Community Paediatric Service

Service description

The community paediatric team offers a specialist service to children and young people residing in Leicester, Leicestershire or Rutland for various health needs. For example:

• Investigation of children presenting with global developmental delay or significant delay in specific developmental areas
• Medical assessment of moderate/severe learning difficulties.
• Medical input to support assessment of preschool/primary school age children presenting with challenging behaviour, where an underlying neurodevelopmental condition such as autism or ADHD is suspected. Guidance on managing this as appropriate.
• Management of children with certain genetic/medical conditions (e.g. Down’s syndrome, tuberous sclerosis, neurofibromatosis) that need ongoing neurodevelopmental surveillance.
• Management of children with neurodisability (e.g cerebral palsy), complex health needs and certain life limiting conditions.
• Assessment of children with coordination difficulties (e.g developmental coordination disorder/dyspraxia).
• Specialist medical input and management for children with continence issues.
• Specialist medical input for looked after children, children undergoing adoption and fostering.
• Safeguarding medical assessment of children with suspected physical abuse and neglect, following referral from social services.
• Specialist medical advice for children with significant special educational needs (e.g children requiring an Education, Health and Care Plan).

Referral criteria

New referrals will be accepted for children and young people up until 16 years of age. If a young person is at a special school, referrals may be accepted up to the age of 19
years. The service will be provided to children and young people registered with any GP within Leicester, Leicestershire and Rutland.

Children should display one or more of the following symptoms:

• Concerns regarding a child’s development such as developmental delay, or disordered development.

Medical assessment and investigations for:

• Children with global developmental delay/significant delay in specific developmental areas i.e., motor delay and/or non-verbal by two years.
• Medical input as part of MDT assessment of children (preschool/primary school age) with suspected underlying neuro-developmental issues (ASD and ADHD). The referral to include school/nursery report.
• Difficulties must be present in more than one setting.
• Please note assessments for ADHD will not be accepted for children under the age of five and a half years due to developmental variation.
• ASD assessment will not be accepted for children under two years.
• Neurological disability e.g. cerebral palsy or other physical disabilities.
• Management of children with certain genetic/medical conditions (e.g., down’s syndrome, tuberous sclerosis, neurofibromatosis) who need ongoing neurodevelopmental surveillance and medical management.
• Medical assessment and management of children with neuro disability (e.g., cerebral palsy).
• Behavioural problems in association with disordered development or when there is a suspected underlying neurodevelopmental disorder.
• Autistic spectrum disorder (primary school age).
• ADHD (unless mental health disorder or oppositional behaviour in a secondary school age child).
• Genetic disorders needing paediatric medical follow up e.g. down’s syndrome.
• Complex needs.
• Symptom management in children with life-limiting conditions.

Community paediatricians will accept referrals for those with emotional or behavioural issues that also have physical symptoms that require a paediatric assessment or where a neurodevelopmental condition i.e. ADHD/ASD is suspected.

Conditions NOT covered by the service are:

• Behavioural support/medical input for emotional behaviour difficulties/sleep in the absence of a neuro-developmental condition (note: melatonin is not first line management) – (consider health visitor/public health nurse/Solihull Approach/Early Help – see leaflets and links below).
• General Paediatric Medical conditions (headache, UTI, constipation, growth issues, including failure to thrive, concerns around head circumference etc., recurrent chest infections, asthma, faints/syncope) – refer to General Paediatrics Team, Leicester Royal Infirmary (LRI).
• Seizures/epilepsy – refer to paediatric neurology, LRI.
• Allergies – refer to Allergy clinic, LRI.
• Skin conditions (scabies, eczema) – refer to dermatology, LRI.
• Cardiac issues (murmur) – refer to paediatric cardiology team.
• Visual difficulties (squint, absence of red reflex) – refer to ophthalmology team.
• Orthopaedic issues (concerns about developmental dysplasia of hips, flat feet, tip toe walking, in toeing gait) – refer to paediatric orthopaedic team, LRI.
• Assessment for Dyslexia (or other specific learning difficulties) – seek information and support through SENCo/SENDIASS (see links below).
• Assessment of children with coordination difficulties over the age of five years (e.g., dyspraxia/developmental coordination disorder) – refer to occupational therapy.
• Depending upon functional difficulties.
• Seizures/epilepsy – refer to paediatric neurology, LRI.
• Support for deterioration of behaviour as part of a previous diagnosis of ASD in the absence of concerns about physical health or new neuro development concern (consider Early Help, Chat Autism, Autism Space, National Autistic Society Leicester for home needs and SENCo/SENDIASS for school needs, see links below).
• Assessment for dyslexia (or other specific learning difficulties).
• Assessment of significant emotional and behavioural difficulties in school age children, unless as part of a formal assessment of special educational needs.
• Isolated speech and language difficulties e.g. stutter.
• Obesity.