This section is about referral pathways-
In the 0-19 Healthy Child Programme we often signpost out to specialist services or create links to community services and the voluntary sector. Below you will see a variety of scenarios.
Consider the scenarios in relation to:
1.) The condition or problem being presented or diagnosed.
2.)The process and referral pathway recommended by 0-19 HCP service, in keeping with the topic specific Clinical Guidance
3.)What your assessment would include during the contact and any advice you may give alongside referral.
1.) Maternal mental health
You are out on a visit with your Practice Supervisor who is completing an Antenatal contact. During the contact the mother to be [Charlotte] shares that she is feeling very low in mood and does not want her baby. The Health Visitor completes PHQ9 and GAD7 assessments, a tool used to monitor emotional wellbeing, for signs and symptoms of depression and anxiety. Charlotte scores very high on these assessments. The Health Visitor also discusses the importance of bonding and attachment between a mum and baby with Charlotte to promote fetal brain development and reciprocal relationships. Charlotte discloses that she does not like the baby, and she finds it irritating when she feels the baby move inside her.
What does the 0-19 HCP service Clinical Guidance say?
- Assess maternal mental health using clinical skills and sensitive questioning. If transient psychological symptoms (baby blues) are unresolved the Health Visitor should consider further assessment or referral to GP.
- If antenatal contact has not been completed a full maternal mental health assessment should be undertaken to identify past or present severe mental illness, past or present treatment by specialist mental health service and any severe perinatal mental illness in first degree relative. Use depression identification questionnaires and GAD-2 with further consideration of tools such as PHQ-9 and GAD –7. For referral see Universal plus tab.
- Does the mother need listening contacts or is it appropriate to ‘watch and wait’?
- Self-referral to CPFT Psychological Wellbeing Service (IAPT) at www.cpft.nhs.uk or calling 0300 300 0055 for low level emotional wellbeing needs
- Referral to Specialist Perinatal Mental Health service (Perinatalreferrals@cpft.nhs.uk) for assessment and treatment all women who have or are suspected to have severe mental illness or any history of severe mental illness. Inform GP and midwife of referral
- Crisis Referrals: to access First Response Service advise calling 111 and choosing Option 2
PIMH and GAD 7/ PHQ-9- [Please see end of section]
PIMH referral form [Please see end of section]
2.) Infant Jaundice
During a New Birth visit with a Health Visitor who is your Practice Supervisor today you encounter a baby with Jaundice.
What is jaundice: https://www.nhs.uk/conditions/jaundice-newborn/
What does the 0-19 HCP service Clinical Guidance say:
Jaundice policy [Please see end of section]
Jaundice referral process for different hospitals across Cambridgeshire and Peterborough:
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Jaundice referral process to Addenbrooke’s Hospital
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- Term babies who appear jaundice at the initial contact (usually 10-14 days) will need to be reviewed between 14-16 days and referred to clinic 6 if jaundice remains
- Clinic 6 will accept referrals up to 28 days of age
- Email Peter Heinz, Paediatric Consultant- Clinic 6 Referrals
Clinic.six@nhs.net
- Pre-term babies to be referred from 21 days if jaundice remains
Natalie (Baby review clinic co-ordinator) will respond within 24 hours. If referrer has not received a response within 24 hours confirming that an appointment will be sent, please ring Clinic 6 on 01223 586632 to confirm receipt of referral
- If baby is unwell and you need to speak to the paediatrician then please call Addenbrooke’s switchboard on 01223 245151 and ask to be put through to Paediatric on call registrar
- Babies who present with jaundice less than 24 hours of age should be seen in the Emergency Department as an emergency
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Referral details for babies within Huntingdon locality with jaundice
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If jaundice is still visible at 14-16 days of age the Health Visitor will contact the on call Paediatric Registrar via Hinchingbrooke Hospital switchboard on 01480 416416.
They would ask for the on call Paediatric Registrar to be bleeped and wait on the telephone to be connected.
The Paediatric registrar may require the following information:
Name of baby
Date of birth
Gestation at birth
Method of feeding
Description of stools/urine
History of jaundice and any significant factors
Contact number for parents if appointment not booked at the time of referral
Details of referrer
The registrar will advise on the plan and will either offer appointment details for the prolonged jaundice clinic held at Hinchingbrooke for you to relay to parents or take all details and contact the parents to advice of the plan.
