Recognizing FASD

Identifying Individuals with Prenatal Alcohol Exposure

Most children diagnosed with fetal alcohol-related problems are not identified before they reach school age, when they are referred for a learning disability or an attention deficit disorder. If clinicians can identify alcohol-related effects early, intervention approaches can minimize the potential impact of these effects.

Clinicians who see young children for routine check-ups have a special opportunity to identify children exposed to alcohol. The physician may want to ask the parent or caregiver bringing the child into the clinic about alcohol exposure during pregnancy. It is important to frame these questions in the context of the overall health of the child.

The brain of a normal individual (A) and two with FAS (B,C) shows permanent loss of the tissue indicated by the arrows (portions of the corpus callosum).

The impairments associated with FASD are often a reflection of underlying structural changes in the brain, as evidenced above by changes in the corpus callosum. An MRI might also reveal decrease in brain size, damage to the basal ganglia, or reduced size of the cerebellum.

If the birth mother brings in the child, clinicians may want to start by asking about her current alcohol use before asking about alcohol use during pregnancy. Women are willing to talk about this issue if it is presented with a caring, nonjudgmental approach.

If the father brings in the child, clinicians may want to ask about the mother’s use of alcohol currently and during pregnancy. It is important to tell the father that this is routine with every patient and is important for the best care of the child. The father may have helpful insight into the alcohol use of the mother.

If a foster parent or other caregiver brings in the child, clinicians may want to ask if the caregiver has any knowledge of the birth mother’s alcohol use during pregnancy. It is always important to be tactful and sensitive when asking for this information. Stress that this information is for the child to receive quality health care and it is routine to ask these questions.