Behavioural problems in a child < 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.

Behavioural concerns

  • Suicidal or immediate danger of self-harm
  • Aggressive behaviour with immediate threatening risk to vulnerable family members.
Useful Management Information
  • Refer to local care pathway
  • Behavioural problems in children < 6 years of age are best managed by family support services and behaviour specialists rather than being referred to general paediatrics in the first instance. Children referred under 5 years of age may be redirected to Primary Care community child and family support services.
  • Raising children network:
  • 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:
  • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
Additional Resources

On-Line Resources for children with developmental or behavioural problems

Click here for further resources and useful tools developed by Dr Ian Shellshear, available from the Ipswich Hospital Foundation.

Are you referring to the right service?

Have the family sought help from a parenting program? It would be advised that involvement of one of the below services be considered before a referral is made to the paediatricians. Provided is a list of community providers related to behavioural management and strategies. This is not an exhaustive list. Please view Table of local parenting programs West Moreton PDF. 

Please considering providing this questionnaire for under 6 years  or questionnaire for school aged children to the families for completion prior to referral.

If referring for oppositional or hyperactive behaviours please consider having family and teachers complete SNAP IV form.

Minimum Referral Criteria

Category 1
(appointment within 30 calendar days)

  • Child in out of home care supervised by the Department of Child Safety where there is imminent threat of breakdown of current foster placement due to behaviour
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • Children > 5 years with oppositional or hyperactive behaviours

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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • 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
  • Description of the behaviours of concern
  • Nature of parent concerns
  • Families of children not yet attending school must have been seen by community child health nurse or an equivalent primary care service for parental support to manage behaviour, and must have seen a behaviour specialist (either a psychologist or individual positive parenting program counsellor) and determined as requiring a specialist paediatrician behavior assessment. The service or practitioner they have seen should be identified in the referral. The specialist assessing this referral may waive this requirement in circumstances where primary care services are inaccessible.
  • For children attending school a letter from the school outlining behaviours of concern is required, if school based behaviours are the primary reason for the referral.
  • Report presence or absence of Red flags

 Presence or absence of Red flags

  • Is the child expected to be in out of home care supervised by the department of child safety for more than 6 months?
  • If so, do you consider that the child’s foster placement is at risk of breaking down due to the child’s behaviour?
Additional Referral Information

Highly Desirable Information – may change triage category

  • GP impression of current developmental status (may be parental assessment) ( = age appropriate, some delays, significant delays).  PEDs and/or ages and stages screening.
  • Guidance officer assessment or other information from the school.
  • Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness.
  • Audiometry
  • Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available.
  • Previous services accessed (other paediatricians, mental health services, developmental therapists, etc.)
  • Previous medications or therapies used.
  • If the child is in foster care please provide the name and regional office for the Child Safety Officer who is the responsible case manager.
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
  • School history –exclusions or suspensions.

Desirable information- Will assist at consultation

  • Pregnancy and birth history
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
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 or phone 3413 7402.