Pediatricians' perspectives on fetal alcohol syndrome

Fetal alcohol spectrum disorders: A practical clinical approach to diagnosis

“…Primary care physicians may tend to underdiagnose FASD and be unprepared to deal with all the ramifications this diagnosis may bring (Morse et al, 1992). Therefore, a multidisciplinary evaluation of a child or adult suspected of having FAS (or FASD) is a reasonable approach.…”

Do Pediatricians Recognize Fetal Alcohol Spectrum Disorders in Children With Developmental and Behavioral Problems?

“…Previous studies have identified similar barriers and found that more than 68% of pediatricians reported that they lacked knowledge of and training about FASDs, [8][9][10] less than 50% felt prepared to diagnose or address FASDs, 7,9,11 and as many as 70% worried about the impact of stigma on the child and family, and 36% worried that parents would resist a referral for services if the child was diagnosed with an FASD. 7,9 Taken together, these barriers have been found to hinder pediatricians from making a diagnosis with as many as 76.5% of pediatricians having suspected FAS at one time but not diagnosing it, and 12.1% having been convinced of the diagnosis but not diagnosing it.…”

“…Previous studies have shown, however, that only 23.3% to 58.3% of pediatricians surveyed reported routinely obtaining this history, more than 50% of pediatricians felt it was difficult to ask pregnant patients about alcohol consumption, and as many as 16% of pediatricians thought discussing alcohol use during pregnancy would frighten or anger pregnant women. 7,11,12 These findings highlight the need to train pediatricians how to routinely obtain a prenatal alcohol history from mothers and to reduce the stigma about asking. Other medical disciplines, such as obstetrics and gynecology, have successfully addressed this issue by using standardized screening questionnaires about alcohol use 16 in all pregnant women during routine prenatal visits and discussing alcohol use in a nonjudgmental manner.…”

“…These studies found that pediatricians identify FAS facial dysmorphic features between 56% and 100% of the time, growth retardation or low birth weight as diagnostic criteria more than 70% of the time, and central nervous system abnormality or dysfunction between 42% and 94% of the time. [7][8][9][10][11][12] Our study is unique in that this was a case-based survey, thought to be more indicative of clinical practice, and interest in FASDs was not disclosed until the diagnoses of the cases were revealed, and therefore, may provide a more accurate unbiased profile of pediatricians' knowledge.…”

Recognition of facial features of fetal alcohol syndrome in the newborn

“…Morse and Weiner [1990] demonstrated that primary care physicians typically underdiagnose FAS. A survey of pediatricians in Massachusetts by this group [Morse et al, 1992] showed that pediatricians in general are unprepared to deal with FAS and its implications. More pediatricians suspected the diagnosis than actually diagnosed it.…”