• Referrals for Developmental delay in children <6 may be redirected or concurrently referred to local Child Development Service (CDS) depending on local HHS procedures. You may be requested to refer directly to CDS
• Developmental optometry and auditory processing assessments are not supported by evidence
• Delay across multiple developmental domains is more likely to be associated with significant impairment and require general paediatric review
• The chronological age versus the “developmental age” (which should be available through screening) can be used as a gauge of functional severity. Considering a 4 year old child:
  • MILD – 6 months delayed
  • MODERATE – 12 months delayed (i.e. a 4 year old who acts more like a three year old re abilities)
  • SEVERE – 18-24 months delayed (i.e. a 4 year old who has the abilities of a 2-21/2 year old child)
• Refer to allied health professional for an assessment and/or intervention and review within a pre-determined period of time (e.g. 3-6 months)
• Children with developmental delays should concurrently be referred to local Early Childhood Early Intervention – ECEI Partners (NDIS for children < 7 years) as may be eligible for ongoing allied health and other community supports through NDIS or other local services
• Refer for hearing/vision testing as part of differential diagnosis and co- morbidities
• Concerning features referral guide: CHQ Early Identification Guide – note that trigger points for referral development assessment are not indicators of severity. Red Flags Early Identification Guide
• Mild or unspecified developmental concerns, including isolated speech delay, should be initially referred to community child health nurse or to a community allied health provider rather than to general paediatric outpatients
• Refer for hearing/vision testing as part of differential diagnosis and co- morbidities.
• Parents’ evaluation of developmental status (PEDS) screening tool - is an evidence based screening tool that elicits and addresses parental concerns about children’s development, health and wellbeing. PEDS  is a simple, 10-item questionnaire that is completed by the parent.
  PEDS is available in the “red book” (hand held child health record) and can be used informally to ascertain concern across single domain or multiple domains. Child Health Nurses are able to formally administer this.
• In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
• Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

Clinical Resources

• Ages and stages questionnaires are available online and can be completed by practice nurse in conversation with parent or formally by Child Health Nurse. Ages and stages questionnaires  are not free but may be purchased on line.
• If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
• Statement of intent – the prioritisation of health services for children and young people in the child protection system

Patient Resources

• Parents' evaluation of developmental status (PEDS) screening tool - is an evidence based screening tool that elicits and addresses parental concerns about children's development, health and wellbeing. PEDS is a simple, 10-item questionnaire that is completed by the parent.
  PEDS is available in the “red book” (hand held child health record) and can be used informally to ascertain concern across single domain or multiple domains. Child Health Nurses are able to formally administer this.

• Provide sufficient information of screening of the developmental concern. Greater detailed information will allow more accurate categorisation. This may be any of the following:
  • a developmental screening tool
  • a community child health nurse or health worker developmental Assessment
  • an allied health Assessment
    
  • sufficiently detailed developmental milestone history
• Include specific developmental attainments by domains:
  • Motor,
  • Cognitive / Learning,
  • Self-Care,
  • Social-emotional,
  • Language / Speech

See CHQ Red Flag Early Identification Guide and report any developmental Red Flags child is not meeting

• Report presence or abscence of concerning features
  • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
  • Are there any associated abnormalities on neurological or physical examination?
  • Is the child expected to be in out of home care supervised by the Department of Children Safety, Seniors and Disability Services for more than 6 months?
  • Is there any risk of child's current placement breaking down?
  • Is the child unable to attend childcare / school, or at risk of expulsions or repeated suspensions to due behaviour or developmental concern
  • Is child engaging in physical aggression or other behaviours that place themselves or others at risk
  • Confirmation of Out Of Home Care (where appropriate)

NB: see information in 'useful management information'

Highly desirable Information – may change triage category

• Birth history
• Other past medical history
• School or Child Care Centre observations / reports
• Family history (parental consanguinity, history of neurological disorders, learning or developmental problems)
• Visual acuity and audiometry (developmental optometry and auditory processing assessments are not recommended – see other useful information)
• Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available
• If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager
• Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, involvement)
• Has the child been referred / are they accessing disability supports through Early Childhood Australia (ECA) /National Disability Insurance Scheme (NDIS)

Desirable information- will assist at consultation

• Immunisation history
• Developmental history
• Medication history
• Height/weight/head circumference and growth charts with prior measurements if available.
• Other physical examination findings inclusive of CNS, birth marks or dysmorphology
• Any relevant laboratory tests or medical imaging results