Recommendations of when to refer to a paediatric subspecialist
| Cardiology | Presence of other significant cardiac symptoms and/or signs, particularly colour change (cyanosis or pallor), syncope, dizziness, palpitations, sweating, nausea, dyspnoea |
| Presence of a crushing, poorly localised pain with radiation to the left arm | |
| Exercise-induced pain (assuming not due to asthma) | |
| Strong family history of heart disease (especially hypertrophic obstructive cardiomyopathy, arrhythmias, sudden death or premature ischaemic heart disease) | |
| Suspicion of Marfan syndrome or other connective tissue disorders | |
| Respiratory | Presence of other significant respiratory symptoms and/or signs, particularly breathlessness, cough, noisy breathing, sputum production, haemoptysis |
| When asthma is likely but has not responded to standard asthma therapy, especially when pain is exercise induced | |
| Gastroenterology | Presence of other significant gastrointestinal symptoms and/or signs, particularly dysphagia |
| When gastro-oesophageal reflux is likely but has not responded to adequate reflux therapy |
This assumes no underlying diagnosis has been made, as referral may be required depending on the presence of an identified cause. Referral may sometimes be necessary to offer further reassurance, even if a significant diagnosis is unlikely.