Neonatal and infant 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)

  • Acute medical or surgical concerns such as, but not limited to:
    • Acute injury
    • Acutely unsettled and inconsolable over a prolonged period
    • Anaphylaxis
    • Apnoeas, episodes of pallor, cyanosis, respiratory distress or stridor
    • Bilious or projectile vomiting and/or haematemesis
    • Hair tourniquet
    • Hypoglycaemia
    • Inguinal hernia that cannot be reduced
    • Jaundice with dark urine and pale stool or bruising or poor weight gain
    • New bulging fontanelle, acute increase in head circumference and/or suspected raised intracranial pressure
    • Newly noted murmur with any of the following features:
      • Poor feeding
      • Post ductal (foot) oxygen saturation < 95%
      • Slow weight gain
      • Weak or absent femoral pulses
    • Possible infantile spasms or other infantile seizures
      Note: this may be frequent brief episodes of head bobbing (with or without arm extension) in an infant
      < 12 months
    • Respiratory signs (wheeze, recession or tachypnoea)
    • Severe diarrhoea
    • Signs of dehydration, abnormal tone and vital signs, and/or malnourishment with or without weight gain
    • Sudden onset of change in neurological function
    • Suspected intussusception
    • Suspected neglect, harm or non-accidental injury, including oronasal bleeding
    • Suspected sepsis and/or fever or hypothermia aged < 3 months
    • Unconsolable over a prolonged period
    • Weak cry or change in usual pitch of cry
    • Weak or absent femoral pulses

When public outpatient services are not routinely provided

  • Circumcision
  • Positional plagiocephaly (unless neck mass or signs of craniosynostosis, or not responding to physiotherapy input)
  • Tongue tie without medical concern
  • Umbilical hernia
  • Well baby follow-up​

Criteria to access public outpatient services

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

  • Abdominal organomegaly
  • Developmental dysplasia of hip
    Note: refer to local HealthPathways and paediatric orthopaedics state-wide referral criteria for more information
  • Forceful vomiting or abnormal stools (without dehydration)
  • Dysmorphic syndrome features
  • Eye abnormality (e.g. absent red reflex, colobomas, abnormal fixation or pupil appearance)
    Note: refer to paediatric ophthalmology state-wide referral criteria for more information
  • Growth asymmetry (hemihypertrophy or limb inequality)
  • High level of carer or infant distress due to infant concern and unresolved with family support therapy
  • Infant aged < 6 months with small or large head, or rapidly growing head circumference (i.e. head growth crossing centiles in Blue Book)
  • Infants aged > 4 weeks with clinical jaundice who
    are gaining weight and have no clinical illness and
    no bruising
    Note: contact on-call paediatrician for advice on concurrent investigations to be performed in primary care
  • Infant who requires medical surveillance within 1 month of discharge from neonatal unit
  • Irritability with sleep or settling unresponsive to input from Child and Family Nursing services
  • Neurodevelopmental regression
  • Persistent blood or mucus in stools
  • Rapidly progressing cranial asymmetry, or ridging of sutures with suspected craniosynostosis, neck lump or head tilt
  • Severe eczema that is not responding to topical treatment
  • Skin haemangioma of concern on head or neck or large haemangioma in any location

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.
  • Developmental delay in more than one domain
  • Infant who requires developmental surveillance within 3 months of discharge from a neonatal unit
  • Recurrent bacterial infections
  • Suspected food allergy
  • Torticollis with poor response to physiotherapy​
​Category 3

Recommended to be seen within 365 calendar days.

  • ​Infant who requires medical or developmental surveillance within 6 months of discharge from a neonatal unit

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms 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:
    • Description of pattern of irritability, including relation to feeding, day night variation
    • Serial height, weight and head circumference measurements
    • Duration and severity of episodes
    • Treatment trialled and response
    • Current management regime
    • Pregnancy and birth history (including if premature birth)
    • Developmental history
    • Feeding history
    • Psychosocial history
    • Family history of infantile irritability or previous food intolerance
    • Relevant physical examination findings
    • Relevant laboratory results or medical imaging reports
    • Details of Child and Family Health Nursing services engaged or parenting assistance
    • Allied health reports or summaries

If available

  • Nil

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