Introduction

This guideline relates to inflammatory bowel disease in paediatric patients. For more information please see: Clinical Practice Guidelines: Abdominal pain - acute or Clinical Practice Guidelines: Abdominal pain - chronic

When to refer

• Patients aged 0-16 years
• Suspected inflammatory bowel disease where chronic diarrhoea (non-bloody) or other symptoms > 4 weeks with elevated faecal calprotectin (> 100 mcg/g), and no other critical features (non-urgent <90 days)
• Suspected or known inflammatory bowel disease where chronic diarrhoea (bloody or non-bloody) or other symptoms > 4 weeks with elevated faecal calprotectin (> 250 mcg/g), and any of the following critical features are present (urgent):
  • New progressive gastrointestinal symptoms (e.g. abdominal pain, vomiting)
  • Faltering growth (weight loss of > 2 weight centiles)
  • Perianal pain or fistulae suspected
  • Laboratory critical feature:
    • Anaemia
    • Low albumin
    • Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
    • Iron deficiency
    • Holotranscobalamin (active vitamin B12) deficiency
  • Abnormal imaging suggesting inflammatory bowel disease 

Note: faecal calprotectin levels can be elevated in healthy, pre-school aged children and should be interpreted with caution 

• Known inflammatory bowel disease with a flare of symptoms
• Known inflammatory bowel disease for routine follow-up

If any of the following are present or suspected, please direct the patient to the Emergency Department (no referral required):

• Suspected or known inflammatory bowel disease with severe abdominal pain and/or bloody diarrhoea, and any of the following features:
  • Fever
  • Haemodynamic compromise
  • Suspected megacolon  
  • Suspected bowel perforation
  • Bowel obstruction
  • Abscess (abdominal or perianal)
  • Haemoglobin < 90 g/L
    

Services available closer to home

Other hospitals with public paediatric general medicine/gastroenterology services include:

• Austin Hospital
• Box Hill Hospital (Eastern Health)
• Monash Medical Centre
• The Northern Hospital
• Sunshine Hospital (Western Health)

Referral criteria/required information

• Detailed history and assessment, including duration of symptoms
• Family history of inflammatory bowel disease
• Provisional diagnosis and current management to date  
• Growth charts: including current weight, weight loss (amount and timeframe)
• Blood tests:
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • Full blood count (FBC)
  • Iron studies
  • Liver function test results
  • Holotranscobalamin (active vitamin B12)
• Stool sample
  • Stool microscopy, multiplex PCR and Clostridium difficile toxin
  • Faecal calprotectin result (in children aged > 4 years)
• Any previous investigations e.g., x-ray, ultrasound
• Current and previous colonoscopy results

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer or Gastroenterology Outpatient Consult Fellow (03) 9345 5522. If after hours ask for Gastroenterology fellow on call

Information for families

• Kids Health Info : Abdominal pain
• Kids Health Info : Inflammatory bowel disease (IBD) – Crohn disease and ulcerative colitis
• Kids Health Info : Inflammatory bowel disease (IBD) – information for schools

Resources and links

• Clinical Practice Guidelines : Abdominal pain - acute
• Clinical Practice Guidelines : Abdominal pain - chronic

Acknowledgements

The development of this guideline was coordinated by the Department of Gastroenterology (A/Prof. George Alex). Guideline reviewed in July 2025.