Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. e657-e668 (doi:10.1542/peds.2005-0516)
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ARTICLE

Pediatricians' Knowledge, Training, and Experience in the Care of Children With Fetal Alcohol Syndrome

Sheila Gahagan, MD, MPHa, Tanya Telfair Sharpe, PhDb, Michael Brimacombe, PhDc, Yvonne Fry-Johnson, MDd, Robert Levine, MDe, Mark Mengel, MD, MPHf, Mary O'Connor, PhDg, Blair Paley, PhDg, Susan Adubato, PhDh and George Brenneman, MDi

a Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
b Fetal Alcohol Syndrome Prevention Team, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
c Departments of Preventive Medicine
h Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
d National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
e Meharry Medical College, Nashville, Tennessee
f Department of Community and Family Medicine, St Louis University School of Medicine, St Louis, Missouri
g Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
i US Public Health Service (Retired), Rockville, Maryland, and Committee on Native American Child Health, American Academy of Pediatrics, Elk Grove Village, Illinois

OBJECTIVES. Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics.

METHODS. This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included.

RESULTS. Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy.

CONCLUSIONS. The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.

Key Words: fetal alcohol syndrome • developmental disabilities • medical home • alcohol

Abbreviations: FAS—fetal alcohol syndrome • CDC—Centers for Disease Control and Prevention • IOM—Institute of Medicine • AAP—American Academy of Pediatrics • FASD—fetal alcohol spectrum disorders • ARND—alcohol-related neurodevelopmental disorder • ARBD—alcohol-related birth defects

Accepted Mar 20, 2006.