thcentile)
Established / significant hearing or visual deficits to consider cause and support
Social Communication Difficulties (possible autism) in younger children. Direct requests for Autism assessment can be directed to the Early Help Hub for consideration by ASDAT but may then be directed to our team in the first instance if child is under 5 years and 6 months and unknown to other services.
Concerns about attention and hyperactivity (Before 5th birthday)
Developmental and Learning assessment in pre-school children
In patients with known learning difficulties for investigation of a possible underlying cause. E.g. a genetic problem.
For assessment of ADHD or hyperactivity in children after 5th birthday please refer to CAMHS via the Early Help Hub
For assessment of ASD/Asperger’s syndrome please refer to the Early Help Hub (ASDAT)
Behavioural difficulties are not assessed or managed by community paediatricians. Families should be signposted to the Family Information Services Website or Early Help Hub to look at options for support.
We do not offer assessment or support for anger management, anxiety, feeding difficulties or eating disorders.
For behavioural support to learning disabled children please refer to learning disability team in CAMHS (Early Help Hub)
Tic disorders are assessed by the CAMHS team (Early Help Hub)
A Counselling service is not provided by our service. We do not have access to psychology services.
We are not able to accept referrals for sleep difficulties in children who are not already under the care of the community paediatricians. We do not offer a melatonin prescribing or monitoring service on children not under our existing care.
Concerns about hearing or vision should be referred to the audiologists or orthoptic teams
Children with speech and language delay should be referred to audiology and speech and language therapy who will refer on if there is a more complex need.
Community Paediatrics do not undertake learning needs assessment on school age children (this is the role of education and educational psychologists)
Dyslexia assessments should be done through the education services
Continence service (enuresis / encopresis / constipation) – refer to school nurses in the first instance.
We do not assess or manage sensory processing difficulties. Referrers could consider referral to Occupational Therapists but would need to ensure their referral criteria are met.
Medical conditions should be referred to general paediatricians. We do not offer a chronic fatigue syndrome / myalgic encephalitis service but will support the lead clinician around education access when needed
From 3rd January 2019 Royal Cornwall Hospitals NHS Trust will be offering an advice and guidance service on e-Referrals for Development or Disability (Community Paediatrics) queries.
GPs will be able to request consultant advice on Development or Disability queries for potential referrals into secondary care. The service is to offer advice on management and treatment options for GPs to consider prior to referral with the aim of reducing the number of patients who need to be seen face to face (as set out in the GP Forward view). The CCG will be charged for the advice and guidance provided. Requests will be responded to within 2 working days.
Clinical responsibility remains with the GP until the patient is seen within secondary care.
The service is for Development or Disability requests and not for specialised or general paediatric queries.
Advice will be given on:
- Physical Disabilities – from birth, evolving or secondary to illness /injury
- Children at high risk of developmental problems (premature births/ acquired brain injury)
- Children with delayed milestones (speech, motor, social communication, play) who are not yet at school
- Established/significant hearing or visual deficits to consider cause and support
- Social Communication Difficulties (possible autism) in younger children (pre-school)
- Concerns about attention and hyperactivity (before 5th birthday)
- Developmental and Learning Assessment in pre-school children
- Children or Young people with known learning difficulties to discuss investigation of a possible underlying cause. E.g. a genetic problem.
Exclusions to this service include:
- Queries for general paediatrics
- Urgent queries.
- Patients who are already under the care of the RCHT Community Paediatrics team.
- Suspected cancer referrals – these should be directed to the 2WR suspected cancer office.
- ADHD, possible ADHD or hyperactivity in children after 5th birthday –please refer to the Early Help Hub
- Advice on ASD assessment in older children – Please refer to the Early Help Hub
- Advice on challenging behaviour in Children or Young People with known ASD/ADHD or other neurodevelopmental diagnosis including Learning Difficulty – please refer to the Early Help Hub
- Advice on anger management, anxiety, feeding difficulties or eating disorders – please refer to the Early Help Hub
- Advice on Tic disorders – please refer to the Early Help Hub
- Advice on Counselling or Psychology
- Sleep advice / sleep medication advice for children not under our existing care
- Advice on medical conditions including Chronic Fatigue / ME / fibromyalgia / hypermobility syndromes
The advice will be available for patients new to the Development or Disability service and who are not already under the care of a Community Paediatric consultant. This is not a named clinician referral therefore if your query is regarding a patient currently under the care of a consultant please contact them directly.