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Referral Pathways

Referral pathways depend on local availability of services and the clinical problem. 

  • Trauma cases will be referred to orthopaedics, day care units or accident and emergency. 
  • Remember that trauma is common in young children and other pathology can be missed. It is important to consider if the clinical assessment is in keeping with the trauma. If in doubt, refer. 
  • The child with suspected inflammatory disease should be referred asap to paediatric rheumatology - Do not wait for the results of investigations - they may be normal anyway. 
  • The presence of red flags warrants referral asap - likely general paediatrics.
  • Concern about normal variants warrants referral - likely paediatric orthopaedics. 
  • Pain that is not explained, limp that is not resolving, systemic upset or regression of motor milestones - all warrant referral - either general paediatrics or paediatric rheumatology. 
  • Delay in walking, gait abnormalities, any suggestion of weakness, ‘coca-cola’ like coloured urine – warrants an immediate blood test for creatine phosphokinase (CPK), followed by a referral - either general paediatrics or paediatric neurology. Do not delay a CPK test; if unable to do in general practice then refer the child to the local paediatric day unit for the blood test.
  • If there are concerns, do refer even if blood tests or imaging are normal. 
  • Do not wait for results of tests if there are clinical concerns. 
  • 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. 

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