Keeping little folk safe

Cite this article as:
Kristin Boyle. Keeping little folk safe, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13844

If my house were a workplace, it would be an emergency department. We operate 24-7, there are frequent tears and sometimes blood, and always a little too much to do in the allocated time. We have also recently experienced a surge in workload, which has arrived in the form of a soft cheeked, downy haired, sweet smelling, all around delightful baby boy. We jokingly refer to him as The Royal Baby, for he is indeed a teeny dictator, but a benevolent one who bestows smiles generously upon his subjects, and is happy to converse with one and all, albeit with a limited vocabulary.

Aidan Baron: Crash course in LGBTQI+ at DFTB17

Cite this article as:
Team DFTB. Aidan Baron: Crash course in LGBTQI+ at DFTB17, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13709

This talk was recorded live on the first day at DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are on sale for the pre-conference workshops and the conference itself at www.dftb18.com.

Fetal Alcohol Spectrum Disorder – Management

Cite this article as:
Mary Hardimon. Fetal Alcohol Spectrum Disorder – Management, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12615

After taking an extensive history and performing multiple clinical examinations in consultation with allied health staff, you come to the conclusion that Callum has a diagnosis of foetal alcohol spectrum disorder. His mother is mortified about the situation and isn’t sure what this will mean for Callum (both now and in the future) as well as the family.

Simon Craig: Acute asthma at DFTB17

Cite this article as:
Team DFTB. Simon Craig: Acute asthma at DFTB17, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13122

This talk was recorded live at DFTB17 in Brisbane. We’ve got plenty more where this one came from so keep on checking in with us every week. If you think you’ve got the chops to pull it off next year then get in touch with us hello@dontforgetthebubbles.com.

Trust me, I’m a GP

Cite this article as:
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.

Clinical features and diagnosis

Cite this article as:
Mary Hardimon. Clinical features and diagnosis, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12577

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. 

Fetal alcohol spectrum disorder

Cite this article as:
Mary Hardimon. Fetal alcohol spectrum disorder, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12421

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… 

 

Why is diagnosis important?

  • Allows focused interventions that better benefit the child
    • Early diagnosis enables early intervention6
    • Is a recognised diagnosis with NDIS!1 (permanent impairment – no further assessment required)
    • May be eligible for a Centrelink carers allowance2
  • Comfort” may be found in a “label” by the family (regardless of the perceived guilt that you may assume would occur)
  • Help to develop appropriate expectations for the young person and their family3
  • Can allow medical practitioner to better “screen” for associations (physical and behavioural/cognitive)
  • Allows identification of women at risk of harm from alcohol and allow referral and treatment which may in turn prevent the birth of a subsequent affected child6

What is it?

 

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:

  • Fetal alcohol syndrome (FAS) – the most common clinically recognisable manifestation of FASD
  • Partial fetal alcohol syndrome
  • Alcohol related neurodevelopmental disorder (ARND)
  • Neurobehavioural disorder associated with prenatal alcohol exposure
  • Alcohol related birth defects (ARBD)

Diagnostic criteria for foetal alcohol spectrum disorders3

 FASD Diagnostic criteria
 Fetal alcohol syndrome

At least two characteristic facial features

Growth retardation

Clear evidence of brain involvement

Neurobehavioral impairment

With or without documented prenatal alcohol exposure

Partial fetal alcohol syndrome

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

Alcohol-related neurodevelopmental disorder

Documented prenatal alcohol exposure

Neurobehavioral impairment

(This diagnosis cannot be definitively diagnosed in children <3 years of age)

Alcohol-related birth defects

Documented prenatal alcohol exposure

At least one specific major malformation associated with prenatal alcohol exposure

Neurobehavioral disorder 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 neglect

Is it actually still 'a thing' anymore considering all the media around women not drinking during pregnancy?

 

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-day

But how much is too much?

Alcohol is a teratogen with irreversible central nervous system effects.3 The teratogenic effects vary depending on:

  • Quantity of alcohol
  • Pattern  of alcohol consumption
  • Maternal and foetal genetics
  • Maternal age
  • Maternal nutrition
  • Smoking

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:

  1. >6 drinks per week for >2 weeks
  2. >3 drinks per occasion on >2 weeks
  3. Documentation of alcohol related social or legal problems
  4. Documentation of intoxication by blood, breath or urine alcohol testing

 

What are the consequences of alcohol during pregnancy?

It has the potential to cause harm at all stages of gestation.

  • First trimester à facial anomalies and major structural anomalies including brain anomalies
  • Second trimester à increased risk of spontaneous abortion
  • Third trimester à weight, length and brain growth

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

 

 

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

The fidget spinner craze – the good, the bad and the ugly

Cite this article as:
Mary Hardimon. The fidget spinner craze – the good, the bad and the ugly, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12234

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.