From panic to protocol: A ?IP on developing a paediatric breast referral pathway

Background: Paediatric patients presenting with breast symptoms are uncommon, yet they often introduce diagnostic and management challenges. Current national guidelines, from the Association of Breast Surgery, outline a referral criterion, however, many hospital trusts lack a standardised referral pathway leading to inconsistent standards of care between clinicians. This Quality Improvement Project assessed the need for a referral pathway at the University Hospital Sussex NHS Foundation Trust to improve timely and consistent referrals.

Methods: A retrospective review of paediatric patients presenting to the Royal Alexandra Children’s Hospital with breast symptoms between January 2024 to 2025 was conducted. Data collected included the presenting symptoms, mode of referral and time for a specialist review. In view of these findings, a referral form was developed collaboratively with the paediatric and breast teams to streamline referrals.

Results: Over the course of one year, 6 female paediatric patients aged between 7 days and 18 years presented with a breast-related pathology. Breast lumps were the most frequent presentation mostly due to breast abscesses with surrounding cellulitis with one oncology case needing chemotherapy. Referrals were primarily made informally by phone without standardized documentation. The median time from presentation to clinic review was 10 days, with only 3 patients being referred for a breast review. A paediatric breast referral form with accompanying guidelines were implemented with departmental teaching.

Conclusion: Current practices highlighted critical gaps in the management of paediatric breast presentation where the lack of a formal referral pathway and guidelines has resulted in uncertainty, delays and variability in care. As these cases are rare, limited clinician experience can lead to uncertainty or inappropriate intervention such as incision and drainage of a malignant lesion. The development of a new referral form supported by new guidelines aims to standardises practice, improves communication, documentation and traceability. Although uncommon, when they do occur, uncertainty often follows, emphasizing the need for clear referral guidance.