This policy provides an overview of how CSWs are to assess Fetal Alcohol Spectrum Disorder (FASD) in infants, with instructions on observing and assessing evidence, and steps to be taken once FASD has been diagnosed.
Table of Contents
This policy guide was updated from the 09/29/10 and 10/05/10 versions, as part of the Policy Redesign, in accordance with the DCFS Strategic Plan.
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome (FAS) is a combination of physical and mental birth defects that may develop when expectant mothers drink alcohol during pregnancy. Although it is usually associated with excessive alcohol intake during pregnancy, differences in dose and conditions of exposure, as well as differences in individual sensitivity, account for different outcomes. Additional consideration must be given to gestational age at which the exposure took place and whether or not alcohol was taken in conjunction with other substances. In addition, other conditions, such as maternal malnutrition, often associated with alcoholism, can contribute to prenatal exposure resulting in Fetal Alcohol Syndrome.
Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.
FASD covers other terms such as:
- Fetal Alcohol Syndrome (FAS) - the only diagnosis given by doctors.
- Alcohol-Related Neurodevelopment Disorder (ARND) – reserved for individuals with functional or cognitive impairments linked to prenatal alcohol exposure, including decreased head size at birth, structural brain abnormalities, and a pattern of behavioral and mental abnormalities.
- Alcohol-Related Birth Defects (ARBD) – describes the physical defects linked to prenatal alcohol exposure, including heart, skeletal, kidney, ear, and eye malformations.
FASD symptoms may not become obvious until a child is three or four years old. Even if they are not mentally retarded, children and adults with Fetal Alcohol Syndrome have varying degrees of psychological and behavioral/emotional problems which affect their ability to function in all areas, including school, social relationships and independent living.
Many children with FASD go unidentified or are misdiagnosed. Often, behavioral problems caused by brain damage due to prenatal alcohol exposure are mistakenly thought to be solely a result of difficulties in the child’s previous home environment.
Only medical personnel can provide a diagnosis of Fetal Alcohol Syndrome. In some cases, a series of tests or diagnostic tools performed by a multi-disciplinary team of professionals may be necessary before a formal diagnosis may be made. However, the CSW should be aware of the possible symptoms of this syndrome when assessing a service family. Some characteristics and symptoms are directly observable and others must be obtained by other means.
Documenting Alcohol Exposure
- Inquire about the mother’s consumption of alcohol during the pregnancy.
- For diagnostic purposes, this inquiry and its documentation are often essential before a formal FAS diagnosis may be made for some children.
- Where FASD is suspected, the CSW must gather information about alcohol consumption during pregnancy or potential maternal alcohol abuse from the following sources:
- Interview mother, father, and other family members that may have direct knowledge of maternal prenatal drinking or evidence of alcohol abuse in general.
- Review the child’s medical birth records which may contain relevant information from medical professionals, tests, and admissions of alcohol use by the mother.
- To obtain additional information on mother’s alcohol consumption, review sibling cases, including information on birth mother, medical history of siblings, and if siblings have a diagnosis of FAS or related conditions.
Assessing the Child
- When assessing for Fetal Alcohol Syndrome, consider the following major identifying characteristics:
- Mild to moderate mental retardation (average IQ of 70)
- Heart defects (30-40%)
- Growth deficiency (extremely small size for age, abnormally small head)
- Unique facial features such as: crossed eyes; small, droopy eyelids; short eye openings; flat, upturned nose with a low nasal bridge; thin upper lip; smooth or flat in place of usual groove in midline of upper lip; malformation of external ear; ears that are set low on the side of the head.
- While unique facial features are a major identifying characteristic of FAS/FASD, they are not always present in children with the disorder. Also, keep in mind that facial features vary among different racial groups and may change as the child gets older.
- When assessing for Fetal Alcohol Syndrome, consider the following behavioral and emotional characteristics:
- Poor fine-motor ability
- Hyperactivity, distractibility, short attention span, poor short-term memory
- Low impulse control
- Speech, language defects, learning disabilities
- Lack of problem-solving abilities
- Inability to understand cause and effect relationships or long-term consequences
- While similarities exist between the behaviors of children who have Attention Deficit Hyperactivity Disorder (ADHD) and FASD, children with ADHD will be able to make cause and effect relationships as they relate to their impulsive behaviors, while children with FASD will not due to their cognitive deficits. Treatment options can vary greatly between children with ADHD and children with FASD so making accurate diagnosis is critical for future positive outcomes.
- When assessing for Fetal Alcohol Syndrome at birth and during infancy, consider:
- Increased/decreased motor tone
- Lower birth weight, smaller head circumference
- Feeding, sleeping problems
- Irritability, prolonged crying
- Failure to thrive
- Pneumonia and other medical problems (evaluation of heart defects, developmental delays) requiring hospitalization
- Document all contacts and observations in the Contact Notebook. Include both positive and negative findings.
