# Rett Syndrome Diagnostic Pathway in Children Under 7

Canonical: https://pinnacleblooms.org/ask/what-is-the-recommended-screening-and-diagnostic-pathway-for-rett-syndrome-in-children-under-7
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Rett syndrome (ICD-11 LD90.0) is diagnosed clinically using consensus criteria and confirmed by MECP2 (plus CDKL5/FOXG1 for variants) testing. There is no population screen, so developmental surveillance for the regression-and-hand-stereotypy phenotype drives referral, alongside EEG, ECG and scoliosis review.

*A girl with normal early months who then plateaus, loses purposeful hand use, and develops hand stereotypies — the pattern that should prompt structured pursuit of Rett syndrome.*

## In short
Rett syndrome (ICD-11 **LD90.0**) is a clinical diagnosis confirmed by molecular testing. In a child under 7, the pathway is: recognise the regression-and-stereotypy phenotype, apply the consensus diagnostic criteria, and confirm with **MECP2** sequencing and deletion/duplication analysis. Screening is *surveillance-based* — there is no population newborn screen — so vigilance at routine developmental reviews drives early referral.

## The pathway, step by step
**1. Surveillance and red flags.** Suspect classic Rett in a girl with a period of relatively normal development (often to 6–18 months) followed by **developmental stagnation, then regression** — loss of acquired purposeful hand skills, loss of spoken language, gait/truncal apraxia, and emergence of stereotypic midline hand movements (wringing, washing, mouthing).

**2. Apply consensus criteria.** Use the revised diagnostic criteria (Neul et al.) distinguishing *classic* (all four main criteria, after a regression-then-recovery/stabilisation period) from *atypical* variants. Exclusion criteria — e.g. acquired brain injury, storage disease — must be reviewed.

**3. Molecular confirmation.** Refer for **MECP2** testing (sequencing plus MLPA for large deletions/duplications). For atypical phenotypes consider **CDKL5** (early-seizure variant) and **FOXG1** (congenital variant). Genetic counselling accompanies testing.

**4. Co-morbidity screen.** Baseline EEG (seizures are common), ECG for QT prolongation, growth/feeding, scoliosis and breathing-pattern review.

A negative gene result does not exclude a clinically definite diagnosis — the criteria remain clinical.

## The Pinnacle way
A clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — our clinician-administered structured assessment complements, and never replaces, genetic confirmation. We co-manage the functional roadmap — hand function, communication and mobility — through [occupational therapy](https://www.pinnacleblooms.org/best-occupational-therapy-center-india-proven-improvement-rate) and integrated [Rett syndrome](/rett-syndrome) support across 70+ centres.

## Trusted sources
WHO ICD-11 (LD90.0); consensus revised diagnostic criteria for Rett syndrome; AAP developmental surveillance guidance.

**Next step —** Refer a suspected case for co-ordinated genetic and functional work-up: [partner with a Pinnacle centre](/rett-syndrome).

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 (LD90.0 Rett syndrome): https://icd.who.int/
- AAP developmental surveillance guidance: https://www.aap.org/
- HealthyChildren developmental monitoring: https://www.healthychildren.org/

## Connected topics and perspectives
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- Context: https://pinnacleblooms.org/ask/lens/domain/context
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## Related question paths

