GP guide: Referral to TDHB developmental paediatrics

Problem is primarily:         Refer to:

• Behavioral                      Primary care provider ¹
• Developmental               Paediatrics

 Include in referral:

• details about presenting complaint
• developmental milestones and any other information about the developmental history
• neonatal history/pregnancy exposure to drugs or alcohol
• name of early childhood center or school
• any other information you know about this family (can state if you do not wish to have this disclosed to family at time of appointment)
• information from pre-school or school (school report or other information the parents bring from the school)

True developmental issues occur at home and (pre) school if of that age - please document both.

If referral is done to more than one service at the same time for the same issue, please state this in the referral letter

Ensure the parent / guardian is well aware of the exact reason of the referral and has consented to this. 

Mild/moderate behavioural concerns with no developmental issues - eg externalizing behaviour (hitting), preschool tantrums, emotional regulation:

• advise parents (children 3-8 years) to self refer to:
  • parenting programme such as Incredible Years - Ministry of Education 06 757 6400 incredibleyears.com
  • Triple P parenting programme.2
  • Family Works - 06 877 8193
  • Barnados - 06 753 3484
  • other primary care providers
• behaviour difficulties in context of developmental issues – referral to TDHB paediatrics
• severe behaviours in context of trauma or mental health issue – referral to CAMHS. 

Refer to paediatrics if:

• delay in two or more areas – language, communication, social skills, fine motor, gross motor, self care or behaviour.

See the Centres for Disease Control and Prevention website for milestones.

Refer to TDB paediatrics. 

• Refer Ministry of Education.
• Alternatively parents can self refer or request their early childhood provider refer to Ministry of Education: newplymouth@education.govt.nz.

Refer to TDHB paediatrics.

Eg Not able to sit unsupported by 9 months, not able to walk by 18 months.

See the Centres for Disease Control and Prevention website for milestones. 

Eg Dyslexia, learning difficulties in a specific area of learning.

• There is no role for the paediatrician in isolated (=not global) learning difficulties.
• We recommend school supports (RTLB/SENCO/RTLit) or learning assessment www.speld.org.nz

Refer to TDHB paediatrics if:

1. more than two years behind chronological age after more than one year of stable schooling AND
2. Resource Teacher of Learning and Behaviour (RTLB) involvement or equivalent has been initiated. Referral for Learning Support from Ministry of Education should be considered at the same time or prior to the paediatric referral. 

Refer to Paediatrics if:

1. delay in two or more areas – communication, social skills, thinking, fine motor, gross motor, daily living skills, self care or behaviour AND
2. the difficulties occur at home and school.

Refer to paediatrics.

A diagnosis of autism is based on concerns regarding:

1. social interaction, communication, peer relationships AND
2. a pattern of repetitive behaviours or rituals/routines or fixations or sensory difficulties.

• www.cdc.gov/ncbddd/autism/hcp-dsm.html
• www.kidshealth.org.nz/autism-spectrum-disorder-asd 

Diagnostic criteria:

1. 6/9 of the following: Difficulties with schoolwork, play, listening when spoken to, following instructions, organisation, reluctance for homework, losses things, distracted, forgetful AND/OR
2. 6/9 of the following: fidgets, leaves seat, climbs or runs, quiet activities, “on the go”, talks excessively, interrupts, can’t wait for turn, blurts out answers) 
3. the difficulties cause significant impairment, have been present for more than 6 months, and are not linked to a difficult phase.

Refer to paediatrics if:

1. child is 5 years old or above
2. above criteria are met AND
3. the difficulties occur at home and school AND
4. Resource Teacher of Learning and Behaviour (RTLB), or equivalent has been initiated. 

• www.cdc.gov/ncbddd/adhd/diagnosis.html
• www.kidshealth.org.nz/attention-deficit-hyperactivity-disorder-adhd
• www.rch.org.au/kidsinfo/fact_sheets/ADHD_ways_to_help_children_with_ADHD