Paediatric: Guidelines for Urgent Referral

Abnormal blood count
       If reported as requiring urgent further investigation.

Petechiae/Purpura
       These findings are always an indication for urgent investigation.

Fatigue in a previously healthy child when combined with either of the following:

• generalised lymphadenopathy

• hepatosplenomegaly

Bone Pain especially if it is:

• diffuse or involves the back

• persistently localised at any site

• requiring analgesia

• limiting activity

Lymphadenopathy is more frequently benign in younger children but referral is advised if one or more of the following characteristics are present, particularly if there is no evidence of previous local infection:

• non tender, firm/hard and > 3 cms in maximum diameter

• progressively enlarging

• associated with other signs of general ill health, fever and/or weight loss

• involves axillary nodes (in the absence of any local infection or dermatitis) or supraclavicular nodes

• seen as a mediastinal or hilar mass on chest x-ray

Headache of recent origin with one or more of the following features:

• increasing in severity or frequency

• noted to be worse in the mornings or causing early wakening

• associated with vomiting

• associated with neurological signs (e.g. squint, ataxia)

• Associated with behavioural change or deterioration in school performance.

Soft Tissue Mass any mass which occurs in an unusual location should be considered suspicious particularly if associated with one or more of the following characteristics:

• shows rapid or progressive growth

• size > 3 cms in maximum diameter

• fixed or deep to fascia

• associated with regional lymph node enlargement