### Understand the subject
- What is Rett Syndrome, and its ICD-11 features in early childhood?: https://pinnacleblooms.org/ask/what-is-rett-syndrome-and-what-are-its-icd-11-features-in-early-childhood
- ICD-11 Classification of Rett Syndrome (LD90.0): https://pinnacleblooms.org/ask/what-is-the-icd-11-classification-for-rett-syndrome
- What is the SNOMED CT concept for Rett Syndrome?: https://pinnacleblooms.org/ask/what-is-the-snomed-ct-concept-for-rett-syndrome
- How Rett Syndrome Affects a Child's Daily Life: https://pinnacleblooms.org/ask/how-does-rett-syndrome-affect-a-child-s-daily-life
- Is Rett Syndrome considered a disability?: https://pinnacleblooms.org/ask/is-rett-syndrome-considered-a-disability
- Is Rett Syndrome Genetic or Hereditary?: https://pinnacleblooms.org/ask/is-rett-syndrome-genetic-or-hereditary
- What are common myths about Rett Syndrome?: https://pinnacleblooms.org/ask/what-are-common-myths-about-rett-syndrome
- Types and Stages of Rett Syndrome: https://pinnacleblooms.org/ask/what-are-the-types-or-levels-of-rett-syndrome
- What causes Rett syndrome in children?: https://pinnacleblooms.org/ask/what-causes-rett-syndrome-in-children
- Early Intervention Outcomes in Rett Syndrome (Under 7): https://pinnacleblooms.org/ask/what-does-current-research-show-about-early-intervention-outcomes-for-rett-syndrome-in-children-under-7
- What is Rett Syndrome?: https://pinnacleblooms.org/ask/what-is-rett-syndrome
- What is Rett Syndrome, and what does it look like in early childhood?: https://pinnacleblooms.org/ask/what-is-rett-syndrome-and-what-does-it-look-like-in-early-childhood

### Recognise signs & concerns
- Early indicators of Rett syndrome for paediatricians: https://pinnacleblooms.org/ask/what-early-indicators-of-rett-syndrome-should-a-paediatrician-watch-for
- Rett Syndrome Red Flags Warranting Referral: https://pinnacleblooms.org/ask/what-clinical-red-flags-for-rett-syndrome-warrant-referral-in-a-young-child
- When to refer suspected Rett syndrome for developmental therapy: https://pinnacleblooms.org/ask/when-should-a-doctor-refer-a-child-with-suspected-rett-syndrome-for-developmental-therapy
- Can Rett Syndrome Be Cured?: https://pinnacleblooms.org/ask/can-rett-syndrome-be-cured
- Can Rett Syndrome Be Prevented?: https://pinnacleblooms.org/ask/can-rett-syndrome-be-prevented
- Rett Syndrome in Boys: https://pinnacleblooms.org/ask/do-boys-show-rett-syndrome-differently
- Do girls show Rett Syndrome differently?: https://pinnacleblooms.org/ask/do-girls-show-rett-syndrome-differently
- Spotting Possible Rett Syndrome Early: https://pinnacleblooms.org/ask/how-can-a-frontline-health-worker-spot-a-child-with-possible-rett-syndrome-early
- Should I be worried my child might have Rett Syndrome?: https://pinnacleblooms.org/ask/should-i-be-worried-my-child-might-have-rett-syndrome
- Early Signs of Rett Syndrome: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-rett-syndrome
- Early signs of Rett syndrome in a 1-year-old boy: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-rett-syndrome-in-a-1-year-old-boy
- Early Signs of Rett Syndrome in a 1-Year-Old Girl: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-rett-syndrome-in-a-1-year-old-girl

### Explore causes & influences
- Known contributing factors for Rett Syndrome: https://pinnacleblooms.org/ask/what-are-the-known-contributing-factors-for-rett-syndrome-in-early-childhood
- Are boys more likely to have Rett Syndrome?: https://pinnacleblooms.org/ask/are-boys-more-likely-to-have-rett-syndrome
- Are girls more likely to have Rett Syndrome?: https://pinnacleblooms.org/ask/are-girls-more-likely-to-have-rett-syndrome
- Early Intervention for Rett Syndrome, UNCRPD & the SDGs: https://pinnacleblooms.org/ask/how-does-early-intervention-for-rett-syndrome-advance-un-child-rights-uncrpd-and-the-sdgs
- What Causes Rett Syndrome in Young Children?: https://pinnacleblooms.org/ask/what-causes-rett-syndrome-in-young-children
- Cost-effectiveness of early therapy for Rett Syndrome in young children: https://pinnacleblooms.org/ask/what-is-the-cost-effectiveness-of-early-therapy-for-rett-syndrome-in-young-children
- Prevalence and Public-Health Burden of Rett Syndrome in India: https://pinnacleblooms.org/ask/what-is-the-prevalence-and-public-health-burden-of-rett-syndrome-among-young-children-in-india

