Community paediatrics

We assess and manage children aged 0-17 (up to 19 in some circumstances), who have developmental difficulties or are at higher risk of developing them.

For example, we see children:

• Who were born very prematurely
• With genetic disorders
• Who have general developmental delays, neurological or motor difficulties
• With neurodevelopmental disorders (e.g. Autism).

Please see the acceptance criteria below for further information.

We also manage associated medical conditions when they occur alongside other developmental problems, such as sleep difficulties or epilepsy, although we wouldn’t normally see a child if these were the only concerns.

Children we are unable to see

We don't see children who:

Are having difficulties with just one aspect of their development – for example only speech difficulties, or only walking difficulties – unless the therapist asks for a doctor’s opinion.

Are having difficulties learning in school without any other medical needs – a referral to educational psychology would be advised instead.

Need initial behavioural advice – a referral to Early Start, SAFE or clinical psychology services would be advised in the first instance, which may lead to a referral to the community paediatricians if needed.

When a child is referred to the community paediatric team, the referral will be reviewed by a consultant paediatrician in a multi-disciplinary meeting with the clinical nurse specialist and therapists.

If accepted, your child should be offered an appointment within 18 weeks.

If rejected, you and the professional who referred you will receive a letter explaining why the referral was not accepted along with specific advice on what to do instead.

Should you have any questions following an unsuccessful referral, please discuss these with the person who referred you as they will be able to advise you on what to do next. We are unable to go into any more detail or reconsider referrals.

What to expect at your first appointment

The first appointment takes around 1 hour. Please bring the child with you to this appointment. If you want to be able to speak to the doctor without your child listening, bring another adult to supervise them during this time, but we need to see the child.

We ask that you don’t bring siblings with you unless it cannot be avoided - we’d like you to be free to focus on the child being assessed. If you do need to bring other children, please bring something to keep them occupied.

At the first appointment, you will be seen by one of the team, who will ask you questions about:

• Your concerns
• Why your child was referred
• Your child’s birth, development, and medical history
• The rest of the family – their health and development
• Housing/sleep/feeding issues
• What support you currently receive
• How your child is doing at nursery or school
• Any other concerns.

Please bring your red book with you, any reports from other doctors or therapists you see (including those you have seen privately) any information from your child’s nursery or school that you’d like us to know.

At the first appointment, the doctor will probably ask to examine your child and measure them.

At the end of the appointment, the doctor will discuss their opinion and make a plan with you about what will happen next.

Developmental assessments

For children under 5 years old, we often carry out developmental assessments. This is typically at the first appointment. A developmental assessment takes around 15 minutes, sometimes more, sometimes less. We use a variety of toys and games, along with some questions and talking, to assess a child’s development.

Most children find them fun and are happy to join in. Some do get shy or excited. If this happens, the doctors might ask for your help in encouraging them, or keeping your child focussed and calm, but will ask that you don’t tell them the answers or show them what to do as this will affect the outcome of the assessment.

Some children find it too hard to join in a developmental assessment at all. If so, we will observe what they can do in the clinic, and talk to you about what you’ve seen at home.

We can’t do developmental assessments on older children. Once children are over 5 years old, if they are having difficulties and don’t seem to be keeping up with their peers, it’s time to stop thinking about developmental delays and start thinking about learning difficulties. Learning Difficulties are something educational psychologists look into – schools can make referrals to the educational psychology service for assessment if needed.

Most clinics are based at Carmelita House on Ealing Broadway. We also run clinics at Acton Health Centre and hope to start at other sites on the western side of the borough. We do run some clinics in specialist schools and specialist nurseries. We don't routinely offer a home visiting service, although this may be done in exceptional circumstances.

There is no general patient/parent parking available on-site at Carmelita House. There are two blue badge spaces, but they get filled up very quickly and we can’t guarantee availability or book spaces.

There is often more parking at Acton Health Centre – there are spaces outside and you can enter your car licence plate on the iPad at reception which gives you 2 hours of parking.

There are street parking and public car parks available at both sites. Both sites also have good public transport links. There are toilets and baby change facilities at both sites.

Addresses

Carmelita House: 21-22 The Mall, London, W5 2PJ

Acton Health Centre: 35-61 Church Rd, London W3 8QE

The community paediatric team accepts referrals from professionals within the health, educational, and social care sectors. We do not accept parental referrals. Referrals from private providers may also be considered if supported by another professional, for example, a private speech therapy report would be considered if sent by the school SENCO as part of their concerns.

General referral criteria

The child must be:

• Eligible to receive NHS care
• ​​​​​​Registered with an Ealing GP practice, and live in Ealing, or within 1 mile of the boundary
  • Children who live within the boundaries of Ealing who are not registered to a GP can also be seen​​​​​
• Aged between 0-17 years (up to 19 years for children in special schools)

Referrals for possible autism spectrum disorder (ASD) assessments

The child must be:

• Aged 2-5yrs old
  • Children under 2 are not accepted for ASD assessments but may be referred for general developmental support if there are overall developmental concerns
• Aged 6 years or more if they have a Learning Disability
  • Children aged 6 and over are usually referred to the CAMHS neurodevelopmental (NDS) service for assessment unless the child also has a learning disability, in which case referral is to the Community Paediatric Team.
  •  Please note that Learning Disability (also called Intellectual Disability) is a medical diagnosis that requires formal assessment, often by Educational Psychology. Learning Difficulties is a different term, used by education to describe children who need extra help in school. As a rule, if a child attends a mainstream school and there’s no clear diagnosis of Learning Disability, referrals for ASD should be sent to CAMHS NDS
• In a nursery or school setting and have attended 1-2 terms prior to referral, or have attended a Stay and Play regularly for 1-2 terms – staff at the Stay and Play will need to be able to provide information about the child
• Seen by speech and language therapy – attended a workshop and had an initial assessment​​​​​​​​​​​​​​
• Have received either one block of therapy or a minimum of 1-2 terms of support from the team in nursery/school before being referred for ASD assessment. In some circumstances, if a nursery/school can demonstrate that they have put intervention in place already for 1-2 terms even if the SLT team has not yet written a programme, this can be accepted.

Children without these requirements may be referred for general developmental assessments but will not be put forwards for ASD assessments unless these criteria are met.  

Referrals for possible attention deficit hyperactivity disorder (ADHD)

The child development team (CDT) does not offer an ADHD assessment service as routine. This service is delivered by the CAMHS neurodevelopmental (NDS) service, for children aged 6 years and upwards.

We can sometimes accept referrals for children under 6, although not under 4 years old, to consider if behavioural challenges might be in keeping with possible ADHD. Parents should have attended a behavioural management programme e.g. Incredible Years programme (this and other programmes are available via the Ealing Parenting Help service), and have strategies put into place in nursery/school, before referring.

In this circumstance, we may be able to advise parents on future actions however at such a young age, a confirmed diagnosis is unlikely. Medical management is not possible in children under 6 years old, therefore children are likely to be discharged with advice to implement at home and in school, and advised to seek onward referral to the NDS when older if medication might be required.

Referral contact information

Please email referrals to ealingcommunity.referrals@nhs.net

Faxed or postal referrals are no longer accepted.

For any queries, please contact the child development team on 0300 1234 544 and select Community Children’s Health Services.