​Emergency

If acute onset vomiting and/or diarrhoea in the context of dehydration unable to be managed hydration at home and/or electrolyte disturbances is present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar.

When public outpatient services are not routinely provided

  • Anaemia or iron deficiency secondary to haematological, renal, dietary, physiological or gynaecological cause.
  • Intentional weight loss or body dysmorphia.
  • Isolated low serum ferritin without anaemia, nutritional or weight concerns.
  • Normochromic, normocytic anaemia with normal iron studies.
  • Weight loss in the neonatal period (referral should be made to paediatrician).

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • ≥ 5% unexplained weight loss in past 1 month or ≥ 10% unexplained weight loss in past 6 months with any of the following:
  • Severe, unexplained iron deficiency anaemia (Hb < 90).
Category 2
Recommended to be seen within 90 calendar days.
  • Child or infant whose current weight or rate of weight gain is significantly below that expected for age and sex, or if weight has decreased ≥ 2 major percentile lines despite paediatric dietetic intervention for nutrition support, (referral should be made from paediatrician.
  • Recurrent, unexplained iron deficiency with or without anaemia, despite appropriate trial of oral iron therapy. See Royal Children’s Hospital Melbourne guidelines on oral iron replacement.
  • Recurrent vitamin B12 deficiency.

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition including duration of symptoms.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • weight loss (amount and timeframe)
    • ‘Blue Book’, growth charts or any recent growth measurements
    • full blood count (FBC)
    • haematinics (iron studies, red blood cell count, folate, active vitamin B12 – holotranscobalamin), if suspicious of malabsorption, child has a restricted dietary intake, vegan or vegetarian diet
    • coeliac serology: tissue transglutaminase IgA (TTG IgA), total IgA (where possible) with or without anti-endomysial antibody (EMA), if infant is on solids or feeds contain gluten
    • faecal multiplex PCR
    • stool MCS, ova cysts parasites (OCP).

If available

  • Paediatrician report.
  • Urinalysis, microscopy and culture (especially infants < 12 months of age, as occult urinary tract infection can present with slow weight gain).
  • Electrolytes, urea and creatinine (EUC).
  • Thyroid stimulating hormone (TSH).
  • Liver function test results.
  • Random glucose.
  • Presence of fat globules and/or fatty acid crystals on stool microscopy.
  • Faecal elastase.
  • C-reactive protein (CRP).
  • Erythrocyte sedimentation rate (ESR).
  • Faecal calprotectin result (in children aged ≥ 4 years).
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ and/or among a vulnerable, disadvantaged or priority population.
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Sunday 12 May 2024
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