Behavioural problem in a child ≥ 6 years

PAEDIATRIC

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

    • Suicidal or immediate danger of self-harm
    • Aggressive behaviour with immediate threatening risk to vulnerable family members
    • Refer to local HealthPathways or local guidelines
    • The following children should be directed to Child and Youth Mental Health Services
      • children who may be at risk of self-harm
      • aggressive behaviour with high risk of significant injury to vulnerable family members
      • primary school child with significant school refusal due to anxiety
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Children and young people in the child protection cohort should be identified at referral and their prioritisation informed by clinical urgency, vulnerability, safety risk, developmental impact and care coordination needs. Child protection involvement should be considered as part of triage decision-making but does not automatically determine triage category
    • A child or young person (0–18 years) who is currently in out‑of‑home care (OOHC), or at risk of entering the child protection system, should be triaged as Category 1, in accordance with the Statement of intent regarding the prioritisation of health services for children and young people in the child protection system (QH‑GDL‑426:2021).
    • Clinical urgency remains the dominant consideration when prioritising referrals. Following assessment of clinical urgency, children and young people who are currently in OOHC, or at risk of entering the child protection system, should be prioritised for timely access to health services.
    • If there is reason to suspect that a child in Queensland is experiencing harm, or is at risk of experiencing harm, Child Safety Services must be contacted in accordance with Queensland Health child protection policies and procedures (Department of Families, Seniors, Disability Services and Child Safety).
    • Vulnerable child considerations may include, but are not limited to:
      • Aboriginal and/or Torres Strait Islander background
      • under guardianship of the Minister
      • culturally and linguistically diverse background
      • recently arrived immigrant or
      • refugee other relevant psychosocial factors

      • The next of kin or person(s) legally responsible for patient consent, with the exception of children subject to guardianship orders with the Department of Families, Seniors, Disability Services and Child Safety, should attend the first outpatient appointment.

      Patient resources

      Raising children network

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Child in out of home care, where there is imminent threat of breakdown of current foster placement due to behaviour
Category 2
(appointment within 90 calendar days)
  • Primary school child needing a medical assessment due to a recent change in behaviour that has resulted in being expelled or repeatedly suspended from school, or is unable to attend due to their behavioural challenges
  • Child whose behaviour is putting self or others at high risk of significant harm (details must be provided)
  • Sudden change in behaviour with a suspected medical comorbidity as a possible cause
  • A child or young person (0-18 years) who is:
    • currently in out of home care (OOHC) or
    • subject to, or at risk of entering, the child protection system
  • Young people transitioning to adulthood following an out of home care experience (15–25 years of age), where managed within a paediatric service
  • Where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 3
(appointment within 365 calendar days)
  • Most other referrals for behavioural problems in children > 6 years. Child must be concurrently supported / referred to external behavioural services.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Description of the behaviours of concern, including where available:
    • nature of the behaviour(s)
    • frequency, duration and severity
    • settings in which the behaviour occurs (e.g. home, school, community)
    • identified triggers or patterns
    • impact on safety, learning, social functioning, family functioning, attendance or placement stability
    • strategies trialled and response to those strategies
    • whether there has been a sudden or significant change from the child’s previous level  of functioning
  • Clinical question or purpose of referral, including the expected assessment outcome were known
  • If educational setting concerns are present, then a letter from the educational setting must be included in a GP referral.
  • Information already contained within school reports, guidance officer reports or allied health documentation may be used to satisfy behavioural and educational information requirements and does not need to be duplicated within the referral
  • Where school information is unavailable, the referrer should provide available contextual information from family, carers, Child Safety, allied health, general practice or other involved services
  • In the absence of a letter from the educational institution provided with the referral, the referral will be categorised Cat 3 unless they meet other non-educational criteria.
  • Report presence or absence of concerning features:
    • Is physical aggression placing family members (e.g. much younger siblings) at risk of injury? If so, provide details outlining which family members and why they may be at risk of injury. Consider referral to Child Youth Mental Health service as per other useful information
    • Is the child expected to be in out of home care supervised by the Department of Child Safety, Seniors and Disability Services 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?
  • Current or previous behavioural services
  • Child and Youth Mental Health Service involvement
  • Allied health involvement
  • School-based supports
  • Parenting support programs
  • Other agencies involved in care coordination
  • Confirmation of child protection status, including whether the child or young person is currently in out‑of‑home care (OOHC) or at risk of entering the child protection system, where appropriate.

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • Brief comment on current school educational attainments (good, average, poor, very poor (>2 years behind))
  • Guidance officer assessment or other information from the school.
  • Information about school attendance, expulsion or suspension.
    • estimate number of days suspended in the previous 3 months.
    • estimate number of days missed because of school refusal.
  • Previous medications or therapies used.
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Child Safety, Seniors and Disability Services involvement)
  • Where ADHD is suspected, provide information regarding:
    • inattention
    • hyperactivity
    • impulsivity
    • duration of symptoms
    • settings in which symptoms occur
    • functional impact at home, school and within the community
    • available educational reports or observations.
  • Where relevant, also provide information regarding:
    • anxiety and school refusal
    • aggression and emotional dysregulation
    • sleep concerns
    • trauma or psychosocial stressors
    • developmental or learning concerns.
  • Previous services accessed (other paediatricians, mental health services, allied health services, etc.)
  • Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness.
  • Copies of previous of speech, occupational therapy, physiotherapy or cognitive assessments if available.
  • Audiometry
  • 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.

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

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    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
    • 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.)

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

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 29 September 2026

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