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Referral to Peterborough Hospital
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For Peterborough Hospital call 07593 519457. They will give you an appointment for you to relay to the family. Please ensure you advise the family to attend the children's outpatients unit Rainforest ward. They will see the baby before they turn 3 weeks old.
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Referral details to Queen Elizabeth Hospital, Kings Lynn
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HV to call the 'early access clinic' on (01553) 214805
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3.) Breastfeeding
One week after you visited to complete the new birth visit, you visit Sarah and Freddie again at home to review Freddie’s weight, because you were concerned about the baby’s weight at the first visit. Freddie is now 3 weeks old. He has been breastfed since birth, but still hasn’t regained birth weight.
What does the 0-19 HCP service Clinical Guidance say?
Practitioner will observe a feed from start to finish and use a breastfeeding assessment tool to help identify the problem. If the problem cannot be resolved, consider referral to Infant Feeding Team or appropriate clinic.
- Ensure information on vitamins and ‘Healthy Start’ has been received
- Provide information regarding 1:1 support, local feeding support groups, online resources, and helplines
- If assessment indicates, give appropriate advice for conditions such as mastitis and candida albicans (Thrush) and prescribe appropriately or refer on to GP
- If assessment indicates a restricted lingual frenulum the Practitioner will discuss with the mother the treatment options, put a feeding plan in place and refer on as appropriate
- If assessment indicates that lactose intolerance is suspected, discuss with the mother the referral pathways and treatment options
- If there are concerns with growth then it is the identifying practitioner’s responsibility to put a feeding plan in place, onward referrals as appropriate and follow up as required- please refer to Growth Policy
Infant feeding team referral pathway: Referral pathway Infant feeding team pdf.pdf
Unicef Health Visiting breastfeeding assessment tool:
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2018/07/breastfeeding_assessment_tool_hv.pdf
Unicef parents breastfeeding assessment tool:
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf
Infant feeding policy [link]
Growth monitoring policy [link]
Unicef breastfeeding video- effective positioning and attachment video link:
Unicef breastfeeding video- ineffective positioning and attachment video link:
4.) Cow’s milk protein allergy
You attend a 6-week development review with your Practice Supervisor, who is undertaking the feeding assessment and a weight review. On examination, the baby Daisy is not gaining much weight and has dry skin.
During the feeding assessment your supervisor enquires about feeding and asks whether there is a history of allergies in the family. Mum [Claire] reports that Daisy is frequently sick and unsettled after feeds. There is a significant history of allergies in the family and older sibling had a problem with dairy when he was a baby. Your supervisor makes the clinical decision that this may be a cow milk protein allergy.
What does the Clinical Guidance Say?:
getresource.axd (cambridgeshireandpeterboroughccg.nhs.uk)
https://www.cambridgeshireandpeterboroughccg.nhs.uk/easysiteweb/getresource.axd?assetid=11716&type=0&servicetype=1
Allergy UK: Cow’s Milk Allergy:
Cow's Milk Allergy | Allergy UK | National Charity
Nice Guidance: Cow’s Milk Allergy in Children:
Cow's milk allergy in children | Health topics A to Z | CKS | NICE
NHS guidance for parent:
https://www.nhs.uk/common-health-questions/childrens-health/what-should-i-do-if-i-think-my-baby-is-allergic-or-intolerant-to-cows-milk/
British Dietetics Association Cows Milk Protein Information:
Milk allergy | British Dietetic Association (BDA)
5.) Placiocephaly
You attend a Health Visitor clinic with a Practice Supervisor- during the clinic you see a 3-month-old baby [Jenny]. You and your supervisor notice that Jenny has a very flat head on one side and Mum also raised this as a concern. Your supervisor explained to you that this is Plagiocephaly.
NHS guidance for parents about Plagiocephaly:
https://www.nhs.uk/conditions/plagiocephaly-brachycephaly/
Great Ormond Street Hospital information about Plagiocephaly:
https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/positional-plagiocephaly/
