As one of the leading pediatric neuroscience programs in the country, Children's Healthcare of Atlanta specializes in medical and surgical treatment of children with neurological disorders.
How to refer a patient to Children's
- Online referral form: Complete and submit our secure online form.
- Print and fax: Download our form and fax it to 404-785-9111.
- accessCHOA: This free, secure, web-based electronic health record system provides physicians the ability to electronically submit referrals to Children’s specialists.
Note, please reference our neurology and neuropsychology referral guidelines below before referring a patient for consultation or testing.
Children’s Healthcare of Atlanta Neurology includes more than a dozen pediatric neurologists who provide care to children and teens with neurological disorders.
Neurology referral guidelines
Below are guidelines to follow when referring a patient for a consultation to Children’s Neurology. These are meant to be general recommendations. If you have specific questions, call 404-785-DOCS (3627), and ask to speak with the on-call neurologist.
Office notes are crucial in helping us determine the intricacies of your patient’s case.
- We require office notes beyond just the reason for referral.
- Whether you refer to them as Clinical Notes, History of Present Illness (HPI), Interval History or Notes, we need notes that the provider took during the last visit that explain the child’s case and chief concern for referral.
- A short “reason for referral” is not sufficient.
Criteria for simple febrile seizures:
- Between 6 months and 5 years old
- Fever
- No focal features
- Less than 15 minutes
- One in 24-hour period
Note, age of first simple febrile seizure does change criteria.
Criteria for simple headaches:
- Infrequent primary headache disorder (ex: migraine with or without aura or tension type) that responds to an abortive (OTC or triptan) and/or a first line preventative and lifestyle changes
- Recurrent headaches for less than 6 months without red flags unless meets criteria for chronic headache (15 days or more for over 3 months)
- Referrals from the ED (can make exceptions for documented chronicity) Suggestion: return to PCP for care and to determine if neurology referral is needed
- Acute onset headache (ex: associated with acute viral illness)
Criteria for syncope:
- Fainting in a standing position, then when sitting or lying
- Turning pale
- Vision went dark
- Low blood pressure
- Dizziness, lightheadedness, palpitations, fainting up on standing or moving to an upright position
If applicable, rule out syncope vs seizure with referral to cardiology first *If possible, obtain vitals when symptomatic (heart rate, blood pressure, etc.)
Criteria for tics (less than 6 months):
- Simple motor (i.e. blinking) and/or vocal tics (i.e. throat clearing, sniffing)
- Onset of tics between ages 4 to 11
- Not causing pain or interfering with activities OR have not tried one first-line tic medication (i.e. guanfacine or clonidine)
- Normal neurological exam
- No neurologic comorbidities
- Acute disseminated encephalomyelitis
- Anti-NMDA receptor encephalitis
- Cerebral palsy
- Complex autism spectrum disorder with a neurological component
- Concussion
- Epilepsy and seizure disorders
- Headaches and migraines
- Infantile spasms
- Leukodystrophy
- Movement disorders
- Multiple sclerosis
- Myasthenia gravis
- Myopathies
- Neurodevelopmental disorders
- Neurometabolic and neurogenetic disorders
- Neuromyelitis optica
- Neuropathy
- Psychogenic nonepileptic events (PNEE)
- Rett syndrome
- Spasticity
- Spells
- Spinal muscular atrophy
- Stroke
- Transverse myelitis
- Traumatic brain injury
Lab documents to send as part of referral:
- Office notes, documentation of birth history and previous neuroimaging, preferred
Criteria for referral:
- Known CP with co-morbid neurological disorders (e.g. epilepsy)
- Known CP without a current CP provider (not already seeing Physiatry)
- Suspected CP:
- Prematurity AND motor delay or problems with posture or muscle tone (hypertonia or hypotonia)
- History of brain injury or abnormal brain development AND motor delay or problems with posture or muscle tone (hypertonia or hypotonia)
- Motor delay AND exaggerated reflexes
- Motor delay AND hypertonia (stiffness, spasticity)
- Spasticity:
- Increased muscle tone
- Involuntary movements which may cause spasms and contractures
- Exaggerated reflexes
- Contractures
- Altered posture
Lab documents to send as part of referral:
- Developmental assessments
- Other referrals
- MRI
- Genetics
- EEG results
