Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
7.2 Paediatricians’ survey, 2004
A similar study of 132 paediatricians conducted in WA in 2004 examined their knowledge, attitudes and practice with respect to FAS and alcohol use in pregnancy (Elliott et al. 2006). Using a questionnaire modified from that developed by Payne et al., 90 consultant paediatricians and 42 trainee paediatricians completed a two-page postal survey. With regard to the features required for diagnosis of FAS, 81% of respondents nominated abnormal facial appearance, 71% identified growth restriction, and 63% indicated central nervous system (CNS) abnormalities. Only 19 percent of respondents identified all four of the essential diagnostic feature for FAS (Elliott et al. 2006).
Just over one-fifth (23%) of paediatricians reported routinely asking women about alcohol use in pregnancy; 38% stated that they ‘sometimes’ asked about alcohol use; 33% asked only when other risk factors were identified, such as smoking or drug use; and 13% reported that they did not ask patients about alcohol use in pregnancy (categories were not mutually exclusive). Forty-one percent of the paediatricians reported that they did not provide patients with information on the effects of prenatal alcohol exposure. With regard to FAS diagnosis, only 49% of paediatricians or trainees had previously diagnosed FAS themselves; however, 92% had seen children with FAS who had been diagnosed by others. Just over three-quarters (77%) had suspected but not diagnosed FAS, 12% had been convinced of but not recorded the diagnosis, and 32% had referred children to others for diagnostic confirmation. Although 80% agreed early diagnosis might be advantageous, 70% (a higher proportion than in the earlier health professional survey) said diagnosis might be stigmatising. In addition, 36% thought parents of children diagnosed with FAS might resist referral for assessment and treatment.3
Only one-tenth (11%) had read the NHMRC Australian alcohol guideline regarding alcohol use in pregnancy that was current at the time (NHMRC 2001) and 9% provided advice entirely consistent with this guideline (i.e. that women should consider abstinence, avoid intoxication, drink less than seven standard drinks per week and that they should have no more than two standard drinks on one day, consumed over at least a two-hour period. The vast majority (87%) reported that they advised women to consider abstinence, 38% stating that this was the only advice they offered. One-third (33%) reported that they advised pregnant women to avoid alcohol intoxication, just over one-third (37%) advised women to have fewer than seven standard drinks per week and almost half (46%) advised women to have no more than two standard drinks on one day spread over at least two hours.
Almost four-fifths (78%) of paediatricians surveyed agreed that avoiding binge drinking might reduce FAS, while 44% believed women should abstain from using alcohol in pregnancy. Just over half the respondents (55%) felt that there was a lack of sufficient awareness of FAS among health professionals and 56% perceived that there was a paucity of services to treat FAS in the community. Only 5% felt ‘prepared to deal with a patient with FAS’ and most wanted educational materials for themselves, parents or carers, and children. When surveyed regarding the types of resources that they would find most helpful, 71% wanted information for distribution to patients/carers; 70% wanted materials for themselves/doctors; 67% felt a FAS diagnostic checklist would be useful; and 51% wanted information for referral (Elliott et al. 2006).