| 1 | Intrinsic to all pediatric medical home well child visits is surveillance of growth and development and documentation of the complete patient history and physical examination, including a history of alcohol exposure and other risk factors.3
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| 2 | FASD signs and symptoms include: growth deficits of height and/or weight at or below the 10th percentile at any age, microcephaly, developmental or behavioral concerns, and specific facial features that include short palpebral fissures, smooth philtrum, and thin upper lip. FAS/FASD risk factors include: known/suspected maternal alcohol or other substance use; patient’s sibling has FAS/FASD; patient was adopted; patient ever in foster care system. Any parental concern expressed about the possibility of an FASD always warrants further evaluation. |
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3, 5
| CNS abnormalities associated with FASD include: microcephaly, focal neurological deficits, known MRI abnormalities, cognitive/developmental/behavioral problems. To meet the FAS diagnostic criteria, structural (microcephaly and/or abnormality on neuroimaging), neurological (seizure or abnormality on neurological exam), OR functional abnormalities must be documented. [Functional = (1) Global cognitive deficits or significant developmental delay in a child too young for an IQ assessment (e.g., IQ or developmental quotient below 3rd percentile) OR (2) Deficits (below 16th percentile) in THREE or more specific functional domains, e.g., cognitive, academic, executive function, attention, memory, adaptive, motor, language, social skills, etc.] |
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5
| Document a comprehensive history and physical exam specifically seeking FASD manifestations. The 5a. growth delay is not explained by post‐natal environment or parental height. Dysmorphic facial features meet strict criteria with racial norms detailed in Jones KL. Fetal alcohol syndrome. In: Smith's Recognizable Patterns of Human Malformation. 6th ed. Philadelphia, PA: Elsevier Saunders; 2006:646‐651. |
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| 6 | Meeting all FAS diagnostic criteria establishes definitive FAS diagnosis.2 Children with prenatal alcohol exposure (PAE) and FASD-associated CNS abnormalities but without the FAS facial features meet the DSM‐5 diagnostic criteria for ND‐PAE. Facial features consistent with FAS but not sufficient to meet complete FAS criteria could be included as additional descriptors (e.g., short palpebral fissures with normal lip and philtrum). |
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6-9
| Refer to specialized care for comprehensive evaluation and/or specific management. Referral does not eliminate the possibility of FAS/FASD or the need for continued care coordination through the medical home. Consider referral to genetics to confirm diagnosis and/or diagnose co-morbid conditions. |
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4, 10-11
| The pediatric medical home coordinates and facilitates all aspects of comprehensive and continuing patient care, including referrals, educational services, health care specialists and community partners. |
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