How should I approach the referral of a child with suspected Hirschsprung's disease to a specialist?

Approach to Referral for Suspected Hirschsprung's Disease:

• Do not perform a digital rectal examination yourself if the child is older than 1 year and has 'red flag' symptoms suggestive of Hirschsprung's disease or other anatomical abnormalities. Instead, refer urgently to a healthcare professional competent in performing and interpreting a digital rectal examination for this condition.
• Ensure that the referral is made to a specialist with the appropriate skills and experience, typically a paediatric surgeon or paediatrician with expertise in Hirschsprung's disease.
• Document all clinical findings and ensure privacy, informed consent, and presence of a chaperone if a digital rectal examination is to be performed by the specialist.
• Referral should be considered especially if the child has any of the following clinical features: delayed passage of meconium (>48 hours after birth in term babies), constipation since the first few weeks of life, chronic abdominal distension with vomiting, family history of Hirschsprung's disease, or faltering growth combined with these features.
• Do not attempt rectal biopsy or other invasive investigations yourself; these should be performed by specialist services after referral.

This approach ensures timely and appropriate specialist assessment and management of suspected Hirschsprung's disease in children.