Consult and Referral Guidelines
Consult and referral guidelines are created to assist referring physicians in the evaluation and management of pediatric patients.
Developed by Seattle Children’s specialists in partnership with community physicians, these guidelines provide you with useful information in working up your patients, and contribute to making the appointment itself most meaningful by having the right clinical information available.
Listed below are the specialties and the guidelines that are currently available. Updates, as well as additional specialties and diagnoses, are added regularly.
- Adolescent behavioral medicine
- Chronic fatigue
- Chronic somatic complaints
- Eating disorders
- Male health
- Overweight
- Pediatric and adolescent gynecology
- Hearing loss, suspected or known
- Severe to profound bilateral sensorineural hearing loss
- Permanent bilateral hearing loss
- Headaches: migraine, recurrent or chronic, 8–21 years
- Raynaud's disease, 8–21 years
- Recurrent vomiting or rumination, 8–21 years
- Recurrent or chronic abdominal pain, 8–21 years
- Dental abscess (emergent) in a healthy child
- Dental trauma (emergent) in a healthy child
- Extensive dental caries (non-emergent) in a healthy child
- Dental caries in a child with mild to moderate medical conditions or developmental disabilities
- Dental caries in a child with major medical conditions or developmental disabilities
- Malocclusion in patients with cleft palate or craniofacial syndromes
- Major facial trauma and/or jaw fracture
- Oral lesions, cysts and tumors
- Complex surgical dental extractions
- Surgical management of clefts or craniofacial anomalies
- Surgical management of severe jaw length discrepancies
- Temporomandibular joint or muscle dysfunction
- Acne
- Herpes simplex, herpes zoster and varicella
- Impetigo and pyoderma
- Inflammatory dermatoses
- Keloids/hypertrophic scars
- Molluscum contagiosum
- Pre-cancerous skin lesions and skin cancers
- Psoriasis
- Vascular lesions
- Wart treatment
- Growth disorders
- Short stature
- Tall stature
- Insulin resistance
- Pubertal disorders
- Precocious puberty
- Early childhood breast development
- Delayed puberty
- Premature menses
- Thyroid disorders
- Congenital hypothyroidism
- Acquired hypothyroidism (Hashimoto's thyroiditis)
- Neonatal hyperthyroidism
- Acquired hyperthyroidism (Graves' disease)
- Goiter
- Chronic abdominal pain
- Chronic, non-bloody diarrhea
- Bloody stool
- Gastroesophageal reflux
- Failure to thrive
- Vomiting with or without abdominal pain
- Referral sources for constipation
- Referral sources for encopresis
- Gastroesophageal reflux
- Inguinal hernia
- Pectus excavatum
- Perirectal abscess
- Pilonidal cyst/abscess
- Surgical constipation
- Umbilical hernia
- Frequent infections
- Lymphadenopathy
- Persistent fever without source
- Positive PPD without evidence of active disease
- Recurrent fevers
- Tuberculosis
- Chronic kidney disease
- Hematuria
- Hypertension
- Nephrotic syndrome
- Proteinuria
- Cerebral palsy
- Developmental delay
- Prenatal counseling
- Spasticity management clinic
- Headache
- Febrile seizures
- First afebrile seizure
- Mitochondrial
- Recurrent unprovoked seizures (epilepsy)
- Intractable epilepsy
- Adolescent Wellness Clinic
- Child Wellness Clinic
- Eating disorders services
- Growth and Feeding Dynamics Clinic
- Nutrition Clinic
- Abnormal pupil
- Decreased visual acuity
- Droopy eyelid/ptosis
- Lid swelling
- Eye turns in (esotropia)
- Eye turns out (exotropia)
- Acute onset of esotropia
- Hemangioma located around the eye
- Increased tearing (nasal lacrimal duct obstruction)
- Red eye or "pink eye"
- Stye or chalazion
- Extreme pain or limping or non-ambulation
- Acute fracture at any anatomic site
- Hip pain (or knee pain referred from hip)
- Bone infection or osteomyelitis
- "Compartment syndrome" or severe traumatic leg or arm pain
- Soft tissue mass or soft tissue sarcoma: Desmoid lipoma, hemangloma, soft tissue abscess/hematoma
- Benign bone tumors
- Non-ossifying fibroma
- Benign cyst or unicameral benign cyst
- Aneurysmal bone cyst
- Eosinophilic granuloma
- Malignant Bone Tumors
- Osteosarcoma
- Ewing sarcoma
- Clubfoot
- Flatfeet
- Bunions
- Toe walking
- Metatarsus adductus (intoeing from the foot)
- Knee sprain or ligament injury
- "Locked knee"
- Bowlegs (possible Blount's disease)
- Knee pain, chronic
- Developmental (congenital) dislocation of the hip (DDH)
- Hip dysplasia
- Slipped capital femoral epiphysis (SCFE), severe hip pain, physeal fracture of femoral head
- Legg Perthes disease or Legg Calve Perthes or Perthes disease
- Scoliosis or spinal curvation
- Back pain, other diagnoses
- Septic discitis
- Vertebral osteomyelitis
- Spinal tumors or herniated discs
- Vertebral fractures
- Musculoskeletal ain
- Spondylolysis and spondylolisthesis (stress fracture of lower back)
- Scheuermann's kyphosis
- Skeletal dysplasia
- Torticollis
- Allergic rhinitis
- Ciliary dyskinesia
- Cough
- Epistaxis
- Hearing loss
- Hoarseness
- Laryngomalacia (or infantile stridor)
- Neck mass
- Lateral neck mass
- Midline neck mass (possible thyroglossal duct cyst)
- Thyroid mass
- Nasal fracture
- Otitis
- Chronic otitis media
- Recurrent otitis media
- Otitis externa ("swimmer's ear")
- Tonsils
- Large tonsils and/or adenoids with obstructed breathing during sleep
- Recurrent tonsilitis
- Rhinorrhea/congestion
- Sinusitis
- Velopharyngeal insufficiency
- Vertigo/dizziness
- Abdominal pain
- Back pain
- Chest pain
- Facial pain
- Headache
- Limb pain
- Musculoskeletal pain
- Neuropathic pain
- Pain associated with disease processes or side effects of treatment
- Dermoid cysts of skull or face
- Ear anomalies
- Facial fractures
- Lacerations
- Lesions
- Scars
- Vascular malformations
- Anxiety and obsessive-compulsive disorder
- Depressive disorders in children and adolescents
- Eating disorders in children and adolescents
- Treatment-resistant ADHD
- Oppositional defiant disorder/behavioral disorders
- Asthma, recurrent cough or wheeze
- Bronchopulmonary dysplasia, chronic lung disease
- Cystic fibrosis
- Sleep disorders
- Ultrasound
- Fluoroscopy
- Nuclear medicine
- Diagnostic X-rays
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Dual-energy X-ray absorptiometry (DEXA) bone scans
- Interventional radiology
- Dermatomyositis, muscle weakness
- Fevers of unknown origin
- Possible SLE
- Raynaud's
- Scleroderma syndromes
- Swollen joint(s), painful joint(s)
- Vasculitis
- Phimosis
- Urinary tract infection
- Voiding dysfunction and/or nocturnal enuresis
- Cytomegalovirus
- Herpes simplex virus
- Human immunodeficiency virus (HIV) Exposure
- HIV infection
Request Physical Copies
You can also request a copy of the initial consult and referral guidelines via our Healthcare Provider Materials Request Form (PDF).
Medical Disclaimer
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.
However, in view of the possibility of human error or changes in medical sciences, neither the authors nor SCHCS nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information.