# When to Refer a Child with Possible FASD

Canonical: https://pinnacleblooms.org/ask/when-should-a-frontline-health-worker-refer-a-child-with-possible-fetal-alcohol-spectrum-disorder-to-a-specialist
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Refer when prenatal alcohol exposure is confirmed or suspected alongside growth, developmental or behavioural concerns — or when unexplained delay and learning or behaviour difficulties appear. You needn't be certain; suspicion plus concern is enough. Confirmation and diagnosis are the specialist's role.

*A frontline worker rarely confirms FASD — but you are often the first to notice the pattern, and your timely referral changes a child's whole trajectory.*

## In short
Refer a child for specialist assessment when you find **a confirmed or strongly suspected history of alcohol exposure during pregnancy** *together with* developmental, growth or behavioural concerns — or when a child shows unexplained developmental delay and learning or behaviour difficulties even without a clear history. You do not need to be certain. Suspicion plus concern is enough to refer; confirmation is the specialist's job.

## When to refer
Route a child to a developmental paediatrician or specialist team if you observe any of the following:

- **Prenatal alcohol exposure** reported by the mother or family — even occasional or early-pregnancy drinking warrants a closer look.
- **Poor growth** — low birth weight, small head, or a child consistently below growth expectations without another cause.
- **Developmental delay** — late milestones in speech, movement, attention or learning.
- **Behaviour and learning difficulties** — poor attention, impulsivity, trouble with memory, planning or social judgement as the child grows.
- **Facial features** sometimes seen with FASD (thin upper lip, smooth philtrum, small eye openings) — helpful if present, but their absence does **not** rule FASD out.

Refer early and refer kindly: approach the mother without blame, frame it as helping the child, and protect the family's dignity.

## The science, briefly
FASD (ICD-11 **LD2F.00**) is a lifelong, brain-based condition caused by alcohol crossing the placenta. Many children have no facial signs at all, so referral must rest on history and developmental concern, not appearance. Early identification means earlier support, fewer secondary difficulties at school, and far better long-term outcomes.

## The Pinnacle way
A clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) baseline and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care — never from a form or a screen. We assess each child against their own baseline, look for other causes, and build a plan. Learn more about [Fetal Alcohol Spectrum Disorder](/fetal-alcohol-spectrum-disorder) and our [developmental therapy](/developmental-therapy) pathways.

## Trusted sources
WHO ICD-11 (LD2F.00); CDC guidance on FASDs; AAP developmental surveillance recommendations.

**Next step —** When history and concern line up, don't wait — [book a developmental assessment](/enroll) so a clinician can see the child early.

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/browse11
- CDC: Fetal Alcohol Spectrum Disorders: https://www.cdc.gov/fasd/
- American Academy of Pediatrics: developmental surveillance: https://www.aap.org/