Evaluation of the child

A pediatrician often diagnoses fetal alcohol spectrum disorder (FASD) from a combination of:

• Medical histories of both the mother and the child. The mother is asked how much and how often she drank alcohol while she was pregnant. The child's medical history includes a review of growth charts and questions about his or her patterns of learning, behavior, and physical skills, such as eye-hand coordination.
• Physical exams of the child. Height, weight, and head measurements are regularly taken and documented. A doctor also evaluates the child for typical physical features that can result from alcohol exposure, such as distinctive facial characteristics.

The doctor may order an ultrasound to look for problems before the baby is born, such as heart defects or irregular growth patterns. The cause of problems that are detected during the ultrasound may not be clear, but they can alert a doctor to any special care a baby may need after he or she is born. If the child's pediatrician knows about the mother's alcohol consumption, he or she can screen a newborn for FASD and follow up closely with the child to catch problems as early as possible.

Problems related to FASD range from mild to severe. It may take several years to identify the cause of a child's problems. Mild symptoms may not be noticed until a child reaches school age, when behavior and cognitive problems often become more noticeable.

A child with a severe type of FASD (fetal alcohol syndrome [FAS] or fetal alcohol abuse syndrome [FAAS]) can be diagnosed within the first 2 or 3 years of life, sometimes soon after birth. A child with FAS has:¹

• Characteristic facial features, which include a small head, flat face, narrow eye openings (slits), a short upturned nose, a flattened groove between the nose and the upper lip (philtrum), and a thin upper lip.
• Slowed growth. Children with FAS are at or below the 10th percentile for height or weight (or both) before or after birth. This means that these children are shorter and weigh less than 90 out of 100 children who are the same age and sex. In general, a birth weight of less than 2500g is considered low. Before a baby is born, his or her height and weight can be estimated by using an ultrasound.
• Central nervous system abnormalities. Signs may include a small head size. Certain behavior and thinking and reasoning (cognitive) problems may also mean there are central nervous system problems.

If behavior problems related to FASD are suspected in an older child, the parents and/or teachers (or day care providers) may be asked to complete a behavior checklist questionnaire. A chromosome analysis, genetic testing, and a complete developmental evaluation may be needed to rule out other causes of the symptoms.