ALT, GGT, Bili, Lipase
Albumin
CBC, ESR/CRP
Celiac screen on gluten
Description of symptoms (if relevant)
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
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
CBC
Celiac screen on gluten
Ferritin
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Celiac Screen: positive finding
C. Diff toxin (age >1 year)
CBC, ESR/CRP
Celiac screen on gluten
Description of symptoms (if relevant)
Electrolytes, TCO2
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Iron studies
Results of lactose free diet trial for 2-3 weeks if indicated.
Stool O&P, culture, fecal calprotectin
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
ALT, AST, GGT
Abdominal U/S
Bili T/D
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
INR
Stool color
Ca
Celiac screen on gluten
Description of stool according to Bristol Stool Chart
Electrolytes, TCO2
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Pediatric consult
Results of treatment according to the Enhanced Primary Care Pathway for Childhood Constipation
TSH
Treatment (dose, duration, results)
1. Refer to pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the required information/investigations.
For guidance on the management of constipation in children, please refer to the
Enhanced Primary Care Pathway for Childhood Constipation or refer to pediatrician.
Diet/texture progression difficulty
Diet/Texture progression difficulty
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 Pediatric Nutrition Counselling (PNC) Fax- 403-476-9621
Nutrition Counselling - Pediatric3. For feeding issues refer to Eating, Feeding, Swallowing Services- Fax 403-476-7756 ph 403-955-7107
Barium Swallow if food sticking
Description of symptoms
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Dysphagia or Odynophagia
Food bolus obstruction should be directed to Emergency Department
CBC, ESR/CRP
Ca, Phos, ALT
Celiac screen on gluten
Electrolytes, BUN, Creat.
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Medication list (including dose, frequency and route)
Pediatric and/or Nutrition Services consult
Total protein/albumin
1. Consider referral to Pediatric Nutrition Counselling (PNC) Fax- 403-476-9621
2. For feeding issues refer to Eating, Feeding, Swallowing Services- Fax 403-476-7756 ph 403-955-7107
Fatty liver with elevated BMI
AST, ALT, GGT, ALP
Abdominal U/S
BIL, ALB
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Lipid profile
Fatty Liver with elevated BMI (BMI 85th percentile or greater for age)1. Refer to pediatrician.
2. Refer to Pediatric Center for Weight and Health (PCWH)
Link3. Referral from pediatrician to pediatric gastroenterology must include required information/investigations.
Fatty liver without elevated BMI
AST, ALT, GGT, ALP
Abdominal U/S
BIL, ALB
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
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 Eating, Feeding, Swallowing Services- Fax 403-476-7756 ph 403-955-7107
2. May require a prior referral to pediatrician and/or Pediatric Nutrition Counselling 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. Consider referral to Pediatric Nutrition Counselling (PNC) Fax- 403-476-9621
4. Refer to Eating, Feeding, Swallowing Services- Fax 403-476-7756 ph 403-955-7107
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. Consider referral to Pediatric Nutrition Counselling (PNC) Fax- 403-476-9621
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 month if complicated or 3-6 months if persistent for long term management
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.
CBC
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
CBC
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
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
Image finding (optional)
Consider contacting pediatric gastroenterology service directly to determine the optimal approach.
Inflammatory bowel disease
ALT, GGT, lipase
Albumin
C. difficile toxin
CBC
Description of symptoms including the following (if active send abnormal labs, if suspected send normal labs):- Diarrhea: bloody/non-bloody- Abdominal pain & characteristic- Vomiting- Weight loss (kgs/month)-Duration of symptoms- Bowel movements per day- Family history of IBD
ESR/CRP
Ferritin/Iron studies
Growth chart (or at least current height/weight)*BMI should be calculated and plotted for children ages 2-17 years
Stool C&S, O&P
Active/suspected/inactive
CBC
Celiac screen on gluten
ESR/CRP
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
CBC
CK
Growth chart (or at least current height/weight) *BMI should be calculated and plotted for children ages 2-17 years.
INR
IgG
Viral hepatitis screen (B&C)
Abnormal on 2 occasions over 3-6 months
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Nutrition/Nutrient Deficiency
1. Consider referral to Pediatric Nutrition Counselling (PNC) Fax- 403-476-9621
Abdominal U/S
Abdominal U/S
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Lipase
Chronic/recurrent
Abdominal ultrasound
Barium swallow
CBC
Electrolytes
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Persistent vomiting/nausea
1. Pediatric gastroenterologists may refer to surgery for confirmed malrotation.
Red flag;
*bilious vomiting (emergency)
Family history (mutation and/or names of polyps if available)
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Previous screening/colonoscopy if available
Polyposis, family history
1. May require referral to medical genetics.
Rectal bleeding age 1 year or older
Albumin
CBC
ESR/CRP
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Age >1 year without constipation
Rectal bleeding age under 12 months
Albumin
CBC
ESR/CRP
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
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
Bili T/D
CBC
Growth chart (or at least current height/weight)*BMI shouldbe calculated and plotted for children ages 2-17 years
Pediatric consult
1. Refer to a pediatrician.
2. Referral from pediatrician to pediatric gastroenterology must include the indicated information/
investigations.