Developmental regression — branching viva

Stem

You are the paediatric registrar. A caregiver says their child “is going backwards.” [1]

Branch A — Confirm regression

Examiner: How do you decide if this is true regression? [1]

Strong answer: Build a skill-by-skill ledger of what was acquired, when, with examples, and what is lost now. Use records and videos. Separate never-acquired delay from true loss. [1] [7]

Branch B — Threat

Examiner: The child is less interactive than usual today. [18]

Strong answer: Treat caregiver concern seriously, complete ABCDE, look for encephalopathy, seizures, infection and metabolic threat before developmental paperwork. [18]

Branch C — Toddler language loss

Examiner: A 20-month-old lost words and pointing but walks normally. [1]

Strong answer: Urgent evaluation pathway; hearing assessment; autism-pathway assessment as indicated; still review progressive red flags; no routine wait-and-see. [1] [7]

Branch D — Rett window

Examiner: A young girl lost hand use and wrings her hands. [6]

Strong answer: Consider classic Rett-window phenotype using revised criteria concepts; refer neurology/genetics; start supports; do not delay for perfect textbook completeness. [6]

Branch E — Overshadowing

Examiner: Staff say “this is just his autism.” [9]

Strong answer: Challenge diagnostic overshadowing when progressive adaptive loss or new neurology appears; reopen the differential for neuroregression. [9]

Branch F — Disposition

Examiner: How do you finish the consultation? [14]

Strong answer: Parallel referrals, interim supports, named owners for results, structured handoff, and explicit safety-net for seizures, further loss and reduced alertness. [3] [4] [14]