Fetal Alcohol Spectrum Disorder in Children

Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 2009/03/23 - Updated: 2023/10/02
Publication Type: Informative
Topic: Pediatric Disabilities - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: This article discusses the key features of Fetal Alcohol Syndrome (FASD). The complete evaluation to determine diagnosis should include an assessment of the child's central nervous system, speech/language, and fine motor skills which are assessed by an occupational therapist.

Introduction

Do you know a child who may have received a prenatal exposure to alcohol?

Have you adopted a child or do you work with a child that may have the affects of prenatal exposure to alcohol?

Would you like to know what the 4 key features of this disorder is?

Main Item

The Center for Disease Control (CDC) has a document entitled: Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. This document established a general consensus among medical professionals, on what constitutes a diagnosis in the USA. There is some disagreement among medical professionals about children that have some of the four key features but not all of them.

Fetal Alcohol Syndrome has the most consensus among medical professionals and has a ICD-9 or ICD-10 diagnosis. The complete evaluation to determine diagnosis should include an assessment of the child's central nervous system, speech/language, and fine motor skills which are assessed by an occupational therapist. After the testing is complete the team should work together to interpret the data of each key feature that was assessed, and develop a multi disciplinary report to diagnose this in a child.

Partial FAS have a confirmed history of prenatal exposure, but may lack growth deficiency of the complete facial stigmata. The following criteria must be met for a diagnosis:

• Growth deficiency-may range from normal to deficient
• Facial features - Two or three specific facial features present
• CNS damage-clinically significant
• Neurological impairment in three or more of the Ten Brain Domains
• Confirmed prenatal exposure

The Four Main Features Are

Growth Deficiency

This is defined as significantly below average height, weight, or both due to prenatal alcohol exposure. Criteria are less specific in the diagnostic system. Low weight to height measurement, or decelerating weight not due to poor nutrition.

Growth deficiency is ranked as follows by the: 4 digit diagnostic code:

• Severe: Height and weight at or below the 3rd percentile.
• Moderate: Either height or weight at or below the 3rd percentile, but not both.
• Mild: Either height or weight or both between the 3rd and tenth percentile.
• None: both above the tenth percentile.

Specific Facial Features

Three characteristic craniofacial abnormalities are visible in children with FAS. The 3 facial features are:

• A smooth philtrum: The digit or groove between the nose and upper lip flattens with increased alcohol exposure.
• Thin vermilion: The upper lip thins with increased exposure.
• Small palpebral fissures:eye width shortens with increased exposure.

Central Nervous System Damage

The primary key feature of any diagnosis. The prenatal exposure can damage the brain across a continuum;from subtle impairments, to more severe impairments. The 4-digit diagnostic code gives four rankings for CNS damage:

• Definite: Structural impairments or neurological impairments
• Probable: Significant dysfunction of two standard deviations or worse in three or more functional domains.
• Possible: Mild to moderate dysfunction of two standard deviations or worse in one or two functional domains.
• Unlikely: No evidence of CNS damage.

Documented Prenatal Exposure to Alcohol

This can be determined by interviews of the biological mother, other family members, court records, as well as chemical dependency treatment records.

Some children with FAS are adopted and it may be difficult to determine if the biological mother used alcohol during the pregnancy. So a determination of unknown exposure is often used for these children. The diagnosis of FAS can still be determined with an unknown exposure if the child has the other three key features.

It is sometimes difficult to determine why a child has a disability, so understanding this information could be critical to being able to help the child learn. Many children with this syndrome require intensive special education services to help them learn and have a happy and fulfilled life.

Author Credentials: Ian was born and grew up in Australia. Since then, he has traveled and lived in numerous locations and currently resides in Montreal, Canada. Ian is the founder, a writer, and editor in chief for Disabled World. Ian believes in the Social Model of Disability, a belief developed by disabled people in the 1970s. The social model changes the focus away from people's impairments and towards removing barriers that disabled people face daily. To learn more about Ian's background, expertise, and achievements, check out his bio.