This website uses cookies to give you the best experience. By continuing to use this website you are consenting to cookies being used. You can delete and block cookies from within your browsers settings. For more information please refer to our privacy and cookie policy page.


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.

Site Statistics

To date (end of August 2021) PMM has >910,640 hits and >376,455 users from 221 countries!

Why register?

Some parts of PMM which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

find out more

Short online courses

from Newcastle University, UK

e-resources from PMM

pmm for you

Please help us ensure pmm is as useful to you as possible by completing this short survey

complete survey