### Understand assessment
- Standardised tools for assessing Rett syndrome in early childhood: https://pinnacleblooms.org/ask/which-standardised-tools-are-used-to-assess-rett-syndrome-in-early-childhood
- How AbilityScore Tracks Progress in a Child with Rett Syndrome: https://pinnacleblooms.org/ask/how-does-abilityscore-track-progress-in-a-child-with-rett-syndrome
- How Rett Syndrome Is Assessed in a Young Child: https://pinnacleblooms.org/ask/how-is-rett-syndrome-assessed-in-a-young-child
- How Rett Syndrome Is Assessed in Children Under 7: https://pinnacleblooms.org/ask/how-is-rett-syndrome-assessed-in-children-under-7
- What an AbilityScore® of 0–100 means for a child with Rett Syndrome: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-0-100-mean-for-a-child-with-rett-syndrome
- What does an AbilityScore of 100–200 mean for a child with Rett Syndrome?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-100-200-mean-for-a-child-with-rett-syndrome
- What does an AbilityScore of 200–300 mean for a child with Rett Syndrome?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-200-300-mean-for-a-child-with-rett-syndrome
- AbilityScore 300–400 in Rett Syndrome: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-300-400-mean-for-a-child-with-rett-syndrome
- What an AbilityScore of 400–500 Means in Rett Syndrome: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-400-500-mean-for-a-child-with-rett-syndrome
- What does an AbilityScore of 500–600 mean for a child with Rett Syndrome?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-500-600-mean-for-a-child-with-rett-syndrome
- What does an AbilityScore of 600–700 mean for a child with Rett Syndrome?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-600-700-mean-for-a-child-with-rett-syndrome
- What an AbilityScore of 700–800 Means for a Child with Rett Syndrome: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-700-800-mean-for-a-child-with-rett-syndrome

### Explore therapy & support
- How Grandparents and Caregivers Can Support a Child with Rett Syndrome: https://pinnacleblooms.org/ask/as-a-grandparent-or-caregiver-how-can-i-support-a-child-with-rett-syndrome-day-to-day
- Can a Child with Rett Syndrome Attend a Mainstream School?: https://pinnacleblooms.org/ask/can-a-child-with-rett-syndrome-attend-a-mainstream-school
- Can a Child with Rett Syndrome Attend a Regular School?: https://pinnacleblooms.org/ask/can-a-child-with-rett-syndrome-attend-a-regular-school
- Can a Child with Rett Syndrome Live Independently?: https://pinnacleblooms.org/ask/can-a-child-with-rett-syndrome-grow-up-to-live-independently
- Helping a Child with Rett Syndrome Take Part and Learn: https://pinnacleblooms.org/ask/how-can-a-classroom-teacher-help-a-child-with-rett-syndrome-take-part-and-learn
- Identifying and Supporting Children Under 7 with Rett Syndrome: https://pinnacleblooms.org/ask/how-can-a-district-early-intervention-programme-identify-and-support-children-under-7-with-rett-syndrome
- How can a teacher include a child with Rett Syndrome in a mainstream classroom?: https://pinnacleblooms.org/ask/how-can-a-teacher-include-and-support-a-young-child-with-rett-syndrome-in-a-mainstream-classroom
- How does therapy help a child with Rett Syndrome make progress?: https://pinnacleblooms.org/ask/how-does-therapy-help-a-child-with-rett-syndrome-make-progress
- How is Rett Syndrome diagnosed in a child?: https://pinnacleblooms.org/ask/how-is-rett-syndrome-diagnosed-in-a-child
- How is Rett Syndrome supported through therapy?: https://pinnacleblooms.org/ask/how-is-rett-syndrome-supported-through-therapy
- Rett Syndrome AbilityScore®: What to Do Next: https://pinnacleblooms.org/ask/my-child-with-rett-syndrome-has-an-abilityscore-of-0-100-what-should-we-do-next
- Rett Syndrome with an AbilityScore of 100–200: your next step: https://pinnacleblooms.org/ask/my-child-with-rett-syndrome-has-an-abilityscore-of-100-200-what-should-we-do-next

### At home & in everyday life
- How can I support my child with Rett Syndrome at home?: https://pinnacleblooms.org/ask/how-can-i-support-my-child-with-rett-syndrome-at-home