Physical Assessment of Children With FASD: Evidence Based Practice

Abstract

Fetal Alcohol Spectrum Disorder (FASD) is the leading preventable cause of developmental delay worldwide. Early diagnosis and intervention are vital to the prevention of secondary disabilities for those with FASD. Current diagnostic guidelines fail to identify the many physical malformations associated with prenatal alcohol exposure and recommendations for diagnostic differentials vary between guidelines. A critical appraisal of the literature and review of current guidelines was conducted to create an evidence-based physical anomaly checklist and differential diagnostic table. The critical appraisal consisted of 27 articles and resulted in 85 physical anomalies associated with prenatal alcohol exposure. The review of current guidelines resulted in five guidelines and four supportive articles that identified 20 different genetic disorder differentials and four exposure related differentials. A Plan-Do-Study-Act (PDSA) quality improvement model was used to implement education on the reference tools and encourage practice implementation in a North American FASD diagnostic team. All providers directly participating in the diagnosis of FASDs must be aware of the many physical anomalies associated with prenatal alcohol exposure and should have a working knowledge of potential differential diagnoses. The physical anomaly checklist and differential diagnoses tables help to provide this information in a clinically practical way.