- Description of medical or neurological complexity
- Current disabilities
Criteria for referral:
- Known primary neurologic or genetic disorder with documented evidence
- Description of reason that psychological evaluation at Marcus Autism Center would not be sufficient (do not include wait list issues)
- Documented visit with general or specialty neurology appointment with findings substantiating complexity
Lab documents to send as part of referral:
- Office notes
- EEG
- Imaging results
Criteria for referral:
- Two or more unprovoked seizures with or without abnormal EEG OR
- Known diagnosis of epilepsy/second opinion
Lab documents to send as part of referral:
- Office notes (including documentation that patient meets criteria)
- Imaging results
Criteria for referral:
- Recurrent headache for >6 months, not responding to abortive treatment and lifestyle modifications
- Headaches with other associated red flags or focal neurological deficits
- Headache that is resulting in missed school days or worsening school performance (including declining grades or decreased participation in extracurricular activities
- Chronic headache criteria: Headache greater than 15 days in a month for over 3 month
Lab documents to send as part of referral:
- Office notes
Criteria for referral:
- Low muscle tone affecting development
Lab documents to send as part of referral:
- Office notes
- Lab results
- MRI results
Criteria for referral:
- Abnormal involuntary movements with retained awareness (i.e. chorea, ataxia, dystonia)
Lab documents to send as part of referral:
- OT, SLP or PT notes
- Lab results
- Imaging results
Criteria for referral:
- Office notes pertaining to the developmental delay in question
- Developmental screening results from within the last 3 months
- Concern for not meeting developmental milestones
- Evidence that idiopathic autism spectrum disorder is not and should not be the primary concern
Lab documents to send as part of referral:
- Office notes
Criteria for referral:
- Numbness, tingling, burning sensation
- Increased sensation to touch
- Muscle weakness
- Pain
- Family history or inherited neuropathies
Lab documents to send as part of referral:
- Office notes
- Lab results
- Genetic testing (if already preformed)
- Any imaging (MRI, EEG, CT)
- Release of information from previous/current facilities
Criteria for referral:
- Slowed growth
- Developmental delays (loss of coordination and movement)
- Unusual hand movements
- Seizures
- Sleep disturbances and irritability
- Genetic testing
- CT/MRI/EEG
Lab documents to send as part of referral:
- Office notes
- EEG results
- ED notes if applicable
- Screening measures if applicable
- Family recorded video of event(s) if applicable
Criteria for referral:
- If applicable, rule out syncope vs seizure with referral to cardiology first
- Screening for depression, anxiety, suicidal or homicidal ideation
- Episodes of full body convulsions, staring spells, or jerking on one side of the body
- Counsel family to record video for events to have available for appointment
Lab documents to send as part of referral:
- Office notes
- Lab results
Criteria for referral:
- Complex motor (jumping, hitting, copropraxia) +/- complex vocal tics (coprolalia, words/phrases)
- Onset of tics after age 11, or under age 4
- Simple tics which have failed one first-line medication
- Abnormal neurological exam or neurologic comorbidities (i.e. autism, cerebral palsy)
- Eye fluttering
- Concern for seizures
- Routine/first available appointment:
- Brief episodes
- No altered mental status
- Previously sought ED care for tics
If you feel your patient needs to be seen as soon as possible, note “urgent” on your referral. All referrals marked “urgent” are triaged to help make sure patients are seen in a timely fashion. If you wish to speak to the on-call neurologist, call 404-785-DOCS (3627).
The Judson L. Hawk Jr., MD, Clinic for Children consists of a multidisciplinary team of doctors who see patients with a wide range of medical conditions. This clinic is different than Children’s Outpatient Neurology and therefore has a different referral review process. If your child requires treatment for one of the following conditions listed below, please fax a referral to 404-785-9111.
- Charcot-Marie-Tooth
- Facioscapulohumeral muscular dystrophy
- Muscular dystrophy
- Neurocutaneous syndrome
- Neurofibromatosis
- Tuberous sclerosis complex
Finding an adult neurologist
Our team has complied a list of adult neurologists for you to consider.
View list
Helping children on a keto diet adjust to and maintain a healthy lifestyle.
