The FASD Trust is one of the United Kingdom’s leading charities concerned with the impact that alcohol can have on babies at both pre-natal and post-natal stages.
Last week, they published a ‘Consensus Report,’ the result of a two-day study and consultation between leading individuals in the field from across the UK, which took place in October 2011.
What is FASD?
Fetal Alcohol Spectrum Disorders (FASD) is the broad name given to conditions and medical issues that arise due to exposing developing babies to alcohol. FASDs can be difficult to detect. You probably already know about how alcohol can stunt the growth of a fetus, for example, but the impact of a Mother drinking during pregnancy can extend far beyond the physical.
Evidence has long shown that alcohol can damage a fetus. It is also known that the impact of alcohol can differ depending on when it is consumed during pregnancy. This is down to vital organs, the heart, lungs, brain, developing at different stages. Therefore, a fetus exposed to alcohol during the early stages of pregnancy could show different signs of FASDs than one whose Mother binge drank in the later stages.
Is FASD Common?
One important aspect the report has demonstrated is that knowledge of FASD is thin on the ground, particularly in the UK. However, studies have shown that FASD is far more prevalent in ‘high risk’ populations, such as poor areas of South Africa, in comparison to countries in Europe with a higher average individual income. This indicates that there may be a link between affluence and FASD.
Difficulties Identifying FASD
Although FASD comes about due to a Mother consuming alcohol during pregnancy, the consequences of that could potentially take years to become known, if the effects are more on the brain, for example, than on physical development and features.
One indicator used to identify potential FASD during pregnancy is the size of the baby. Even then, however, doctors cannot diagnose FASD without evidence of alcohol exposure, as the symptoms of FASD are common in other conditions. The way in which each fetus reacts to alcohol exposure differs, too, one may not be effected at all, while another could be severely so.
Guidelines were set out across five main themes, which we have analyzed.
Essential: Early Diagnosis
Early diagnosis is often the key to dealing with any medical condition, and FASDs are no different. There is difficulty, however, in that we already know that FASD is difficult to detect and diagnose. It is recommended that medics diagnose as early as possible, but only when all indicators are present and there is enough information available present to make a confident diagnosis.
Barriers to Diagnosis
The biggest barrier is the lack of knowledge surrounding FASD. However, because there needs to be clear evidence prior to diagnosis, others are perhaps more difficult to deal with.
These may include incomplete medical records of the Mother, which fail to indicate treatment for an alcohol disorder, or the already noted point that the symptoms of FASD could point to a whole manner of conditions. Medical professionals are also less likely to look for FASD, especially if they are conducting an examination after birth.
As diagnosis can happen up to and beyond a child’s fourth birthday, the accuracy and thoroughness of prenatal and antenatal records is also important. Correct information could lead a doctor to diagnose FASD accurately.
Lack of In Depth Information (For Medics)
Dealing with disruption in communication streams is important to identifying more cases of FASD quicker and sooner. Does a hospital know something that has not been communicated to the regular doctor, for example? Are birth records completed? Has a person’s doctor provided a full medical history of the Mother to the hospital?
It should not happen, but the medical profession has a horrible tendency to shoot itself in the foot. Now that they have recognized, at least in the UK, that they need to do better with FASD, we can expect this to change.
At the same time, it was noted that doctors could do more to utilize diagnostic tools and the information that is already at their disposal.
Education (For Parents and Medics)
If this stage is carried out fully, then the need for a system to deal with FASD should decrease, as people will recognize the dangers of alcohol consumption during pregnancy and refrain from it completely.
However, even if that were to happen it would be complacent of anyone to believe that the problem has been dealt with. The key is for education to start at an early age, during regular schooling, so that when one is confronted with literature upon falling pregnant, it is all second nature. This will likely lead to women choosing not to consume alcohol when they are trying for a baby, too.
Better training of everyone involved in the postnatal and antenatal stages, from pediatricians to doctors and social workers will help, in addition.
A key question the report raises is “What good is diagnosis without a service?” While this is central to everything around FASD, it is critical that other problems, such as the stigma attached to an FASD diagnosis, or the attitude of parents are also addressed.
If a doctor is scared of a reaction to such a degree that they are unwilling to make a diagnosis, then that will be to the detriment of a child’s health.
It is also recognized that children will need to be monitored as they grow older. It is not the case of dealing purely with parents and toddlers. Those identified as having an FASD need support throughout childhood and their teenage years, whether that relates to learning difficulties, emotional development, or another outcome.
It is clear that more needs doing to identify and then manage cases of FASD. Given the lack of similar studies from around the world, it is likely that many other countries find themselves in the same situation as the UK.
Advice from medical bodies will always be that parents should not drink during their pregnancies, however it must be recognized that the processes discussed here could well serve as an intervention when dealing with alcohol dependent parents, for example, which could ultimately save children’s lives as well as make their childhood prospects much brighter.
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