Hypotonic infant (Paediatric Neurology)
Paediatric

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Seizures/epilepsy

New onset seizures that require emergency care/advice
Status epilepticus (convulsive or non-convulsive)
Developmental/cognitive/psychiatric regression accompanying new onset or ongoing epileptic seizures
New onset seizure with new neurological deficit (e.g. focal weakness, speech impairment, cognitive impairment) – call 000 for emergency assessment for stroke and transport to the Emergency Department
Specific seizure types with epileptic encephalopathy risk e.g. infant with possible epileptic spasms
High initial seizure burden (>5 seizures, before first AED), excluding typical absence seizures
Neonate / infant (<12-month-old) with epileptic seizure onset

Headaches/migraine

Headache with papilledema or change in vision/double vision (excluding established migraine with visual aura) or new neurological examination findings (e.g. sixth nerve palsy, gait disturbance, focal weakness)
Headaches that wake at night or headaches immediately on wakening
New severe headaches
Sudden onset headache reaching maximum intensity within 5 minutes (= explosive onset)
Focal neurological features
Associated with significant persisting change of personality or cognitive ability or deterioration in school performance

Functional neurological symptoms

The patient is unable to mobilize safely or has frequent falls/seizure like attacks

Movement disorder

Abrupt onset or deterioration of a movement disorder
Acute onset of ataxia / chorea
Impairment of function i.e. walking, attend school

Hypotonic infant

Tachypnoea (signs of respiratory distress such as accessory muscle use are NOT seen in patients with neuromuscular disorders)
Feeding difficulties with weight loss

Gait abnormality, isolated motor delay or focal weakness

Acute onset of (or rapidly progressive) weakness e.g. Guillain Barre syndrome, transverse myelitis
Acute onset focal weakness (suspected stroke – call 000)
Breathing difficulties (NB tachypnoea may be the only sign of respiratory distress in a child with a neuromuscular condition)
Feeding or swallowing difficulties
Acute foot drop or acute onset focal neuropathy

Stroke

Acute stroke – call 000 and request urgent transfer (timelines apply for t-PA and thrombectomy for embolic/thrombotic stroke)

Other neurological conditions

Developmental/ intellectual impairment or behavioural / psychiatric disorders with regression
Acute encephalopathy, acute confusional state, altered level of consciousness

Useful Management Information

If guidance is required regarding appropriate investigations, contact Neurology on call services
In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
Referral from a health practitioner other than a General Paediatrician may be accepted if there is limited access to public Paediatric services in the patients’ local area
A change in patient circumstance (such as condition deteriorating) may affect the urgency categorisation and should be communicated as soon as possible.
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.

Clinician Resources

Statement of Intent
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
Child Muscle Weakness
Child Muscle Weakness: Video library

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	If signs and symptoms suggestive of spinal muscular atrophy, then direct referral to Neurology (and local General Paediatrician, if not already involved at time of consultation) for immediate diagnosis and initiation of treatment Profound head lag Proximal weakness, most marked in lower limbs, especially if less than antigravity Absent deep tendon reflexes Diaphragmatic breathing Tongue fasciculations (not always visible) Age <3 months Weakness less than antigravity movement Plateau or regression of motor skills Absent deep tendon reflexes History of ventilatory support in neonatal period or with illness
Category 2 (appointment within 90 calendar days)	Antigravity power in upper and lower limbs Ongoing gains in motor milestones Reduced or normal deep tendon reflexes Non progressive bulbar dysfunction without weight loss e.g. swallowing problems, poor feeding, sialorrhoea, Chronic non progressive ptosis or ophthalmoplegia
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

History related to hypotonia
Neurological examination findings, including tone, contractures, power, deep tendon reflexes, cranial nerve involvement, muscle wasting

Additional Referral Information

Antenatal history including foetal movementsBirth and developmental history
Family history, including consanguinity
CK, SNP microarray and store DNA (requested but results not required prior to initiation of referral)
Growth parameters
Medication history (including over-the-counter preparations)
Significant psychosocial risk factors
Neuroimaging only under advice from Neurology (as it is not necessary if a primary neuromuscular disorder is suspected AND anaesthesia risk maybe high with specific conditions). If neuroimaging has been done, arrange image transfer to PACS at the hospital the patient is being referred to, with the imaging reports. If electronic imaging transfer is not available, then a CD of the neuroimaging and report should be sent to the neurologist named in the referral.
Previous investigations – please include copies of results if performed external to Pathology Queensland
Allied Therapy reports
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.

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Neurology (E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Saman Heshmat

Medical Director Neurology

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Child Safety

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, contact Department of Children, Youth Justice and Multicultural Services . Please consider if mandatory reporting applies.

Hypotonic infant (Paediatric Neurology)Paediatric