- If Fetal Alcohol Syndrome is suspected because the child has exhibited symptoms of FAS/FASD, consult with the Public Health Nurse.
- After consulting with the PHN regarding suitable diagnostic assessment referrals (e.g., FAS/FASD testing programs or medical professionals) for the child, document follow-up discussions with the caregiver to ensure all assessments have been completed, and whether additional resources for testing or treatment are needed.
Fetal Alcohol Syndrome Has Been Diagnosed
- Request assistance from the in the investigation using the , Public Health Nurse Consultation Request.
- Continue to work with the PHN to gather documentation of maternal prenatal drinking or alcohol abuse, results of any FAS/FASD testing and other relevant medical history of the child to the appropriate medical professional for follow-up treatment.
- Document follow-up discussions with the caregiver in the Contact Notebook to ensure all assessments have been completed, and whether additional resources for testing or treatment are needed.
- When allegations of alcohol consumption are received during a mother’s pregnancy, assess the caregiver’s alcohol use/abuse as it affects her ability to appropriately parent any and all children in the home and potential for alcohol exposure of the unborn child.
- Provide information, and help educate the parent about Fetal Alcohol Syndrome as it relates to alcohol intake.
- Advise the parent of the serious non-medical consequences (such as Juvenile Court intervention) of the continued use/abuse of alcohol during pregnancy.
- Provide referrals for alcohol abuse treatment.
- Refer parent for appropriate prenatal medical care.
- When allegations are received after the birth of a child who exhibits characteristics of Fetal Alcohol Syndrome, and document the caregiver’s alcohol use/abuse, as it affects his/her ability to appropriately parent and for possible assessment and diagnosis of other minor children for Fetal Alcohol Syndrome or Fetal Alcohol Spectrum Disorder.
- Determine the nature and extent of the child’s special needs by referring the child to a physician who is qualified to assess and diagnose Fetal Alcohol Syndrome, as well as psychological, behavioral, and educational specialists for a formal FAS/FASD diagnosis.
- If possible, obtain a signed form from the parent(s) in order to access the child’s medical records.
- Provide and referrals e.g., behavioral therapies/clinic specializing in children with FAS, Regional Center, Special Education to the parent(s) to help meet the child’s special needs.
- Complete and fax , Referral to Regional Center.
- File DCFS 5004 in the Psychological/Medical/ Dental/School report folder (purple).
- Assess the parent(s) ability to follow through on accessing resources and providing ongoing care for the child, including follow-up medical treatment.
- Document all contacts and observations in the Contact Notebook. Include both positive and negative findings.
- Review and document medical information in the Health Notebook.
- Discuss medical information with CSW in order to determine the most appropriate course of action to take, which may include, but is not limited to: conducting joint visit, consultation with medical provider, assisting in obtaining additional medical information, etc.
- Document consultation and plan of action (or recommendations) in CWS/CMS Contact page.
- Make a home visit with the CSW to observe the child/parent(s) and advise the CSW regarding any abnormalities in the child’s physical appearance.
- Provide informational resources on Fetal Alcohol Syndrome for distribution to caregivers.
- Help identify any special medical needs of the child to assist in planning placement or special training for the caregiver.
- Assist the CSW in the development of the health component of the case plan.
DCFS 5646-1, Public Health Nurse Consultation Request
DCFS 5004, Referral to Regional Center
Referenced Policy Guides
0070-521.10, Assessment of Drug/Alcohol Abuse
0070-524.10, Assessment of Failure to Thrive
0070-560.05, Joint Response Referral: Consulting with PHN
0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals
0070-548.24, Structural Decision Making (SDM)
0070-548.25, Completing the Structured Decision Making (SDM) Safety Plan
0400-503.10, Contact Requirements and Exceptions
0600-500.20, Health and Medical Information
0700-504.20, Referring Children for Special Education or Early Intervention Services
Penal Code, Section 11165.13 – States the legal basis for reporting a positive toxicology screen at the time of the delivery of an infant.
Welfare and Institutions Code Section 300(b) - Any child who comes within any of the following descriptions is within the jurisdiction of the juvenile court, which may adjudge that person to be a dependent child of the court:
(b) The child has suffered, or there is a substantial risk that the child will suffer, serious physical harm or illness, as a result of the failure or inability of his or her parent or guardian to adequately supervise or protect the child, or the willful or negligent failure of the child's parent or guardian to adequately supervise or protect the child from the conduct of the custodian with whom the child has been left, or by the willful or negligent failure of the parent or guardian to provide the child with adequate food, clothing, shelter, or medical treatment, or by the inability of the parent or guardian to provide regular care for the child due to the parent's or guardian's mental illness, developmental disability, or substance abuse.