FIGURE 1
Fetal alcohol syndrome facial features ( the most recognisable part of the spectrum )
Facial features
Smooth philtrum
Short palpebral fissures
Thin upper lip
Short upturned nose
part of neurological domain and the latter not quantifiable at the time . Other features , such as micrognathia , upturned nasal flares and characteristic hand and ear presentations , were also noted but presented more inconsistently .
Whist the prevalence of FASD is relatively common , all these features seen together is rare . Most recent UK prevalence estimates suggest that FASD presents in 1.8 – 3.8 % of the population 3 but full FAS criteria might only be seen in around 2 % of this group . 4 Therefore , FAS represents not the most severe , but the most recognisable part of the spectrum .
It became evident that there were timing effects of alcohol exposure that led to the physical manifestations . 5 Also , in the late 1970s and early 1980s , when much of this work was being undertaken , technology did not exist to allow accurate measurement of many of these features . More recent work and understanding has led , through computer technology and 3D camera analyses , to a better quantification of dysmorphology .
Because these techniques use thousands of landmarks for accurate measurements , linked to mathematical computer algorithms and calculations , better recognition of the features is possible . Therefore , early established features such as a flat midface can now be measured and quantified whereas before it was only assessed subjectively . 6
The recognition that there were a range of presentations related to different levels of alcohol exposure led to different criteria being established . In 1996 , the Institute of Medicine developed a consensus statement to begin to consider this broader-spectrum presentation . 7 The terms fetal alcohol syndrome with or without confirmed alcohol exposure , partial fetal alcohol syndrome , through to alcohol-related neurodevelopmental disorder or alcohol-related birth defect were created . These did not define severity , only how clear-cut or obvious the diagnostic presentation might be . The lack of consensus around thresholds for the cognitive domain has
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