Professionals

Physicians, nurses, mental health providers, social workers, psychologists and other professionals play a crucial role in preventing FASD.  As trusted sources for information, it is important to talk to women about the dangers of drinking while pregnant.  Healthcare providers and other professionals also have the responsibility of identifying patients with FASD to ensure they receive the proper care and services they need.

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.

The term FASD is not intended for use as a clinical diagnosis. Diagnoses such as fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder (ARND), partial fetal alcohol syndrome (PFAS), alcohol-related birth defects (ARBD) and fetal alcohol effects (FAE) all fall under the umbrella term of FASD.  Those affected by FASD can have brain damage; facial deformities; growth deficits; heart, lung and kidney defects; hyperactivity; attention and memory problems; poor coordination; behavioral problems and learning disabilities.  FASD is the leading known cause of mental retardation.

FASD is difficult to identify and often takes several physicians, psychologists, speech pathologists and/or occupational therapists to confirm its presence. While mothers who readily admit to consuming alcohol during pregnancy make identifying the disorder easier, doctors can still confirm a child has FASD when the following four conditions are met:

• Prenatal alcohol exposure (confirmed or not)
• Growth deficits
  • Prenatal/Postnatal weight is less than 10th percentile
  • Prenatal/Postnatal height/length is less than 10th percentile
• Facial characteristics
  • Smooth philtrum (i.e. the vertical groove in the upper lip)
  • Thin vermillion border (i.e. demarcation between red on the lip and the skin)
  • Small palpebral fissures (i.e. separation between upper and lower eyelids)
• Neurodevelopment problems (must have at least one of the three examples)
  • Structural
    • Head circumference at or below 10th percentile
    • Observation of abnormal brain structure from image studies
  • Neurological
    • Does not include external factors like fevers
    • Deficits in coordination, visual motor skills and other neurological activities
    • Involuntary eye movement
  • Functional
    • Cognitive or intellectual deficits below the 3rd percentile for standardized testing
    • Functional deficits below the 16th percentile in at least three of the following: cognition or development trouble, poor executive functioning, poor motor functioning, attention or hyperactivity issues, poor social skills, and/or other challenges including sensory problems and memory deficits

For specific guidelines to identify prenatal alcohol exposure, visit: http://www.nofas.org/healthcare/identify.aspx

As a trusted source of technical and medical information, healthcare providers and other professionals are in a unique position to influence the behavior of patients. It is therefore imperative that providers speak regularly to their female patients about the dangers of FASD and the importance of abstaining from alcohol while pregnant. Providers should also speak to their male patients about the importance of building strong support systems for the women in their lives who are or may become pregnant.

Healthcare providers and professionals should pay special attention to female patients who are pregnant or in a position to get pregnant. It is important to reiterate often that FASD is 100% preventable by abstaining from drinking while pregnant. No amount of alcohol is safe.

Treating Patients with FASD

The sooner FASD is identified in a patient, the better, as early intervention may potentially lessen the impact of certain problems. However, unless a mother voluntarily admits alcohol consumption, it may take years to recognize a child has FASD.

Children with FASD experience a range of negative health and social side effects and often require special educational, legal and social services as well as medical treatment.

To best serve parents and children, primary care practitioners should be knowledgeable of the latest FASD treatment research and apply such techniques when appropriate. Providers also should help patients understand the reality of the child’s diagnosis and offer non-judgmental support and compassion. When necessary, providers can refer the child to special medical services and refer both the child and family to community support services.

Every child’s particular case and home life is different. It is key for providers to be cognizant of the situation and respond appropriately with care.

For more helpful information specific to healthcare providers, visit: http://www.nofas.org/healthcare/

Patient Screenings for Alcohol Use

Below are some methods used to screen patients for alcohol dependence. These are only three suggestions – there are other ways to screen patients. Visit the sites listed below for more information.

1. The CAGE test is an Internationally-used assessment instrument for identifying problems with alcohol. It is a four-question screening test that can be self-administered or given by a professional. (link: http://counsellingresource.com/quizzes/alcohol-cage/index.html)
2. The alcohol use disorders identification test (AUDIT) is made up of 10 questions focusing on the amount of alcohol and the frequency a patient drinks, the patient’s alcohol dependence and common problems caused by alcohol for the patient. AUDIT can be self-administered or given by a professional. (link: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=1860&cn=14)
3. Healthcare professionals often use a single question when screening: “When is the last time you had more than 4 drinks (5 if male) in one day?”

For more information about screening patients for alcohol dependence, visit: http://www.aafp.org/online/en/home/clinical/publichealth/alcohol.html