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Community paediatrics

A child or young person with complex developmental needs or disability may be referred to our Community Paediatric Service.

We provide assessment, diagnosis, treatment, support and monitoring for children with complex developmental needs and profound disability. We work in partnership with other professionals with whom we may liaise or refer your child onto for therapeutic interventions. We can advise parents and carers on useful resources and other sources of support.

We can assess, diagnose and support children with development delays or disorders such as cerebral palsy, autism spectrum conditions and attention deficit hyperactivity disorder.

Information about the services we provide:

The Child Development Team (CDT) is a multidisciplinary team for children under five with more significant developmental/health needs. Many of these children have complex health issues and may be under other Doctor (e.g. acute Paediatricians, Paediatric Neurologists etc). The Community Paediatrician’s role is to assess and review health and developmental needs while Speech and Language Therapists, Physiotherapists and Occupational Therapists will perform functional assessments and identify priorities for intervention. These may include home/nursery programmes of treatment activities and strategies, consultation and training for parents and nursery staff and providing equipment when necessary at home and at nursery. The team will work closely with Education and Social Care.

 

We see children and young people with:

  • Downs Syndrome and other genetic disorders which cause disability
  • Physical disability including motor disorders such as cerebral palsy
  • Children with Learning disabilities attending Specialist Schools who have associated complex medical problems such as epilepsy.

 

  • We provide diagnostic assessments for children between the ages of 1 to 5 years of age with social communication difficulties suggestive of a possible autism spectrum disorder.
  • We also work jointly with CAMHS colleagues within the Neuro-collaborative pathway (delivered through CAMHS Oxford Health), to provide ASD and ADHD assessments for school aged children.
  • We offer medication reviews for children under the age of 11 with already confirmed ADHD and stabilised on medication (Children over 11 years of age & on medication for ADHD should be referred to CAMHS).
  • We offer assessment and review of children with sleep disorders associated with a neurodevelopmental disorder.
  • For children with coordination concerns in line with a possible developmental coordination disorder/dyspraxia, we will provide assessment following a functional assessment from an Occupational Therapist. Our role is focussed on excluding any neurological basis for the child’s difficulties. We will also support an MDT approach to diagnostic clarity with our OT colleagues.

This includes diagnoses such as:

  • Autistic spectrum disorder, attention deficit hyperactivity disorder.
  • Statutory medicals for children living in special circumstances e.g. children looked after by the local authority and medical input to the adoption process.
  • Community Paediatricians assess children who have recently come into the care of the local authority, to ensure that their health needs are met. Parents or people with parental responsibility will be asked to provide consent for information about the child to be shared between the Community Paediatric service and the local authority.
  • Medical advice on the impact of health problems in educational settings.
  • If a child has health or developmental needs that are impacting on their education, the Community Paediatric team may be asked to share information about the child with the school and the education authority. Parents will be asked to provide consent for this. Children may also be assessed by the team if the education authority has decided to initiate an Education Health and Care Plan (EHCP). This is usually a one-off appointment to complete a profile of the child’s health and developmental needs and how this may impact on their education.

Information about who we are and where we work:

We are a team of:

  • Community Paediatricians (Consultants and Specialty Doctors)
  • Paediatric Doctors in training
  • Clinical Psychologists
  • Trainee and Assistant Clinical Psychologists
  • Advanced Clinical Pharmacists
  • Administrators

We also work closely with:

  • Children and Young Peoples Therapy team (Speech and Language Therapists, Physiotherapists & Occupational Therapists)
  • Health Visitors and School Nursing Team
  • Children with Disabilities Nursing Team
  • Paediatric Dieticians

Paediatricians, Medical Trainees, Clinical Psychologists, Community Pharmacists, Advanced Practitioners and Administrators.

We see children in outpatient clinics across the county in:

Amersham Hospital, Wycombe Hospital and Rayners Hedge site in Aylesbury, where clinically appropriate we will aim to use technology to provide virtual appointments.

We also conduct clinics in Special Schools and in some instances members of the team may conduct school observations if felt appropriate. Although not frequently, we may sometimes need to see a child and family at home according to their level of need.

Referrals

The service accepts referrals from professionals involved with a child or young person.

For example, a referral may be made by a School or Nursery, Health Visitors, School Nurses, Therapists, GPs, Acute Paediatricians, Tertiary Centre or other Paediatricians from neighbouring hospitals.

We can only accept referrals made to us using the referral form which should be sent using the NHS mail safe email bht.communitypaediatricsadmin@nhs.net address which is also provided on the form.

 Community paediatric referral form for children under 5

 Community paediatric referral form for school aged children over 5

Under the age of 19 years, except:

  • Children who have recently moved into Buckinghamshire County/or Country
  • Attending a special school within Buckinghamshire
  • Due to the potential need for Occupational Therapy of Speech and Language support we can only accept referrals for children who are registered with a Buckinghamshire GP

For a referral to be accepted it is imperative that  supporting evidence and documentation is provided

  • ASQ completed
  • Report from education setting
  • OT report or OT support from school setting for children with Dyspraxia/ Co-ordination problems
  • Portage report if under portage
  • Hearing assessment if completed
  • SALT assessment for children with primary Social / Communication/Speech concerns
  • Reports confirming diagnosis & treatment to date if the child has been seen out of area previously or privately (For children already on medication, they should continue to receive private medication support, for children referred back to the NHS they will be seen in order of waiting times)

The following are NOT appropriate referrals as a primary presentation unless there is an undiagnosed or diagnosed neurodevelopmental condition

Condition

Provider

Complex behavioural difficulties CAMHS
Self-harm CAMHS
Violent and aggressive behaviours – GP to see or acute CAMHS
Eating disorders CAMHS
Tourette’s Syndrome/TIC disorder CAMHS/Acute Paediatrics
Mental Health problems (anxiety and depression) CAMHS
Counselling CAMHS
Sleep problems (unless there is a neurodevelopment disorder concern) Health Visitor or School Nurse
Toileting concerns – Nocturnal enuresis Health Visitor or School Nurse
Toileting concerns – Referrals for children with daytime wetting, constipation and/or soiling GP review/Acute Paediatrics
Sexual abuse SARC
NAI Acute Paediatrics
Primary/isolated speech delay Speech and Language (SLT) assessment required prior to referral to Community Paediatrics
Referrals for children in whom there are concerns around specific learning difficulty/dyslexia/working memory difficulties should be referred to the educational psychology service or the cognition and learning team Education
Children over 11 years of age & on medication for ADHD should be referred to CAMHS CAMHS

The following conditions should be referred to acute paediatrics or the appropriate speciality via doctor (GP):

  • ENT/audiology
  • Acute medical conditions (excluding acute/chronic psychiatric)
  • Epilepsy
  • Failure to thrive
  • Growth problems
  • Physical abuse
  • Constipation
  • Daytime Enuresis

Pathway of referral for children with feeding problems:

Health visitor to refer to doctor (GP) to assess and refer on as needed to paediatric dietician or acute paediatrician.

For children with feeding problems due to disability:

Refer to multi-disciplinary feeding team.

We aim to review, accept/reject or redirect referrals within 6 weeks of referral receipt, a letter confirming the referral status will be sent to the referrer.

We aim to expedite clinically prioritised referrals and referrals for looked after children, children in care and children of armed forces family.