Our specialists may recommend the ketogenic diet for children with seizures that are hard to control with medications or when medications have not worked. For these children, we offer a multidisciplinary clinic.
MAKE A REFERRALEducational materials to support community pediatricians in managing specific conditions
Our neurology team has developed the following educational resources designed to address frequently asked questions, assisting community providers in effectively managing specific conditions within their practice. For specific questions, call 404-785-DOCS (3627).
Community Provider Guidelines for Managing Simple Headaches
Commonly asked questions
What is the root cause of my migraine symptoms?
- Migraine is a complex neurologic disease that has genetic, environmental and lifestyle factors that contribute.
What non-medicine options do I have to treat migraine?
- Lifestyle modifications can include getting adequate sleep, avoiding prolonged periods of fasting (don't skip meals), managing stress, exercising regularly, maintaining healthy body weight and nutrition, and avoiding regular caffeine use.
Do I need an MRI or blood work to diagnose my headache disorder?
- Patients do not need an MRI or blood work to diagnose a primary headache disorder such as a migraine or tension type headache.
How do you know I do not have a brain tumor or aneurysm?
- Take a detailed history and perform a neurologic examination.
- Based on well establish data, if there are no "red flags" in your patient’s history and the neurologic exam is normal, the chances of your patient having a brain tumor or aneurysm are highly unlikely.
What can I do about headaches at school?
- For headaches at school, it is recommended to have rescue medications available.
- You can provide a letter for school that will allow your patient accommodations and access to medications as needed during the school day.
Worrisome headache red flags (SNOOP)
- Systemic symptoms: fever, hypertension, weight changes or
- Secondary headache risk factors: HIV, systemic cancer or recent trauma
- Neurologic symptoms or abnormal signs: confusion, impaired alertness or consciousness
- Onset: sudden, abrupt or split-second
- Older or other: new onset at age >50, young age
- Previous headache history or headache progression: first headache or different (change in attack frequency, severity or clinical features)
Community Provider Guidelines for Managing Simple Febrile Seizure
Commonly asked questions
What is a febrile seizure?
- A febrile seizure is a seizure occurring in a child (between the ages of 6 months and 5 years) with a febrile illness, who has not previously had a non-febrile seizure, and who does not have another cause for their seizure, such as central nervous system infection or electrolyte abnormality.
- Sometimes, the fever can present after the seizure.
- Febrile seizures are very common and occur in approximately 2 to 5% of children.
What is a simple febrile seizure?
- A simple febrile seizure is a febrile seizure that occurs as a single seizure lasting 15 minutes, then it would be classified as a complex febrile seizure.
Do simple febrile seizures need to be treated with anti-seizure medication?
- We do not treat patients with simple febrile seizures with daily anti-seizure medication.
- You may consider offering the family a seizure rescue medicine to be given if the child experiences a future seizure which lasts >5 minutes.
- In this age group, the rescue medicine we use is called Diastat, which is diazepam administered rectally.
Should I order a brain MRI, EEG test, or refer them to Neurology?
- MRI and EEG are not needed for patients with simple febrile seizures.
- With simple febrile seizures, the overwhelming majority (~98%) of patients will outgrow their seizures and Neurology consult is not needed.
Would anti-pyretic medications help prevent subsequent febrile seizures when they develop fevers in the future?
- Antipyretics like acetaminophen or ibuprofen may help with reducing the fever, but they haven't been shown to reduce the chances of having a febrile seizure
Community Provider Guidelines for Tic Disorders
Commonly asked questions
How do we diagnose tic disorders and Tourette syndrome?
- Tics are repetitive, patterned, and involuntary movements or sounds that can occur starting in early childhood.
- Examples of common motor tics include eye blinking, eye rolling, and twitches or jerks of the head or shoulders.
- Examples of common vocal tics include sniffing, throat clearing, humming and grunting. Tics can be somewhat suppressible, but they can be more frequent with fatigue, stress and illness.
- Tics occurring on and off for less than one year are referred to as "transient tics" or "provisional tic disorder."
- When tics have been occurring on and off for greater than one year, we consider this a chronic tic disorder. Chronic tic disorders are further classified as chronic motor tic disorder, chronic vocal tic disorder or Tourette syndrome (a combination of at least two motor tics and at least one vocal tics).
