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 loss or disruption of communication
Sudden slurred, absent or disordered speech can reflect stroke, seizure, encephalitis, intoxication, metabolic disturbance or airway and bulbar disease rather than developmental delay.
Action: Use ABCDE, check glucose and obtain an exact onset and last-known-well time. New dysarthria, aphasia, facial asymmetry, weakness, ataxia, altered consciousness or severe headache needs immediate paediatric neurological and emergency imaging assessment; follow the local paediatric stroke or seizure pathway where relevant. Drooling with inability to swallow, stridor, choking or aspiration requires urgent airway and feeding-safety management. Treat suspected meningitis, encephalitis, poisoning or hypoglycaemia promptly. Do not send an acutely changed child to a routine speech-and-language waiting list.
Synopsis
Distinguish speech, language, communication, fluency, voice and hearing concerns, identify urgent neurological or safeguarding presentations, select age-appropriate audiology and speech-language assessment, and coordinate early support without waiting for diagnostic certainty.
Define the concern: speech is sound production, language is understanding and formulation, pragmatic communication is social use, fluency is flow, and voice is quality or resonance.
Assess receptive language separately from expressive language; a child who speaks little may understand well, while fluent speech can conceal poor comprehension.
A passed newborn hearing screen does not exclude unilateral, mild, acquired, fluctuating, progressive or auditory-neuropathy-spectrum hearing loss.
Key red flags
Loss of previously established words, comprehension, social communication or motor skill is developmental regression and requires prompt paediatric or neurological assessment.
Investigation priorities
01
First-line: integrated developmental and communication historyFirst stepFirst line
Define domain, onset, trajectory, regression, languages, functional impact, hearing and medical context across settings.
02
Reference standard: comprehensive audiological assessmentReference standard
Estimate ear-specific hearing thresholds and type of loss using developmentally appropriate behavioural and objective measures.
Management branches
Initial assessmentDefine domain and urgency
A child is not communicating as expected or hearing is questioned.
Determine whether change is acute or regressive and assess swallowing, neurological, infectious, ENT and safeguarding red flags.
Take a multi-language developmental and medical history, observe spontaneous communication and examine ears, mouth, growth and neurology as indicated.
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.