This talk was recorded live at DFTB17 in Brisbane. Watch out for more talks from our inaugural conference in the coming weeks.
Callum is a 6 year old boy who has been referred to paediatrics by his GP due to school concerns regarding his poor attention span and difficulty with learning and remembering new information. Whilst his peers in year 1 are working on their sight words, Callum is unable to recognize any sight words. He is described as a very social and talkative child although he doesn’t appear to always understand tasks despite being able to repeat the instructions. His parents are concerned as Callum’s older sibling also has learning difficulties.
Callum is a 6 year old boy who has been referred to paediatrics by his GP due to school concerns regarding his poor attention span and difficulty with learning and remembering new information. Whilst his peers in year 1 are working on their sight words, Callum is unable to recognize any sight words. He is described as a very social and talkative child although he doesn’t appear to always understand tasks despite being able to repeat the instructions. His parents are concerned as Callum’s older sibling also has learning difficulties. On your thorough history, you note that Mum consumed alcohol during pregnancy and you wonder whether this child could have FASD…
Fetal alcohol spectrum disorder (FASD) is a non-diagnostic umbrella term used to describe the permanent, severe neurodevelopmental impairments that may occur as a result of maternal alcohol consumption during pregnancy.4 A history of alcohol consumption during pregnancy alone is not sufficient for diagnosis however; further assessment and clinical examination is required before assigning this significant label (with significance applicable not only for the child but also the family). FASD is an umbrella term that includes a range of disorders3 including: Diagnostic criteria for foetal alcohol spectrum disorders3 At least two characteristic facial features Growth retardation Clear evidence of brain involvement Neurobehavioral impairment With or without documented prenatal alcohol exposure With documented prenatal alcohol exposure: § At least two characteristic facial features § Neurobehavioral impairment Without documented prenatal alcohol exposure: § At least two characteristic facial features § Growth retardation OR clear evidence of brain involvement § Neurobehavioral impairment Documented prenatal alcohol exposure Neurobehavioral impairment (This diagnosis cannot be definitively diagnosed in children <3 years of age) Documented prenatal alcohol exposure At least one specific major malformation associated with prenatal alcohol exposure Documented prenatal alcohol exposure Neurobehavioral impairment and onset in childhood Facial features, growth retardation, and clear evidence of brain involvement not necessary (but may be present) Not better explained by other teratogens; genetic or medical conditions; or environmental neglectWhat is it?
FASD
Diagnostic criteria
Fetal alcohol syndrome
Partial fetal alcohol syndrome
Alcohol-related neurodevelopmental disorder
Alcohol-related birth defects
Neurobehavioral disorder associated with prenatal alcohol exposure
Fetal alcohol spectrum disorder is the leading cause of preventable non-genetic intellectual disability in Australia.4,5 Up to 50% of Australian women report drinking during pregnancy. Binge-drinking occurs in 4 – 20% of pregnancies, with a peak in Indigenous Australians with approximately 22% of Aboriginal women stating that they binge drink during pregnancy.5 www.starkmhar.org/training-and-events/fasd-awareness-dayIs it actually still 'a thing' anymore considering all the media around women not drinking during pregnancy?
Alcohol is a teratogen with irreversible central nervous system effects.3 The teratogenic effects vary depending on: Australian and international guidelines advise that there is no safe level of alcohol consumption during pregnancy, with alcohol avoidance being the goal.7 As such, the level of danger has not been determined. Some suggestions have been that the foetus is more at risk where: But how much is too much?
It has the potential to cause harm at all stages of gestation. Neurobehavioural/neurodevelopmental effects may occur throughout gestation/pregnancy, even in the absence of facial or structural brain anomalies.3 https://www.cdc.gov/dotw/fasd/index.html What are the consequences of alcohol during pregnancy?
References
1
2 https://www.humanservices.gov.au/customer/forms/sa426
3 Weitzman C, Rojmahamongkol P. 2016 September 13. “Fetal alcohol spectrum disorder: Management and prognosis”. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA.
4 Australian Medical Association. 2016 August 24. “Fetal Alcohol Spectrum Disorder (FASD) – 2016.” Barton, ACT. Link: https://ama.com.au/position-statement/fetal-alcohol-spectrum-disorder-fasd-2016
5 Parliament of Western Australia. September 2012. “Foetal Alcohol Spectrum Disorder: the invisible disability.” Perth, WA. Link: https://www.parliament.wa.gov.au/Parliament/commit.nsf/%28Report+Lookup+by+Com+ID%29/1740F63B37A1314A48257A7F000766DD/$file/Final+FASD+Report+with+signature.pdf
6 Elliot, E. British Medical Journal. 2017 January 11. “Fetal Alcohol Spectrum Disorder” Westmead, Australia.
7 National Health and Medical Research Council. (2009). “Australian Guidelines to Reduce Health Risks from Drinking Alcohol.” Canberra, Australia.
8 Department of Health and Human Services – USA. April 2015. “Fetal Alcohol Exposure”. United States of America. Link: https://pubs.niaaa.nih.gov/publications/fasdfactsheet/fasd.pdf
Unless you have been walking around with your eyes closed, you will have noticed fidget spinners are everywhere! If not in the hands of your little patients, then in the hands of their parents. But is the hype worth it? Whilst they are being marketed as the latest tool for helping those with ADHD and autism, many are left wondering will this actually improve learning or is it just another distraction in our already hectic lives?
Firstly, one must remember that a fidget spinner is a type of fidget toy. The terms are not in fact synonymous. Rather they are just one spoke for the umbrella term:
Fidget toys/tools aren’t new. Occupational therapists have been recommending them for years. Whilst evidence behind fidget toys as a group is sparse, generally just being anecdotal, studies have shown that sensory tools such as weighted blankets and vests can produce a calming and relaxing effect in children with ADHD and Autism. When in the “right hands,” these tools can improve concentration and learning whilst reducing anxiety.
We all have a sensory “profile”. Some people prefer deep pressure touch, whereas others cannot stand touch. Some people need music to study whereas others require silence. Some people like to move and touch everything in sight, whereas for others this is incredibly frustrating. The problem is that fidget spinners have oversimplified this. It suggests that every person’s sensory profile can be managed using what is predominantly a visual sensory tool. This is obviously not the case. If the young person requires proprioceptive stimulation to stay focused (think about that person that always shakes their legs whilst they work), a spinning toy is obviously not going to fill that need. Fidget toys – whilst undeniably useful when used appropriately – need to be targeted to the young person’s needs. Strict recommendations around fidget toys are also important to highlight their role as a tool rather than a toy. Teachers should be given recommendations surrounding utilization of these tools, as well as advice that should it not be used for its intended function (e.g. should the young person throw their stress ball rather than squeeze it) it should be removed for a short period.
Finally the ugly of the fidget spinner; when used inappropriately, not only are these toys distracting to other students (as well as their teachers and parents) but they can result in injury. Whilst choking and swallowed foreign bodies are a major concern, minor head injuries and incarcerated digits have been recorded.
From honey.nine.com.au
Fidget tools are useful when applied to the right person with the right sensory profile.
The words are always thrown around when a teenager refuses treatment – but how much do you actually know about the Gillick case?
Trust me, I’m a GP
Andrew Tagg. Trust me, I’m a GP, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12808
Here at DFTB we are keen to promote a culture that breaks down the silos of who can do what. We all care about one thing, above all else, the wellbeing of the children we treat. Working in a hospital environment sometimes gives us a skewed view of illness. Just like every neurosurgeon that sees a patient with a headache is concerned about a sub-arachnoid haemorrhage, every doctor in the paediatric emergency department is concerned about missing sepsis.