- Tic disorders may be associated with other problems such as anxiety, ADHD, OCD or learning problems. It is important to screen for these comorbidities.
When should tics be treated?
- Most tics are transient, not harmful and do not require treatment.
- It is recommended to start medication when tics are causing the patient pain or negatively impacting the patient's quality of life. Medication should be considered when the potential benefit of reducing tics outweighs the risk of potential side effects.
- There is no cure for tics and medications do not usually suppress tics completely, but they can help reduce the frequency and severity of tics.
- Behavioral therapies such as Comprehensive Behavioral Intervention for Tics (CBIT) or Habit Reversal Therapy can be helpful for children who are old enough to describe their tic urges (usually age 8 and older). However, these therapies can be difficult to find in Georgia.
What first-line medications should be used to treat tics?
- Alpha agonists (clonidine or guanfacine) are recommended as first-line medications for tics. They may also provide some benefit for symptoms of hyperactivity, inattention and aggression. These medications may be titrated slowly or quickly depending on severity of symptoms. The final daily dose needed varies by patient.
- The most common side effect is sedation. Less common side effects include mood/personality changes (depression), headaches, light-headedness, stomach upset and nightmares.
- If the patient is taking other medicines that cause sleepiness, lightheadedness/dizziness or low blood pressure as a side effect, adding clonidine or guanfacine may make these symptoms worse.
Is treatment of ADHD with stimulant medications recommended in patients with tics?
- Tic disorders are associated with ADHD, and the presence of tics should not prevent a patient from being treated for ADHD if needed.
- Stimulant medications can sometimes increase the frequency of tics. If this occurs and the tics are bothersome, lowering the dose or switching medications sometimes helps.
- In some children, treating ADHD results in improvement of tics as improving ADHD symptoms can relieve stress. Non-stimulant medications for ADHD can also be considered.
What is the prognosis of tic disorders?
- In general, the prognosis of tic disorders is good. Tics tend to peak between ages 9 and 14.
- After 14 years, most patients tic less often than they did as a child, whether they were treated with medication or not.
Resources to share with families
Community Provider Guidelines for Managing Syncope
Commonly asked questions
What is syncope?
- Syncope is used to describe a loss of consciousness for a short period of time. It can happen when there is a sudden change in the blood flow to the brain.
- Syncope is usually called ‘fainting’ or ‘passing out’.
- Syncope can happen in healthy subjects.
- It affects all ages.
- People affected will slowly return to normal.
What are the associated symptoms of syncope?
- Feeling dizzy
- Feeling lightheaded
- Palpitation
- Feeling like they have to vomit
- Vision that becomes unclear or blacks out
- Cold or clammy skin
What to do if I encounter a person with syncope?
- First, make sure the person is still breathing after they faint.
- The individual should lie down flat for 10 to 15 minutes if they can in a cool, quiet area. If this is not possible, they should sit up with their head between their knees.
- Sipping on cold water can also help.
- People tend to recover within a few minutes.
Should I order a Brain MRI, EEG test, or refer them to neurology clinic?
- MRI and EEG are usually not needed for patients with syncope.
- Evaluating the patient for lifestyle risk factors and identifying triggers, especially those causing stress/anxiety, can help mitigate these symptoms.
- Referral to a psychologist and therapy can often be beneficial for patients with triggers related to stress and anxiety.
Does syncope need to be treated with anti-seizure medication?
- No, we do not treat patients with syncope with anti-seizure medication as the underlying cause is not due to epileptic discharges (seizures) from the brain.
- Syncope occurs due to factors that cause inadequate cerebral perfusion, for example low blood pressure.
What conservative/non-medication options do I have to treat syncope?
- Emphasis should be given on healthy lifestyle modifications that include good hydration, avoiding caffeinated and sugary beverages, and avoiding prolonged periods of fasting (don't skip meals).
- Adding salt in the diet can help improve low blood pressure.
- Consider a cardiology referral if symptoms prevail despite conservative measures.
Seizure resources for your practice and your patient families
Learn MoreChildren’s Healthcare of Atlanta Neuropsychology team evaluates children and teens to help identify behavioral issues. Whether your patient needs an assessment of an injury or a scan to see how his brain functions, our pediatric neuropsychologists can help identify conditions and treatment options.
