Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute regression or encephalopathy
Skill loss with altered consciousness, seizures, new weakness, ataxia, fever, head injury, toxic exposure, hypoglycaemia or metabolic decompensation is an acute paediatric emergency.
Action: Use ABCDE, check glucose and treat seizure, hypoxia or shock immediately. Obtain a precise time course, recent illness, fasting, medication and exposure history and refer to acute paediatrics or paediatric neurology. Capture caregiver video of events when safe. Suspected infantile spasms in a child under 2 requires tertiary neurology advice and urgent referral within 24 hours for assessment including sleep EEG. Collect time-critical metabolic samples only under specialist guidance and without delaying stabilisation.
Synopsis
Confirm true loss of acquired skills, recognise time-critical epileptic, neurological, metabolic, neuromuscular and safeguarding causes, route referral by age and affected domain, and preserve function during urgent investigation.
Regression is loss of a skill that was previously acquired and used reliably; delayed acquisition and temporary poor performance are different.
Confirm the skill, duration of mastery, contexts in which it was used, date of last normal function and whether loss is continuous, episodic or task specific.
Ask for videos, nursery or school observations and medication timelines; apparent regression may reflect hearing loss, pain, depression, sleep deprivation or environmental change.
Key red flags
Loss over hours or days, altered consciousness, focal weakness, ataxia or new gait abnormality requires immediate acute assessment.
Investigation priorities
01
First-line: regression chronology and collateral evidenceFirst stepFirst line
Confirm true loss, domain sequence, rate and triggers.
02
First-line: full neurological, sensory and systemic assessmentFirst line
Localise the affected system and identify immediate danger or phenotype clues.
Management branches
ConfirmProve and time the loss
A caregiver or professional reports that development has gone backwards.
Identify the exact skill, how securely and how long it was used, the last normal date and settings affected.
Seek video and nursery or school collateral, medication and illness timelines and distinguish loss from plateau or refusal.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.