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Referral Pathways to specialist services

Referral pathways depend on local availability of services:

  • Trauma cases will be referred to orthopaedics, day care units or emergency departments. Remember that trauma is common in young children; other pathology can be missed and if in doubt, refer. 
  • The child with suspected inflammatory disease should be referred urgently to paediatric rheumatology. Do not wait for the results of investigations as they may be normal anyway. 
  • The presence of red flags warrants urgent referral - likely to general paediatrics.
  • Concern about normal variants (e.g., knock-knees, flat feet), may warrant referral - likely paediatric orthopaedics. 
  • Unexplained pain, unresolving limp, systemic symptoms, or regression of motor milestones - all warrant referral - most commonly to general paediatrics or paediatric rheumatology. 
  • Delay in walking, gait abnormalities, or any suggestion of weakness – warrant blood test for creatine kinase (CK), followed by a referral – most commonly to general paediatrics or paediatric neurology. Do not delay a CK test if there are concerns; refer even if blood tests or imaging are normal.
  • 'Coca-cola-coloured’ urine may also suggest post streptococcal glomerulonephritis and urgent referral to general paediatrics or nephrology or rheumatology is warranted.
  • Blood tests can be done in the paediatric day unit - do not traumatise the child (or yourself !) if you are not experienced in taking blood from children. 
  • Do not hesitate to speak with a paediatrician on-call or a paediatric rheumatologist on-call if you are unsure of how urgently you should refer a patient or of the tests that need to be requested.

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