Haringey Community Paediatrics: Pathway for children referred with developmental delay

When your child is being referred to this service this should be discussed with you so that you are aware of the reasons for the referral and your consent given

Please note:

• We use an electronic patient record to hold our clinical notes and documents. This in turn is accessible by other professionals who work for Whittington Health and helps greatly with our information sharing
• At the end of each appointment we will write a report that is sent to you with an agreed plan and copy list of all relevant professionals. We aim to send this out within 2 weeks of the appointment (QS-1)
• We welcome and actively seek, and act on feedback from all who use our services (QS-2)

All referrals are triaged by a paediatrician who will:

• Review the referral of your child and take a decision based on the information provided
• Request additional information if there are any gaps identified in the information provided
• Make any additional referrals to therapy services, e.g. physiotherapy, speech and language therapy etc, so that any waiting time for these services can be minimised
• Take the more complex cases to our multidisciplinary meeting with the Child Development Centre therapists to ensure that we coordinated care between paediatricians and therapists

The national standard is for all children to be seen within 18 weeks of referral – although we aim to see children well before then.

It may take several appointments to complete the holistic paediatric assessment.

Your child will be seen by a paediatrician who will undertake a holistic assessments that  will take in areas of your child's development (including motor, communication, cognitive skills etc), vision, hearing, medical history and psycho-social history.

The appointments offered may be:

• Uni-disciplinary – the child is seen by a paediatrician, OR
• Multi-disciplinary – this brings together a paediatrician and therapists at the same appointment

As part of the assessment the paediatrician will agree a plan for the following with you:

• Any investigations and how the results will be fed back to you
• Referrals to local services, e.g. therapy services, early intervention programmes, the voluntary sector, child and adolescent mental health services, social care and tertiary centres
• Prescribing of medications

 At the end of the assessment if a diagnosis can be confirmed this will be discussed in detail with you as will the management plan and follow up.

In the lead up to starting school the emphasis shifts to nursery provision and then to preparing for school.

At follow up appointments we would:

• Answer any questions that you may still have about the diagnosis and outlook for your child
• Review your child’s developmental progress
• Review the management of any existing and emerging health problems
• Consider if there was a need for additional referrals, as set out in the description of the initial assessment
• Where indicated, notify Education if your child is likely to need significant additional support in school
• Agree timing of any follow up appointment or discharge if our contribution had come to an end

For most children with developmental delay the focus of their support moves to education when they go to school. With this the terminology also changes and ‘developmental delay’ to ‘learning delay’ or ‘learning disability’. Assuming that the diagnostic assessment phase has been completed and unless there were any identified medical problems, children are usually discharged from the Community Paediatric Service once they are in school.

If there is any follow up planned this will be agreed with you based on the medical need.

If your child has a place in a special school they will be seen in their school, while children attending mainstream school will be followed up in clinics in the Child Development Centre.