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General Paediatrics

General paediatric services in the Metro South region are delivered by both Metro South Health and Children's Health Queensland. Please type your patient's suburb or postcode below to find their health service catchment:

Emergency Immediate transfer to the Emergency Department

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.

It is proposed that the following conditions should be sent directly to emergency. This is not a list of all conditions that should be sent to the emergency department, it is intended as guidance for presentations that may otherwise have been directed to general paediatric outpatients:

Brain & Nervous System

  • Headaches
    • that wake at night or headaches immediately on wakening
    • new and severe headaches
    • associated with significant persisting change of personality or cognitive ability or deterioration in school performance
    • recent head injury or head trauma
    • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
    • sudden onset headache reaching maximum intensity within 5 minutes  ( = explosive onset)
    • presence of an intracranial CSF shunt
    • hypertension above 95th centile by age for systolic or diastolic
  • Seizures
    • all children with new onset of clinically obvious epileptic seizures should be referred to emergency for initial assessment, observation and consideration of emergency investigation or management.
    • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
    • significant change in seizures for established epilepsy:
      • new onset of focal seizures or
      • a dramatic change in seizure frequency or duration
  • Faints syncope and funny turns
    • loss of consciousness in association with palpitations
    • sudden loss of consciousness during exercise
    • possible infantile spasms. this may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old

 Respiratory

  • Asthma, stridor and wheeze
    • infants who have apnoea or cyanosis during paroxysms of coughing
    • children with recurrent or persistent respiratory symptoms who have had an episode of choking
    • suggestive a possible inhaled foreign body
    • recent onset or escalating stridor and respiratory distress
    • acute respiratory distress not responding to home management
    • acute respiratory symptoms causing inability to feed or sleep in an infant
  • Persistent and chronic cough
    • infants who have apnoea or cyanosis during paroxysms of coughing
    • children with recurrent or persistent respiratory symptoms who have had an episode of choking suggestive a possible inhaled foreign body
    • prominent dyspnoea, especially at rest or at night
    • cough causing inability to feed or sleep in an infant

Gastroenterology

  • Chronic & Recurrent Abdominal Pain
    • severe pain not able to be managed at home with simple analgesia
    • significant change in location or intensity of chronic abdominal pain suggestive of a new pathology
    • pain associated with vomiting where this has not occurred before
    • bile stained vomiting
  • Chronic Diarrhoea and/or Vomiting
    • vomiting or diarrhoea with weight loss in an infant <1 year
    • suspected pyloric stenosis
    • bile stained vomiting
    • acute onset abdominal distention
    • weight loss with cardiovascular instability, e.g. postural heart rate changes
    • new onset of blood in diarrhoea or vomitus
  • Constipation with or without soiling
    • severe abdominal pain or vomiting with pain

Urinary

  • Urinary Incontinence and enuresis.
    • recent onset of polyuria/polydipsia that might suggest diabetes (mellitus or insipidus)
  • Recurrent Urinary Tract Infections (UTI)
    • acute infant  urinary tract infection presenting septicaemia or acutely unwell

Musculoskeletal

  • Acute joint pain with fever
  • Acute joint pain unable to weight bear.   

Cardiac

  • Infant <3 months with newly noted murmur and any of the following:
    • poor feeding
    • slow weight gain
    • weak or absent femoral pulses
    • post ductal (foot) oxygen saturation < 95%
    • respiratory signs (wheeze, recession or tachypnoea)

Allergies

  • Anaphylaxis
  • Allergic reaction where there are any respiratory or cardiovascular symptoms or signs
  • Reaction to peanut or other nut should be referred to Emergency as these reactions can progress rapidly and should be observed and assessed in Emergency
  • Exposure to a known allergen with a previously identified potential for anaphylaxis in this patient even if the reaction appears currently mild
  • Severe angioedema of face

Growth concerns

  • Faltering growth (failure to thrive in children < 6 years
    • severe malnutrition
    • temperature instability
    • cardiovascular instability – postural heart rate change
  • Short stature
    • possible CNS signs (visual disturbance, morning headaches)

Developmental concerns

  • Non verbal child with acute distress and unable to examine adequately for medical conditions causing pain  eg tooth abscess, bone infections or osteopaenic fractures

 Behavioural concerns

  • Suicidal or immediate danger of self-harm
  • Aggressive behaviour with immediate threatening risk to vulnerable family members

Irritable Infant

  • Fluctuating or altered conscious level – weak cry, not waking appropriately for feeds, lethargy, maternal concern of failure of normal interaction
  • Suspicion of harm or any unexplained bruising, especially in infant <3 months
  • Significant escalation in frequency or volume of vomiting
  • New onset of blood mixed in stool
  • Fever
  • Increased respiratory effort
  • Weak or absent femoral pulses in infant <3 months
  • Presence of newly noted heart murmur in infant <3 months

Physical findings of concern in an infant <1 year

  • Inguinal hernia that cannot be reduced.
  • Painless firm neck swelling that is increasing in size.
  • White pupil or white instead of red reflex on eye examination.
  • Previously unrecognised intersex genitals (ambiguous as either virilised female or incomplete formation male eg bilateral absent testes).
  • Possible Infantile Spasms. This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old. 
  • Absent femoral pulses.
  • Infant <3 months with newly noted murmur and any of the following:
    • poor feeding
    • slow weight gain
    • weak or absent femoral pulses
    • post ductal (foot) oxygen saturation < 95%
    • respiratory signs (wheeze, recession or tachypnoea)

Diabetes

  • New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
  • Ketoacidosis in a known diabetic with any of the following:
    • systemic symptoms (fever, lethargy)
    • vomiting
    • inability to eat (even if not vomiting)
    • abdominal pain
    • headache

Are you referring to the right service?

  • General paediatric services in the Metro South region are delivered by both Metro South Health and Children's Health Queensland. Please use the suburb finder to find your patient's catchment hospital.
  • Crying (colicky) well babies, with no identified medical condition e.g. Gastro Oesophageal Reflux, (GOR), vomiting, jelly stools, lethargy, diarrhoea, fever) who are under 6 months to attend Child Health Services / Day Centre
  • Logan Hospital: General paediatrics up to 16 years of age. Referrals for Paediatric Surgery should be directed to the Department of Surgery. Referrals for Paediatric ENT should be directed to the Department of ENT.
  • Redland Hospital: General Paediatric, up to 16 years old. No paediatric surgical or ENT services.
  • Beaudesert Hospital: General Paediatric, up to 16 years old. No paediatric surgical or ENT services.

Urgent referrals Arranging urgent review

To arrange an urgent review, please phone the Paediatric Registrar at Logan Hospital directly on 07 3299 8087, or the relevant hospital’s switchboard and ask to speak to the Paediatric Registrar.

Conditions

Paediatric

Out of scope services

The following are not routinely provided in a public General Paediatrics service.

  • Educational assessment of school age children
  • Services that should be initially provided by primary care or community based allied health care for children, including well infant care and advice, parenting and behaviour management for young children, developmental services for children with mild developmental delay
  • Health screening assessments including on entry to foster care

Notes

  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • 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.
Last updated 5 March 2019