Referral pathways for children

Problem / Milestone

Test / Examination

Referral

Phenylketonuria (PKU)

Congenital Hypothyroidism

Blood spot at 5 days

Abnormal result direct to Endocrinology at RVI – GP informed

Congenital dislocation of the hip

Examination as neonate and 6 weeks

Breech delivery / talipes / spina bifida / family history

Screen fail or risk factors - direct to Orthopaedic Surgeon at Wansbeck Hospital

Undescended testes

Examination as neonate and 6 weeks

Screen fail referred direct to surgeon at RVI

Congenital heart disease

Auscultation and feel femoral pulses as neonate and 6 weeks

Newborn: if murmur but well and femorals present, review in 1 week.  If concern refer.

6 weeks: Refer direct Freeman

Cataracts

Red reflex as neonate and at 6 weeks

Urgent referral to Opthalmologist at RVI

Cleft palate

Check as neonate and at 6 weeks

Refer direct to cleft palate team at RVI

Deafness

Neonatal Hearing Screen

(If screen missed -distraction test at 8 months)

Referred directly to Freeman Hospital – GP informed

Sitting at 9 months

History and observation

If concern - refer to local Paediatrician

Squint

Check at 7 – 9 months

Refer direct to Opthalmologist at RVI - GP informed

Walking at 2 years

History and observation

If concern - refer to local Paediatrician

Language Development

Speech and language check at 2 years

Refer to local Paediatrician / Speech Therapist / autism pathway depending on circumstances

Height

Measure at 4 years

If below 0.4^th Centile refer to local Paediatrician