Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
ALT, GGT Bilirubin
Albumin
CBC, ESR/CRP
Celiac Screen on Gluten
Description of Symptoms (if relevant)
Pediatric Consult
Abdominal Pain (chronic or recurrent)
1. Refer to pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the indicated information/investigations.
Red flags include;
*weight loss
*diarrhea +/- blood
*vomiting
*nocturnal waking
*fever
*fatigue
*age <3 years old
Autoantibody screening for celiac disease positive
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Celiac Screen on Gluten
Complete blood count
Ferritin
Celiac Screen: positive finding
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
C Diff Toxin (age >1 year)
CBC, ESR/CRP
Celiac Screen on Gluten
Description of Symptoms (if relevant)
Electrolytes, TCO2
Iron Studies
Stool O&P, culture
Total Protein / Albumin
Chronic diarrhea = duration >4 weeks
1. Refer to pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the indicated information/investigations.
Red flag;
*>5% weight loss
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Liver disease (chronic)/Portal Hypertension
Conjugated hyperbilirubinemia
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
ALT, AST, GGT
Abdominal U/s
Bili T/D
INR
Stool Color
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Calcium
Celiac screen on Gluten
Description of Stool
Electrolytes, TCO2
Pediatric Consult
TSH
Treatment (dose, duration, results)
1. Refer to pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the required information/investigations.
Note: Simple constipation is triaged initially to constipation teaching sessions. Four sessions are currently offered per year.
Diet / texture progression difficulty
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Diet / texture progression difficulty
1. Refer to pediatrician.
2. Consider referral to Nutrition Services if one or more food groups are missing from diet or very low food variety with suspected nutritional deficiency.
3. For feeding issues; refer to Feeding and Swallowing Services
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Description of Symptoms
Dysphagia or Odynphagia
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
CBC, ESR/CRP
Ca, Phos, ALT
Celiac screen on Gluten
Electrolytes, BUN, Creat.
Pediatric and/or Nutrition Services consult
Total protein/albumin
1. Consider referral to both pediatrician and Nutrition Services.
2. Refer to Feeding and Swallowing Services when there is difficulty eating due to an anatomical or developmental concern or when there is a swallowing difficulty.
3. For case with suspected GI causes, refer to pediatric gastroenterology.
Fatty liver with elevated BMI
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
AST, ALT, GGT, ALP
Abdominal U/S
Bil, ALB
Lipid Profile
Fatty Liver with elevated BMI (BMI 85th percentile or greater for age)
1. Refer to pediatrician.
2. Refer to Provincial Pediatric Weight Management Services - Central Access Service.
3. Referral from pediatrician to pediatric gastroenterology must include required information/investigations.
Fatty liver without elevated BMI
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
AST, ALT, GGT, ALP
Abdominal U/S
Bil, ALB
Lipid Profile
Fatty Liver without elevated BMI (BMI 85th percentile or less)
Feeding difficulty with suspected aspiration
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
1. Refer to Feeding and Swallowing Services
2. May require a prior referral to pediatrician and/or Nutrition Services for a clinical assessment.
Feeding difficulty without failure to thrive
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
1. Refer to pediatrician.
2. Consider referral to Nutrition Services if one or more food groups are missing from diet or very low food variety with suspected nutrient deficiency.
3. If child is not able to eat anatomically/developmentally, refer to Feeding and Swallowing Services
4. For suspected eating disorder refer to Eating Disorder Program
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
History and type of allergy
1. Refer to pediatrician.
2. Pediatrician may consider referral to Nutrition Services for overall assessment and/or to pediatric allergist for allergy confirmation.
Gastroesophageal reflux disease
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Pediatric Consult
1. Refer to pediatrician.
2. Persistent complicated (FTT, hematemesis, respiratory symptoms) or medication-dependent GE reflux may be referred to pediatric gastroenterology for long term management.
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Complete blood count
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
ALT, AST, GGT
Bili, T/D
Complete Blood Count
INR
Hepatitis: Acute (ALT >10x normal, normal INR)
Hepatitis B and hepatitis C
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Hepatitis B, C - serology positive
Imaging of abdomen abnormal
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Imaging Report
Consider contacting pediatric gastroenterology service directly to determine the optimal approach
Inflammatory bowel disease
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
ALT, GGT, lipase
Albumin
C. difficile toxin
Complete blood count
Description of symptoms (if active send abnormal labs, if suspected send normal labs)
ESR/CRP
Ferritin/Iron studies
Stool C&S, O&P
Active/suspected/inactive
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Celiac screen on Gluten
Complete blood count
ESR/CRP
Iron studies
Potential reason for deficiency
1. Refer to pediatrician.
2. For anemia with suspected GI cause, refer to pediatric gastroenterology.
3. Refer to Nutrition Services if one or more food groups are missing from diet or very low food variety with suspected nutritional deficiency.
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
ALT, GGT, Bili T/D
Abnormal ultrasound
Albumin
CK
Complete blood count
INR
IgG
Viral hepatitis screen (B&C)
Abnormal on 2 occasions over 3-6 months
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Nutrition/Nutrient Deficiency
1. Consider referral to both pediatrician and Nutrition Services.
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Abdominal U/S
Lipase
Chronic/recurrent
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Abdominal U/S
Barium Swallow
Complete blood count
Electrolyte
Persistent vomiting/nausea
1. Pediatric gastroenterologists may refer to surgery for confirmed malrotation.
Red flag;
*bilious vomiting (emergency)
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Family history (mutation and/or names of polyps if available)
Previous screening/colonoscopy if available
Polyposis, family history
1. May require referral to medical genetics.
Rectal bleeding age 1 year or older
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Albumin
Complete blood count
ESR/CRP
Age >1 year without constipation
Rectal bleeding age < 12 months
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Albumin
Complete blood count
ESR/CRP
Pediatric Consult
Age <12 months without constipation
1. Refer to pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the indicated information/investigations
Unconjugated hyperbilirubinemia
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years
Bili, T/D
Complete Blood count
Pediatric Consult
1. Refer to a pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the indicated information/investigations.