Faltering growth (failure to thrive) in children < 6 years


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Growth concerns

  • Faltering growth (failure to thrive in children < 6 years)
    • severe malnutrition
    • temperature instability
    • cardiovascular instability – postural heart rate change


Useful Management Information
  • Refer to local care pathway
  • If breast-fed baby, offer advice about technique – lactation consultant or child health nurse
  • Prematurity needs to be corrected on growth charts
  • Severe acute malnutrition is defined by more than 10% recent acute weight loss or crossing two major centiles or visible severe wasting or nutritional odema: http://www.who.int/childgrowth/standards/en/
  • Royal Children’s Melbourne Growth charts and calculators: RCH Growth Charts
  • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: https://www.communities.qld.gov.au/
Minimum Referral Criteria

Category 1
(appointment within 30 calendar days)

  • Infants < 1 year with faltering growth
  • Significant weight loss in a child up to 6 years
Category 2
(appointment within 90 calendar days)
  • Most other referrals with faltering growth in children < 6 years
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be returned

  • General referral information
  • For infants less than 12 months must provide gestational age at birth (or weeks of prematurity)
  • Details of concern about growth
    • current height and weight, and include date of measurement
    • if under 2 years include head circumference
Additional Referral Information

Highly Desirable Information – may change triage category.

  • Height/weight/head circumference/percentile charts (measured serially and plotted to note trend, if available). It is recommended that WHO growth standards be used for children under 2 years of age and CDC growth charts for children over 2 years of age
  • Feeding history:
    • infants – breast or formula, volumes or effectiveness of feeding
    • older children – feeding refusal, restrictive food choices
  • Gestational age at birth and birth weight.
  • Bowel habit and any history of vomiting
  • GP impression of current developmental status (may be parental assessment) (= age appropriate, some delays, significant delays).
  • Family history (family history with short stature)
  • Social history
    • parental mental health problems
    • lack of financial resources for food requirement
    • lack of suitable housing
    • lack of family/community supports
    • refugee or recent immigrant background
    • failure to attend/engage hospital or community services appointments
    • previous history of child protection involvement

Desirable Information- Will assist at consultation

  • Other past medical history
  • Immunisation history
  • Medication history
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology

Investigations that may be considered with referral

  • Urinalysis
  • Stool PCR or M/C/S for infections, calprotectin, elastase
  • FBC with differential, LFTs U&Es TFT
  • If gluten in diet: coeliac serology, total IgA
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.