Introduction

This guideline relates to altered bowel habits 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
• Persistent diarrhoea (bloody or non-bloody) >4 weeks with any of the following features:
  • Negative stool multiplex PCR for infection
  • Faltering growth (weight loss of > 2 weight centiles)
  • Elevated inflammatory markers (raised platelet count, C-reactive protein, erythrocyte sedimentation rate and/or reduced albumin)
  • Tissue transglutaminase IgA (TTG IgA) >10 x upper limit normal (ULN)
  • Elevated faecal calprotectin (>100mcg/g)
    • Faecal calprotectin levels can be elevated in healthy, pre-school aged children and should be interpreted with caution
    • Not to be done in children <4 years old

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

• Acute, severe colitis (> 6 bloody bowel motions per 24 hours)
• Dehydration unable to be managed at home
• Suspected bowel obstruction (bilious vomiting, significant distention, lack of passage of flatus, obstipation)

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  
• 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
  • Coeliac serology: tissue transglutaminase IgA (TTG IgA), total IgA (where possible) with or without anti-endomysial antibody (EMA)
• Stool sample
  • Faecal multiplex PCR result
  • Faecal calprotectin result (in children aged > 4 years with diarrhoea > 4 weeks)
• Any previous investigations e.g., x-ray, ultrasound

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 on (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.