Growth and nutritional concerns

​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • > 10% unexplained weight loss in the neonatal period
  • Acute gastrointestinal bleeding (i.e. haematemesis, melena)
  • Clinical rickets
  • Concerns about child abuse or neglect
  • Concerning features on physical examination including, but not limited to, malnutrition
    with features of medical instability as indicated by:
    • Bradycardia, postural heart rate or blood pressure changes
    • Hyperglycaemia or diabetic ketoacidosis
    • Hypoglycaemia
    • Jaundice
  • Onset of vomiting and/or diarrhoea in the context of dehydration unable to be managed
    with oral hydration at home and/or electrolyte disturbances
  • Severely deranged investigations (e.g. hypocalcaemia, hypophosphateaemia)
  • Suspected pyloric stenosis​

When public outpatient services are not routinely provided

  • ​​Iron deficient anaemia in a child aged > 2 years without oral iron supplementation for a minimum of 12 weeks (or where oral iron supplementation not tolerated) or suspicion of underlying illness or other cause for concern​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.​​

  • Aged < 3 months with weight loss or poor weight gain
  • Body mass index (BMI) is over 95th centile for age with any of the following features:
  • Growth and/or nutritional concerns with any of the following features:
    • Chronic diarrhoea (especially nocturnal)
    • Recurrent vomiting
    • Refractory iron deficiency
    • Sudden or significant weight loss (i.e. > 5% unexplained weight loss in past 1 month or > 10% unexplained weight loss in past 6 months)
  • Suspected chronic disease leading to growth arrest
  • Symptomatic anaemia


Note: if urgent assessment is clinically indicated within 1 week, consider contacting the on-call paediatrician

​Category 2
Recommended to be seen within 90 calendar days.​
  • ​Body mass index (BMI) is over 85th centile for age with any of the following features:
    • Concerns of obstructive sleep apnoea
    • Fatty liver disease
    • Signs of insulin resistance
  • Persistent joint pain, Perthes disease or Slipped Capital Femoral Epiphysis (SCFE)
  • Recurrent or persistent micronutrient deficiency
    (e.g. vitamin B12, folate, iron)
  • Unexplained short stature
  • Underlying medical or endocrine cause is suspected
​Category 3

Recommended to be seen within 365 calendar days.

  • Body mass index (BMI) over 85th centile for age despite trial of lifestyle intervention where general practitioner requires management support
    Note: refer to Healthy Habits for lifestyle intervention strategies

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms, nature and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
      • Family history (including gastrointestinal or colorectal cancer, coeliac disease, inflammatory bowel disease)
      • Full examination findings
      • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Communities and Justice involvement)
    • Gestational age at birth or weeks of prematurity (if aged < 2 years)
    • Current height, weight and head circumference
    • Serial measurements from Blue Book and/or previous clinic visits
    • Weight gain or loss (amount and timeframe)
    • Previous management trialled and/or response
      • Dietary history, including whether there is a restricted dietary intake, vegan or vegetarian diet, sensory and texture issues with food, food avoidance or restricted eating patterns
      • Oral supplementation trialled, including doses and duration

If underweight or faltering growth,

      • Urinalysis, microscopy and culture (especially aged < 1 year, as occult urinary tract infection can present with slow weight gain)
      • Full blood count (FBC)
      • Haematinics: iron studies, red blood cell count, folate, active vitamin B12 – holotranscobalamin
      • Coeliac serology: tissue transglutaminase IgA (TTG IgA), total IgA (where possible) with or without anti-endomysial antibody (EMA) (if infant is on solids or feeds contain gluten)
      • C-reactive protein (CRP)
      • Urea, electrolytes and creatinine (UEC)
      • Liver function tests (LFTs)
      • Thyroid function test (TFT)
      • Faecal calprotectin (if aged > 4 years and concerned for inflammatory bowel disease)

If overweight,

      • Fasting glucose, insulin, C-peptide, triglycerides and cholesterol
      • HbA1c
      • Electrolytes, urea and creatinine (EUC)
      • Liver function tests (LFTs)
      • Full blood count (FBC)
      • Iron studies
      • Thyroid stimulating hormone (TSH)
      • Liver ultrasound (if abnormal LFTs)

If available

  • ​Blood pressure

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing