Early Management of Children with Foetal Alcohol Syndrome in France
Toutain, Stéphanie, Chabrolle, Rose-Marie, Chabrolle, Jean-Pierre, Alcoholism
Summary - Perinatal management of infants born to alcohol-abusing mothers and their families is difficult. French Centres for Early Medical-Social Intervention (Centres d'action médico-social précoce; CAMSP) attempt to attenuate the handicaps of children suffering from foetal alcohol syndrome (FAS) or foetal alcohol spectrum disorders (FASD) by intervening early. Perinatal data from the hospital neonatology files and the medical-social outcomes of 11 FAS/FASD children obtained during interviews with the CAMSP director were analyzed. Management of the mother-child couple starting from hospital discharge relies on a medical-psychological-social network. Specialized CAMSP services accompany FAS/FASD children until the age of 6 years, contributing to diminishing their handicaps and favouring social participation, language acquisition and psychological construction, while encouraging their mothers to confront their alcohol dependence. CAMSP-like structures are essential for FAS/FASD children but too few exist. Their too sporadic linkage with neonatology departments means that children enter the system too late, which has detrimental repercussions on their future.
Key words: alcoholism; pregnancy; foetal alcohol syndrome; foetal alcohol spectrum disorders; handicaps
Despite its status in France as a legal culturally well accepted drug, alcohol is clearly the most dangerous addictive product for the foetuses. Moderate-to-high alcohol intake during pregnancy can be responsible for a variety of more-or-less complete malformations and dysmorphic anomalies, pre and postnatal growth retardation, and severe neurological and behavioural developmental disorders,1 which, depending on their severity, are classified under the foetal alcohol syndrome (FAS) or the foetal alcohol syndrome disorders (FASD) in accordance with the criteria in use at the time of our examination as defined by the American Institute of Medicine2 revised in 2000.3,4
Perinatal management of infants born to alcohol-abusing mothers and their families is difficult. We evaluated 11 children suffering from foetal alcohol syndrome (FAS) or foetal alcohol spectrum disorders (FASD). In the region of Upper Normandy in France alcohol consumption is particularly prevalent and at least 3/1000 newborns have obvious signs of prenatal alcohol exposure and are diagnosed with FAS.5 In France, the incidence of FAS varies between 1 and 1.3/1000 births versus 5.83 and 8/1000 births for FASD .6,7 For comparison, the incidence of FAS varies between 0.3 and 1.5/1000 births in Norway,8 0.3 and 4.8/1000 births in the United States,9 0.02 and 2.76/1000 births in West Australia,10 1.0 and 3/1000 births in industrialized countries.11,12 According to the Canadian Pediatric Society, in the world this incidence would be 1.9/1000 births. In addition to the possible physical handicaps, FAS is usually responsible for central nervous system disorders, intellectual incapacities and social, professional and familial inaptitudes.13 The association between the physiological involvement and social handicaps seems rather obvious.
The future of these children is severely impaired. Attenuating the handicaps and disturbances associated with FAS/FASD requires early and intensive management in medical departments or specialized centres which today are still too few.
SUBJECTS AND METHODS
The paediatric medical files of FAS/FASD children followed in French Centres d'Action Médico-Social Précoce (CAMSP, Centres for Early Medical-Social Intervention) between 2000 and 2005 were identified in the database of a university hospital neonatology department. These files were retrospectively analyzed by comparing different criteria (weight, length and head circumference at birth, intrauterine growth retardation (IUGR), weeks of amenorrhea, etc.) concerning the 11 FAS/FASD newborns. When available, the mothers' obstetrical files were also analyzed. Finally, to retrace the itineraries of these children after their discharge from the neonatology department, questionnaire-oriented interviews were conducted by the CAMSP director. …