A better future for baby: stemming the tide of fetal alcohol syndrome.

Family physicians who care for infants and young children are often asked to diagnose growth lags and failure to meet parents’ expectations for reaching developmental milestones: Why isn’t my child gaining weight? Why isn’t he talking? Th e other kids in the day-care center ride tricycles—why can’t he? Will he catch up? My mother thinks he’s funny looking. Do you? Simple reassurance is all that most of these worried families need. But for families with children whose growth or developmental milestones are suffi ciently outside the usual parameters, more than reassurance is called for. As you consider whether the lags that worry parents are signs of a serious disability, it’s important to make a place for fetal alcohol syndrome (FAS) in your diff erential. FAS, a congenital disorder caused by alcohol exposure during pregnancy, is characterized by growth defi ciency before and after birth, distinctive facial features, and central nervous system (CNS) dysfunctions. Th e cognitive and developmental eff ects of FAS persist throughout life and are severe enough to limit employment and independent living. ❚ A spectrum of severity. FAS is the most severe expression of prenatal alcohol exposure. Th e term fetal alcohol spectrum disorders (FASD) is a nondiagnostic umbrella term that includes FAS as well as ARND (alcohol-related neurobehavioral disorder) and ARBD (alcohol-related birth defects). Children with ARND and ARBD fail to meet the full FAS diagnostic criteria but still exhibit the negative eff ects of gestational alcohol exposure. Centers for Disease Control and Prevention (CDC) diagnostic criteria for FAS are summarized in TABLE 1. Studies by the CDC have reported FAS prevalence rates from 0.2 to 1.5 cases per 1000 live births, with a higher prevalence among minority (Native American and African American) and impoverished groups. Mary C. Boyce, MD Department of Family and Community Medicine and Wesley Family Medicine Residency, University of Kansas School of Medicine, Wichita