Pediatric Neurology Referral Guidelines
The Neurology practice at Valley Children’s provides diagnostic services, medical treatment and follow-up care to infants, children and adolescents who have suspected or confirmed neurological disorders. Our pediatric neurologists manage and treat a variety of patients including those with seizures, epilepsy disorders, neuromuscular disorders and other neurological conditions.
We offer outpatient neurology services across the region to provide children and families access to care close to home. We provide full-time services in Madera and some of our neurologists live in Modesto and Merced and practice full-time at Valley Children’s pediatric subspecialty centers in those communities.
Refer to Neurology
Refer to the Neurology Department at Valley Children's online through CareLink or our referral portal, or refer via fax.
Refer a patientNeurology Office Numbers
Contact Pediatric Neurology via phone (559-353-6215) or fax (559-353-6222).
Contact a Physician Liaison
Physicians can reach a physician liaison for help with referrals or other questions by calling 559-353-7229.
The Neurology Practice at Valley Children’s provides diagnostic services, medical treatment and follow-up care to children who have suspected or confirmed neurological disorders, such as tumors, encephalitis, seizures or neuropathies. Follow-up care can include monitoring treatment outcomes, referring the child for additional medical care, and providing information and recommendation to the family for health, school and quality of life decisions. A neurologist is on call, 24 hours a day, 7 days a week, for emergencies.
The following conditions may be best treated by a pediatric neurologist:
- Abnormal/involuntary movement disorders (e.g., tics, ataxia, chorea)
- Cerebral palsy with seizures
- Developmental regression
- Headaches/migraines with no response to first line medications
- Neurological aspects of head injuries and brain tumors
- Seizure disorders, including seizures in newborns, febrile convulsions, and epilepsy
- 2nd seizure in 1 year
- <1 year of age
- Recent onset associated with traumatic brain injury
- In association with genetic syndrome, metabolic abnormality, or cerebral palsy
- Suspected muscular dystrophy
- Weakness – Non-acute, including cerebral palsy, muscular dystrophy, and nerve-muscle disorders
A pediatric neurologist has completed a residency in pediatrics and had additional training in adult and child neurology. Most pediatric neurologists have certification from the American Board of Pediatrics and the American Board of Psychiatry and Neurology (with special competency in child neurology).
Pediatric neurologists combine the expertise in diagnosing and treating disorders of the nervous system (brain, spinal cord, muscles, nerves) with an understanding of medical disorders in childhood and the special needs of the child and their family.
In many cases, pediatric neurologists work as a team with pediatricians or other primary care doctors.
In addition, pediatric neurologists may work with other pediatric specialists to care for children with more complex or serious medical issues, such as epilepsy, birth defects, or muscular dystrophy.
| Condition | Pre-Referral Work-up | When to Refer |
|---|---|---|
| Headache |
Patients with recurrent headache and a normal neurologic exam generally do not require ancillary testing MRI suggested for patients who have headaches that awaken them in the middle of the night, or begin All patients should have a fundoscopic exam to evaluate for papilledema prior to their referral |
Persistent or frequent (more than 1 per week) headaches not responding to first-line medications or for patients with headache Patients with a new severe headache of acute onset, headache with a focal neurologic deficit, or headache associated with papilledema should be |
| Febrile Seizures | Infants and toddlers up to 6 years with simple (benign) febrile seizures do not require brain imaging, EEG, or neurological consultation |
Children with multiple recurrences of simple febrile seizures may benefit from consultation on a case-by-case basis. Consultation may be considered for children with atypical (complex) febrile seizures, defined as lasting >15 minutes, a febrile seizure with partial onset, focal features during the seizure, or recurrent febrile seizures within 24 hours of the first episode. |
| First Afebrile Seizure | An awake and asleep EEG is optional after a first unprovoked afebrile seizure. Prefer EEG obtained at Valley Children’s. EEG should be scheduled at least 1 week after initial event |
After second event (EEG highly recommended) |
| Any seizure < 1 year old | EEG | Refer urgently (after EEG is completed) |
| Recurrent Unprovoked Seizures (epilepsy) |
Awake and asleep EEG MRI optional |
Consulting neurologist will provide the primary care physician with recommendations for further evaluation and management |
| Cerebral Palsy combined with epilepsy or other movement disorder |
Documentation of current interventions, therapies, and treatments Description of functional limitations Brain images such as MRI, CT, or ultrasound X-rays of the spine and lower extremities (for movement issues) |
As soon as diagnosed |
| Hypotonia / Suspected Neuromuscular Disease |
Serum CPK | After completion of study refer to Neurology Clinic |
| Developmental Delay | Some method of developmental screening / surveillance indicating global delay or delay in specific area (especially birth to age 3 assessments) completed | Refer to Central Valley Regional Center and then possibly Neurology Clinic depending on results of evaluation |