Introduction

This guideline relates to upper gastrointestinal dysfunction 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
• Recurrent dysphagia with previous food bolus obstruction
• Persistent or recurrent vomiting with small volume haematemesis
• Aged > 2 years with reflux and recurrent or persistent dyspepsia despite 2-month trial of proton pump inhibitors
• Failure to progress to solid foods (after speech pathology and/or dietetics review)
• Lack of progression to harder food textures due to swallowing difficulties (after speech pathology and/or dietetics review)
• Dysphagia without food bolus obstruction but with faltering growth and/or weight loss
• Persistent or recurrent vomiting (> 4 weeks) without small volume haematemesis
• Positive Helicobacter pylori testing (stool antigen or urea breath test) in the presence of refractory upper gastrointestinal symptoms and associated with iron deficiency anaemia and/or family history of gastrointestinal cancer

Note: Helicobacter pylori testing not indicated in the absence of above features.

• Nausea with associated weight loss > 2 weight centiles with or without vomiting
• Aged > 2 years with painless, effortless regurgitation

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

• Caustic ingestion
  
• Dysphagia with obstruction from food
  
• Suspected or known oesophageal foreign body (especially button battery or > 1 magnet)

Note: local or network guidelines may determine the appropriate specialty or service to manage these presentations

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
• Provisional diagnosis and current management to date e.g. proton pump inhibitors, Helicobacter pylori treatment
• Growth charts: including current weight, weight loss (amount and timeframe)
• Previous endoscopy or histopathology results
• Recent pathology reports
• Helicobacter pylori results, either stool or urea breath tests (there is no role for Helicobacter pylori serology test)
• Relevant imaging reports

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

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.