# FASD Red Flags for Referral in Young Children

Canonical: https://pinnacleblooms.org/ask/what-clinical-red-flags-for-fetal-alcohol-spectrum-disorder-warrant-referral-in-a-young-child
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Refer for FASD assessment when growth restriction, sentinel facial features (short palpebral fissures, smooth philtrum, thin upper lip) and CNS dysfunction co-occur — especially with confirmed or suspected prenatal alcohol exposure. Persistent neurobehavioural difficulty with a positive exposure history warrants referral even without the full facial phenotype.

*A child with prenatal alcohol exposure rarely presents with a single sign — they present with a constellation that, recognised early, opens the door to timely support.*

## In short
Refer when growth restriction, characteristic facial features and CNS dysfunction co-occur — particularly against a history of confirmed or suspected prenatal alcohol exposure. FASD spans a spectrum: many children have neurobehavioural difficulties without the full facial phenotype, so persistent developmental and behavioural concerns warrant referral even when dysmorphology is absent.

## Red flags that warrant referral
**Growth**
- Prenatal or postnatal growth restriction — weight, length or height ≤10th centile, not otherwise explained

**Sentinel facial features** (most specific when all three present)
- Short palpebral fissures
- Smooth philtrum
- Thin vermilion border of the upper lip

**CNS / neurodevelopmental**
- Microcephaly or structural brain findings
- Global developmental delay; later, disproportionate cognitive, language or motor deficits
- Difficulties with attention, executive function, memory, adaptive behaviour and self-regulation
- Marked hyperactivity, impulsivity and social-communication difficulty out of keeping with environment

**History**
- Confirmed or strongly suspected prenatal alcohol exposure — a sensitive prompt to assess, even alone

## When to refer
No single feature is diagnostic. Refer for multidisciplinary assessment when features cluster across growth, structure and neurobehaviour, or when neurobehavioural impairment persists with a positive exposure history. A child need not meet full [ICD-11 LD2F.00](/fetal-alcohol-spectrum-disorder) criteria to justify onward referral — early intervention improves functional outcomes. Arrange a vision and hearing review in parallel.

## The Pinnacle way
Pinnacle Blooms Network supports the referral pathway with structured developmental profiling. The clinician-administered [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) gives an objective multi-domain baseline that complements your clinical impression and tracks change once support begins. A clinical AbilityScore® and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care — never the output of a screen. Onward [developmental therapy](/developmental-therapy) is matched to the child's profile.

## Trusted sources
Aligned with WHO ICD-11 (LD2F.00), CDC FASD resources, the American Academy of Pediatrics and NICE guidance on assessment of FASD.

**Next step —** to refer a child or establish a clinical referral partnership, reach the Pinnacle clinical team on WhatsApp: +91 91001 81181.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 — Fetal Alcohol Spectrum Disorder: https://icd.who.int
- CDC — Fetal Alcohol Spectrum Disorders: https://www.cdc.gov
- NICE — FASD assessment and diagnosis: https://www.nice.org.uk
- American Academy of Pediatrics — FASD: https://www.aap.org