Case history
Case history #1
A girl is born to a woman with alcohol dependency who presented in labour having had no antenatal care. The baby is preterm (35 weeks' gestation) and small for gestational age, with a low birth weight (2kg). She is irritable and feeds poorly. During the newborn check, the paediatrician notes a number of abnormalities. The baby's head circumference is 30 cm (<10th percentile) and her length is 40 cm (<10th percentile). She has a systolic heart murmur consistent with a ventricular septal defect, which was later confirmed by echocardiogram. Her palpebral fissures are short (1.4 cm length, <10th percentile) and she has a thin upper lip (rank 5 on the lip-philtrum guides used in the 4-digit diagnostic code) and an indistinct (flat) philtrum (rank 4), flat midface, and a small chin. Fetal alcohol syndrome is suspected.
Case history #2
A 6-year-old boy is brought to the surgery by his grandmother, his permanent foster carer. She describes him as 'difficult' and says that he is now having learning problems in school, has poor concentration, is hyperactive, and exhibits risk-taking behaviour. She has been told by his teacher that he is disruptive in class, is difficult to discipline, and is struggling with reading and numeracy. On examination, his vision is normal but he has mild sensorineural hearing loss. His grandmother says that he was a 'slow developer', but that she does not know his milestones because he lived with his mother until the age of 4 years. He has had some occupational therapy in the past in an attempt to improve his fine motor skills. His mother was observed to 'binge' drink and smoked cigarettes throughout her pregnancy, but apparently used no other medications or illicit drugs. Alcohol-related neurodevelopmental disorder is suspected.
Other presentations
Asymptomatic children may present with their parent/carer because of concerns about alcohol exposure during pregnancy and its possible adverse effects. Children may also present with birth defects, postnatal growth failure, mental health problems, and a range of developmental, medical, social, behavioural, and learning problems. Some children are identified through screening programmes, including prior to foster-care placement. Others are identified when they fail at school, have siblings with FASD, are recognised at birth or during gestation as being alcohol-exposed during pregnancy, or enter the juvenile justice system. Adolescents and adults may present with mental health and/or drug and alcohol problems, education failure, inappropriate sexual behaviour, or antisocial behaviour. Contact with the law and/or incarceration is also common.
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