CONSULT REQUEST GUIDELINES                                                                         Print

Failure to Thrive - requires Gastrostomy Tube

Suggested Pre-Referral Evaluation and Management Guidelines
  • Frequent small meals
  • Higher caloric formula
  • NG tube feeds
  • Celiac Panel or stress test
  • Sweat Test
  • Lab test
  • NG night feeds as supplement
  • Dietary consult 1st
Suggested Additional Test/Management Prior to Specialty Visit 1) Prep for Pediatric Upper GI
2) Ph probe (if clinically indicated)
Patient Education/Information (includes preps) 1) Gastrostomy tube
2) Prep: Prep for Pediatric Upper GI
3) Prep: ph probe
Appointment Timeframe Next Available Appointment.
Please complete Outpatient Consult Request Form and fax to 734-936-9784
How to Get Results to Consultant UMHS Patients: See MiChart
External Patients: Hand carry or fax records to 734-936-9784
Clinic Contact Information Physician: 800-962-3555
Patients: 734-764-4151
Clinic Location Sites C.S. Mott Children's Hospital
UM Consulting Physician Pediatric Surgery Faculty
Revised on: 01/15/2016



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