13 MATERNAL RISK SCORE SCORE ____Age Over 25 years ____Unmarried, Divorced, Widow, Living with Partner Check any one,____On AFDC, WIC, Social Security or Income < $16,000 Per Year Add 5 ____Did not Graduate From High School ____Poor Diet ____Smokes More Than ½ Pack per Day ____Drinks less than 2 days/week & less than Check here, drinks /drinking day Add 20 ____Age First Drunk Less Than 15 years ____In Treatment Over Three Times ____In Treatment in Last 12 Months Check any one, ____Previous Child With FASD, Add or Developmental Disability ____Previous Child Died____Children Out of Home (Foster Care or Adopted) Check any one, ____Heavy Drinker (3 or more days per week or over 3 drinks Add per drinking day) ____Uses Inhalants, Sniffs or Illegal Drugs Score Risk Category Recommendations None Standard Prenatal Care Low Standard Prenatal Care Moderate Standard Prenatal Care and Patient Education on FAS High High Risk pregnancy, Alcohol-Drug Abuse Treatment Very High High Risk Pregnancy, Inpatient Treatment Total ScorePrenatalCopyright 2000
20 A.A. Nava-Ocampo et al./Reproductive Toxicology 18 (2004) 613-617 Time-course of maternal blood ethanol concentrations. Symbols represent the observed ethanol concentrations and lines resent the predicted values. The different shapes were used to represent the six patients; however, no specific order was used.
25 FASD: Screening and Early Identification Sibling with FASDMother in substance abuse treatmentFoster care placementWIC clinicsJuvenile Justice ProgramsSpecialty Care Clinics
26 Phenotype Detectability Criteria are Age DependentHighPhenotypeDetectabilityLowBirth24681012141618202224262830323436FASD Diagnostic Age in Years
27 Percent of Children who Moved Up in Height Percentile Category from Birth to DiagnosisN=232%
28 Ikonomidou C, et al. Science 287:1056-1060, 2000.
29 FASD Related Impairments MemoryAttentionAdaptive behaviorUse of social rulesSleepBehavior regulation
30 Reprinted with permission: Wattendorf, Daniel J Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72
31 Fetal Alcohol Screening Small head circumferenceLow nasal bridgeEpicanthic foldsShort palpebral fissures obscure the canthus (the inner corner of the eye)a normal feature in certain species of the Mongolian raceShort noseShort midfaceIndistinct philtrum(an underdeveloped groove in the center of the upper lip between the nose and lip edge)Thin reddish upper lip
32 Reprinted with permission: Wattendorf, Daniel J Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72
33 Reprinted with permission: Wattendorf, Daniel J Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72
34 Reprinted with permission: Wattendorf, Daniel J Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72
44 FASD: Diagnosis Specific Management Issues Mortality rate increased 3-7 foldSubstance abuse treatment for motherEvaluate all siblingsIncreased risk of substance abuseRecurrence rate in younger siblings 75%Long term planningPrevention of secondary disabilities
45 Treatment of FAS Start early-Avoid Abuse Avoid multiple foster homes Treat in communityMake a place in the communityAvoid problem peersUse legal systemLong term treatment-more than 10 years
46 Common Recommendations Annual EvaluationPositive Behavior Management ProgramRespite CareIEPMonitor PeersSchedulePlan AheadEvaluate All SiblingsFind the Mom
47 Prevention of FASD Prevent recurrence Prevent subsequent exposed pregnancies
48 FASD Recurrence in Washington D.C. Annual birth cohort: 7,893New FASD cases: 78Recurrent cases: 205 will recur in families with multiple affected children.Start Prevention Here
49 Washington D.C. had 3,157 women using alcohol during pregnancy in 2006 How many are identified?Heavy uses who drink all 40 weeks of pregnancy = 158.
50 Can your program prevent one case of FASD this year? In Washington D.C. on this date next year, there will be 78 more people with FASDCan your program prevent one case of FASD this year?