The following
pre-referral guidelines aim to support local doctors to make appropriate
referrals to the deformational plagiocephaly clinic and to ensure all necessary
information is provided at the time of referral so the referral can be
appropriately triaged.
Referral
information
- A medical referral is requested for General Medical/Deformational
Plagiocephaly Clinic.
- Additional information from the local Physiotherapist and MCHN can be
very helpful and we encourage them to liaise with the referring
doctor/specialist to include this information with the referral.
Initial
work-up
- Assessment
of Head Shape, include severity assessment scores completed by a
physiotherapist (inclusion of the severity score is recommended by not
required)
- Assessment of neck range of movement
- Birth history (gestation, mode of delivery including
instrumentation, postnatal complications)
- Thorough general medical and developmental history
Pre-referral
management of plagiocephaly
- Referral
to local paediatric physiotherapist – either through local community health
centre, local hospital or privately. Community physiotherapy, in
particular for the management of torticollis, is strongly recommended prior to
a referral to deformational plagiocephaly clinic.
- No
imaging is required.
- Please
provide relevant handouts to parents/carers regarding Tummy Time, Safe
Sleeping, Repositioning of Baby’s Head (see resources below).
When to refer
- Persistent
congenital muscular torticollis not improving with treatment.
- Please
refer infants with persistent plagiocephaly/brachycephaly/scaphocephaly at 4
months of age.
- Referral is appropriate
for children with the below severity rating scale scores (where available):
- Plagiocephaly severity
assessment score of greater than or equal to 6/15
- Brachycephaly severity
assessment score of greater than or equal to 4/9
- Scaphocephaly severity
assessment score of greater than or equal to 4/9
- Posterior flattening
equal to 2 or more with facial asymmetry
- Moderate plagiocephaly
with developmental delay and/or congenital muscular torticollis
Please
note the following
- Your
child will be seen by a Physiotherapist and/or General Paediatrician depending
on needs determined by assessment at triage and in clinic. The clinic does not
provide ongoing physiotherapy management.
- Children
must be reviewed in the Deformational Plagiocephaly Clinic prior to being
considered eligible for helmet therapy.
- The
optimal age for helmet therapy is between 6-9 months corrected age. Please
consider this when referring patients to the plagiocephaly clinic.
- Concerns regarding Craniosynostosis should be referred directly
to Cranio-facial surgery
- Persistent
congenital muscular torticollis not improving with treatment and older than 18
months of age should be referred to General Surgery for an opinion regarding
surgical release.
How to refer
- Complete
the SPECIALIST CLINIC REFERRAL FORM RCH-Specialist-Clinics-Referral(1).pdf
- This allows us to determine the level of urgency for the referral and ensure
the patient is triaged to the correct clinic and clinician.
- The referral
should be faxed as follows:
Attention: RCH Deformational Plagiocephaly Clinic
Facsimile (03)
9345 5034
Telephone (03) 9345 6180*
*The GP or
medical referring doctor should call to check the referral has been received.
It can take up to 3-5 days for a referral to be uploaded onto the RCH system
Private options
The RCH
General Medical and Deformational Plagiocephaly Clinics are public
clinics.
There are the following
private options:
- Local private
paediatricians who can assess for presence of torticollis, severity of head
shape deformity and causes of both.
- Local private
paediatric physiotherapists. Please be aware that these services are very
limited in regional and rural areas. Physiotherapy department can be
contacted for further guidance as required however suggest checking the
following website which allows you to search for local physiotherapists by
area: https://choose.physio/findaphysio
- Local private
orthotist services are available.
Contact
information
Specialist Clinics
Ph: (03) 9345 6180, 830am -5pm Monday to Friday
Fax: (03) 9345 5034
https://www.rch.org.au/specialist-clinics/contact-us/
General Medicine Department
Ph: (03) 9345 5579
Physiotherapy Department
Ph: (03) 9345 9300 (via Allied health reception), 830am
-5pm Monday to Friday
http://www.rch.org.au/physiotherapy
Orthotics and Prosthetics Department
Ph: (03) 9345 9300 (via Allied health reception), 830am
-5pm Monday to Friday
http://www.rch.org.au/orthotics?
Resources, references and further information
Related pre-referral guidelines