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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Delay with acute neurological deterioration
Established delay does not explain a new seizure, encephalopathy, weakness, ataxia, raised intracranial pressure or loss of acquired skills.
Action: Use ABCDE, check bedside glucose and treat seizure or metabolic compromise through the current paediatric emergency pathway. Establish the last known baseline and refer immediately for new gait abnormality, focal neurology, altered consciousness or suspected infection or trauma. Suspected infantile spasms need tertiary paediatric neurology guidance and referral within 24 hours for rapid assessment including sleep EEG. Continue safeguarding assessment when injury, poisoning or neglect is possible.
Synopsis
Define a child's developmental profile, distinguish isolated from global delay and developmental difference, identify sensory, neurological, genetic, medical and environmental contributors, and begin needs-led support while diagnosis proceeds.
Global developmental delay means significant delay in at least two domains in a child younger than 5; isolated delay predominantly affects one domain.
Describe the profile and function before seeking an aetiological label: gross motor, fine motor or vision, speech and language, cognition or play, social-emotional and adaptive skills.
Use exact and corrected age, serial acquisition and real-world examples from caregivers and nursery or school; one clinic performance is insufficient.
Key red flags
Loss of any established developmental skill changes the problem from delay to regression and requires prompt neurodevelopmental or neurological referral.
Investigation priorities
01
First-line: standardised developmental and adaptive assessmentFirst stepFirst line
Define which domains are delayed, severity, strengths and functional support needs.
02
First-line: formal hearing and vision assessmentFirst line
Detect sensory impairment causing or compounding delay.
Management branches
ProfileDefine delay before testing
A caregiver, health visitor, nursery or clinician raises developmental concern.
Map every domain, adaptive function, acquisition and any loss using exact and corrected age and reports from more than one setting.
Plot growth and head circumference and complete sensory, neurological, dysmorphology and systemic assessment.
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.