Neuropsychology referral guidelines
Below are guidelines to follow when referring a patient to Children’s Neuropsychology for a consultation or testing. These are meant to be general guidelines. If you have specific questions, call the neuropsychology provider line at 404-785-2849, option 4.
Note, our practice accepts all payers when a child's diagnosis is medical or neurological; however, based on our practice's availability, patients deemed to be outside the typical scope of care (a behavioral issue not related to a medical diagnosis) will be processed as a self-pay patient.
Due to the specialized nature of our practice, we only see patients with a primary neurological diagnosis. While some of these patients might have secondary psychiatric or behavioral diagnoses*, we can only see them if they have a primary neurological diagnosis from a medical doctor.
If your patient does not have a primary neurological diagnosis but needs a psychological evaluation, please contact our office at 404-785-2849 for recommendations.
*We do not see patients with a primary diagnosis or presence of severe psychiatric or mood symptoms.
- Abnormal electroencephalogram (EEG)
- Abnormal MRI of brain
- Anoxic or hypoxic brain injury/encephalopathy
- Arteriovenous malformations
- Brain or neurological injury (not listed elsewhere)
- Brain tumor
- Cardiac condition (congenital heart disease, heart failure, heart transplant)
- Cerebral palsy
- Chiari malformation
- Concussion
- Congenital brain abnormality (not listed elsewhere)
- Di George's Syndrome (22q11.2 Deletion Syndrome)
- Duchenne muscular dystrophy
- Encephalitis
- Epilepsy and seizure disorder
- Genetic and metabolic disorders
- Hydrocephalus
- Meningitis
- Neurofibromatosis
- Neuroimmunological disorders (e.g., Anti-NMDA receptor encephalitis, multiple sclerosis, autoimmune encephalitis)
- Spina bifida
- Stroke, brain hemorrhage, cerebral ischemia
- Traumatic brain injury
- Tuberous sclerosis
- Learning/retention or memory problems
- Attention or processing speed problems
- Executive functioning (e.g., disorganization, forgetfulness, prioritizing)
- Reduced adaptive functioning or independence with activities of daily living (ADLs)
- Emerging adult transition or post high school planning
- Risk for neuropsychological impairment
- Speech/language, fine/gross motor, and/or global developmental delay
- Social development
- Emotional symptoms
- Behavior problems (e.g., hyperactivity, impulsivity, aggression)
- Medication monitoring
- Follow up evaluation (established patient)
- Rule out autism spectrum disorder
When referring your patient, please be sure to include:
- Clinical notes documenting the neurological/medical diagnosis and patient demographics.
- Any imaging done to support the injury, if applicable.
- Copy of current IEP/504 plan and any previous psychological, psychoeducational or neuropsychological evaluation reports, if appropriate and available.
These guidelines are provided for general informational purposes to assist referring providers and do not constitute medical advice for any specific patient. They are not a substitute for independent professional judgement. These guidelines do not create any right to be seen within a particular timeframe or guarantee acceptance or scheduling of any referral.
How to Place an Order for an EEG or EMG
To order an electroencephalogram (EEG) or electromyography (EMG) for your patient, download and complete our EEG order form. Fax the completed form to:
- Arthur M. Blank Hospital: 404-785-1795
- Scottish Rite Hospital and Children’s at Forsyth: 404-785-2204
You will receive a return fax with the first available date and time.
If pre-certification and authorization is required, it is your office’s responsibility to obtain it and fax it to our office two weeks before the appointment. If pre-certification and authorization has not been obtained, the appointment will be canceled.
To ensure a precise EEG/EMG recording, make sure to discuss the patient family instructions with a parent or legal guardian:
- Patients age 13 months and older must be at least four hours sleep deprived. The patient should sleep no more than four hours the night before the study, as we need to obtain natural sleep brain wave patterns. We do not sedate patients for the study. The study will last about an hour to an hour and a half.
- Patient must refrain from refined and processed sugars or caffeine for 24 hours before the study. Natural sugars are acceptable.
- Patients must arrive 30 minutes before their appointment to register in the patient registration department on the first floor. If your patient is 15 or more minutes late, the appointment may be canceled.
Contact Us 404-785-DOCS (3627)