Development delay 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.

Developmental concerns

  • Non verbal child with acute distress and unable to examine adequately for medical conditions causing pain eg tooth abscess, bone infections or osteopaenic fractures
Useful Management Information
  • Refer to local care pathway
  • Developmental optometry and auditory processing assessments are not supported by evidence
  • Delay across multiple developmental domains is more likely to be associated with significant impairment and require general paediatric review
  • The chronological age versus the “developmental age” (which should be available through screening) can be used as a gauge of functional severity. Considering a 4 year old child:
    • MILD – 6 months delayed
    • MODERATE – 12 months delayed (i.e. a 4 year old who acts more like a three year old re abilities)
    • SEVERE – 18-24 months delayed (i.e. a 4 year old who has the abilities of a 2-21/2 year old child)
  • Refer to allied health professional for an assessment and/or intervention and review within a pre-determined period of time (e.g. 3-6 months)
  • Concerning features referral guide: Red Flags Early Identification Guide
  • Mild or unspecified developmental concerns, including isolated speech delay, should be initially referred to community child health nurse or to a community allied health provider rather than to general paediatric outpatients
  • Refer for hearing/vision testing as part of differential diagnosis and co- morbidities.
  • Parents’ evaluation of developmental status (PEDS) screening tool - is an evidence based screening tool that elicits and addresses parental concerns about children’s development, health and wellbeing. PEDS is a simple, 10-item questionnaire that is completed by the parent.
    PEDS is available in the “red book” (hand held child health record) and can be used informally to ascertain concern across single domain or multiple domains. Child Health Nurses are able to formally administer this. 
  • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    Ages and stages questionnaires are available online and can be completed by practice nurse in conversation with parent or formally by Child Health Nurse. Ages and stages questionnaires are not free but may be purchased on line.
  • 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
Minimum Referral Criteria

Category 1
(appointment within 30 calendar days)

  • Definite history of developmental regression
  • Significant developmental delay in an infant less than 1 year
Category 2
(appointment within 90 calendar days)
  • Severe developmental delays
  • Developmental delay with related medical co morbidities
  • Child not walking at 18 months
  • Marked low tone or high tone
  • Differences between right and left sides of body in strength, movement or tone
  • Child expected to be in out of home care supervised by the department of child safety for more than 6 months (only those with developmental delay)
Category 3
(appointment within 365 calendar days)
  • Moderate developmental delay/ multiple domain concerns

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
  • Provide sufficient information of screening of the developmental concern. This may be any of the following:
    • a developmental screening tool or
    • a community child health nurse or health worker developmental Assessment or
    • an allied health Assessment or
    • sufficiently detailed developmental milestone history

NB: See information in “useful management information”

Presence or abscence of Red flags

Report presence or abscence of Red flags

  • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
  • Is the child expected to be in out of home care supervised by the department of child safety for more than 6 months?
Additional Referral Information

Highly desirable Information – may change triage category

  • Birth history
  • Other past medical history
  • School or Child Care Centre observations.
  • Family history (parental consanguinity, history of neurological disorders, learning or developmental problems)
  • Visual acuity and audiometry (developmental optometry and auditory processing assessments are not recommended – see other useful information).
  • Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available.
  • 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 (esp parents mental health, family violence, housing and financial stress, department of child safety involvement)

Desirable information- will assist at consultation

  • 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
  • Any relevant laboratory tests or medical imaging results
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.