CAMHS - Southampton Children’s Sleep Disorder Service Referral Form For Referrals From Wessex CAMHS Logo

  • Referral from Wessex CAMHS

    Please complete all relevant details in the form below. Any boxes marked with a star are required before your referral can be submitted. 

    • Referrer's Details 
    • Child's details 
    •  - -
    • Details of referral 

    • Please note: if sleep disordered breathing is the primary reason for referral, the referral should be sent to the paediatric respiratory service.

  • Please indicate which of the following suspected diagnoses are present. Please click all that apply and include the requested details/reports when available. 

    (click each heading for more details)

    • Chronic Insomnia in the Context of a Neurodevelopmental and/or Complex Medical Disorder 

    • Please ensure support from local services has been provided to optimise sleep habits and behaviours prior to referral if any of the above are present.

    • Anxiety Related Chronic Insomnia  

    • Please note, the sleep service does not have capacity to provide psychological support for the following:

      • Where risk is being actively monitored and managed
      • Generalised anxiety
      • School related anxiety/phobia/school refusal
      • Where the sleep difficulty is predominantly secondary to a mental health disorder/emotional regulation difficulty/ systemic concern
      • Where a mental health disorder is impacting multiple areas of the young person’s life/functioning, of which disturbed sleep is understandably one

      Please consider instead referring to CAMHS or accessing support through ELSA. The following resources may also be helpful:

      • Teen sleep hub: https://teensleephub.org.uk/
      • The sleep charity: https://thesleepcharity.org.uk/information-support/children/
      • ‘What to Do When You Dread Your Bed’ by Dawn Huebner.
    • Challenging Behaviour During the Day 
    • Parasomnias 
    • Circadian Rhythm Disorder  
    • Suspected Sleep Related Rhythmic Movement Disorder 
    • Difficulty with Sleep Initiation or Maintenance Secondary to Suspected Restless Legs Syndrome 

    • Please send blood test results for FBC, ferritin, transferrin saturations and serum iron. If ferritin is below 50mcg/L, consider starting oral iron.

      For further guidance please see Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018;41:27-44. doi:10.1016/j.sleep.2017.11.1126

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Suspected Narcolepsy 

    • Please send results of baseline blood tests including thyroid function and narcolepsy HLA association DQB1*0602

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Suspected Kleine-Levin syndrome 

  • Following submission of this referral for {name13}, it will be reviewed by the Sleep Team and a decision on the need for a clinic appointment made.

  • Should be Empty: