Alcohol syndrome babies slip through safety net

LARGE numbers of children in Scotland affected by their mothers drinking alcohol during pregnancy have not been diagnosed, experts suspect.

Estimates suggest more than 100 children a year in Scotland could be born with foetal alcohol syndrome (FAS) – the most severe form of disability caused by alcohol use among pregnant women.

However, a monitoring project has received just 37 confirmed reports of the disorder in three-and-a-half years.

Experts said lack of awareness and low rates of diagnosis meant children were missing out on special care to deal with their disabilities, while it could also mean missed opportunities to prevent other babies being born to mothers who abuse alcohol when pregnant.

Based on worldwide estimates that FAS affects between 0.5 and two in every 1,000 births, Scotland would expect to see between 29 and 117 affected children born each year.

However, the 37 confirmed reports in more than three years suggests many are being missed. This included just eight cases from Scotland’s biggest health region, Greater Glasgow and Clyde.

Dr Chris Steer, a paediatrician in Fife involved in the monitoring project, said based on the prevalence estimates, his team would expect to see more cases of the condition being identified in Scotland.

“There is a lack of familiarity with clinical presentation, or sometimes lack of reliable information about maternal drinking habits in pregnancy, either because you haven’t taken your enquiries far enough or there has been some evasion and people not giving a truthful account of their drinking,” Dr Steer told The Scotsman. “It is sometimes difficult for people to admit they have been drinking more in pregnancy.”

Symptoms of FAS can vary, but in many severe cases includes distinct facial features such as a small head and short nose. Babies may also be small when they are born and remain so.

Other signs include developmental delay and emotional, behavioural and learning difficulties, but symptoms are not always obvious.

Dr Steer said the figures also showed huge variation in diagnosis across Scotland.

“That probably reflects that clinician awareness in some areas is at a more alert level,” he said.

As well as those with FAS, an estimated five to nine times as many children are thought to suffer from foetal alcohol spectrum disorders (FASD), where disabilities may be less severe but also require extra help and support.

Dr Maggie Watts, the Scottish Government’s co-ordinator on foetal alcohol disorders, said identifying children with these disorders was not always easy in cases where symptoms were not obvious or the mother’s history was not known.

“In Canada and the US, they have had established services specifically around FASD for a considerable number of years and they are demonstrating that you can get the diagnosis and you can make a difference,” she said.

The Royal College of Paediatrics and Child Health has been running workshops in Scotland to raise awareness of alcohol disorders in children. More are planned.