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Foetal Alcohol Spectrum Disorders in a Paediatric Patient in Sub-Saharan Africa.

Patient details
Patient details.
T, a 4-year-old female from a rural community in South Africa.
Patient case fields
Presenting Complaint

T was brought to the paediatric clinic by her grandmother, who is concerned about her developmental delays, behavioural issues, and difficulty in school. The grandmother notes that T struggles with fine motor skills and often has trouble following instructions.

History

T was born at full term via vaginal delivery, but her mother consumed alcohol regularly during pregnancy. The family has a history of alcohol use, and the mother was often stressed and faced socioeconomic challenges. T met some early milestones, but her progress has plateaued. She was delayed in speech and had trouble with social interactions.

Examination

Growth Parameters: T is below the 10th percentile for height and weight.

Physical Exam: Facial features suggestive of Foetal Alcohol Spectrum Disorders (FASD) include a smooth philtrum, thin upper lip, and small palpebral fissures. No other congenital anomalies were noted.

Neurological Exam: T exhibits signs of hyperactivity and impulsivity. She has difficulty with tasks requiring concentration and fine motor skills, such as drawing or buttoning her shirt.

Developmental Assessment: Standardized developmental tests indicate significant delays in both cognitive and motor skills.

Investigations

A developmental screening tool showed marked delays in language and social skills.

No specific laboratory tests were conducted, as the diagnosis was primarily clinical based on maternal history and physical examination findings.

Diagnosis

T was diagnosed with Foetal Alcohol Spectrum Disorders (FASD), likely related to her mother’s alcohol consumption during pregnancy.

Management Plan
  1. Multidisciplinary Approach: T was referred to a team including a paediatrician, speech therapist, occupational therapist, and psychologist for comprehensive support.
  2. Early Intervention: Individualized educational support was initiated, focusing on language and motor skills development.
  3. Family Support: The grandmother was provided with counselling and resources to help her understand T’s needs and the impact of FASD.
  4. Follow-Up Care: Regular follow-up appointments were scheduled to monitor T’s development and adjust her care plan as needed.
Prognosis

With early intervention and supportive theraT can make progress in her development. However, FASD is a lifelong condition, and ongoing support will be necessary to help her navigate educational and social challenges.

Discussion
No data was found
Questions
1. What is the primary cause of T’s Foetal Alcohol Spectrum Disorders?

(a). Genetic factors

(b). Maternal alcohol consumption during pregnancy

(c). Environmental toxins

(d). Infections during pregnancy

2. Which physical characteristic is commonly associated with Foetal Alcohol Spectrum Disorders?

(a). Low birth weight

(b). Smooth philtrum and thin upper lip

(c). Large head circumference

(d). Clubfoot

3. What is the most effective approach to manage T’s developmental challenges?

(a). Medication to control behaviour

(b). Multidisciplinary early intervention

(c). Traditional herbal remedies

(d). Home schooling

4. What long-term support will T likely require as she grows older?

(a). Intensive physical therapy

(b). Ongoing educational and psychological support

(c). Regular medical check-ups for congenital issues

(d). Surgery to correct physical abnormalities

Reveal answers

Answers

  1. (b) Maternal alcohol consumption during pregnancy
  2. (b) Smooth philtrum and thin upper lip
  3. (b) Multidisciplinary early intervention
  4. b) Ongoing educational and psychological support.