Referral guideline – Abnormal movements, tics or unsteadiness

Introduction

These are neurologic syndromes in which there is either an excess of movement or a paucity of voluntary and automatic movements, unrelated to weakness or spasticity.

GP management

• Neurological examination including fundoscopy
• Video of suspected abnormal movement

When to refer

Consider referral to the nearest emergency department that treats children if an acutely unwell patient presents with the following:

• other neurological symptoms
• prodromal illness
• regression of developmental milestones
• abnormal neurological examination
• well children should be referred to the nearest general paediatric service in the first instance
• general paediatricians should consider referral to QCH neurosciences following failure of first line treatment (e.g. child psychology and/or medications).

Essential referral info

• Detailed history of the movements (nature, severity, onset, associated symptoms etc.)
• Presence of any concerning features
• Patient details
• Medicare number
• Parent/carer name and contact details
• Referring clinician details (name, contact details, provider number, date and length of referral)

Helpful referral info

• Examination findings including fundoscopy
• Height/weight/head circumference
• Birth and developmental history
• Any relevant laboratory tests
• Medication history (including OTC)
• Significant psychosocial risk factors