Agenda item

Report of the Consultant Paediatrician and Designated Doctor Safeguarding Children, Gateshead Health NHS Foundation Trust

The Committee received an overview of the report by Dr Carmen Howey – Consultant Paediatrician and Designated Doctor Safeguarding Children, Gateshead Health NHS FT.

Concerns were raised by partner agencies, Local Authority and Public Health, in relation to a potential excess of Foetal Alcohol Spectrum Disorder/Foetal Alcohol Syndrome (FASD/FAS) diagnoses amongst the Gateshead paediatric population, particularly those children who are Looked After (LACYP). It was agreed by Gateshead NHS Foundation Trust (GHNT), in conjunction with Newcastle Gateshead Clinical Commissioning group (CCG), to review the diagnoses of this group to establish if those concerns are valid.

The Committee were advised that a new review tool has been developed to review the diagnosis of children on the FASD database. This has been completed for 60 randomly selected children from a total of 223 on the database which was compiled by the previous Designated Doctor LAC.

The accepted diagnostic criteria for FASD that the review has been working to are:

A.   History of maternal alcohol intake in pregnancy (quantities needed to cause effects of FASD/FAS are uncertain with limited evidence available)

OR

B.   Presence of typical facial features associated with FAS

AND

C.   Microcephaly (head circumference <3rd centile for age) in pre-school children

OR

D.   Clear evidence of significantly impaired function across at least 3 domains of the FASD checklist

An overview of the outcomes of cases reviewed to date was provided from the report and the Committee were advised that the review is a significant piece of work which is ongoing.

It was noted that the results of the review so far support the view that some children were receiving a FASD/FAS diagnosis without the relevant diagnostic criteria being evidenced. The Committee were also advised that in order to determine the validity of a child’s diagnosis further assessments would need to be done.

A comment was made that professionals working with young women and expectant mothers need to get better at discussing the risks of drinking alcohol during pregnancy in a non-judgemental way. It was also noted that improvements need to be made to keep a record of when an expectant mother makes an admission of drinking alcohol – having such a record can assist in making a diagnosis of potential FASD/FAS should a child display symptoms later on.

A comment was made that the information presented at Committee on this occasion was a more neutral and balanced view than what had been previously reported. Information presented to Committee previously suggested an epidemic of FASD/FAS which would have a significant impact on Children’s Services. It was commented that the volumes identified by the previous Designated Doctor LAC were deemed to be large proportion of children however it was much about perception.

It was asked whether enough importance on diagnosing FASD/FAS was being given by the CCG. It was noted that the process has been manageable so far however there may be a need for a more formal approach in the future. The Committee were also advised that a discussion needs to take place with the CCG to see if the diagnosing FASD/FAS could be balanced with other statutory functions. It was also noted that the children identified so far on the database are not at any immediate risk of harm.

It was asked as a result of the comments above whether this issue of FASD/FAS is not as worrying as other health issues in children. It was noted that more work needs to be done in prevention and that young women needed to improve their awareness of the risks alcohol poses to unborn children. Targeted work with young women who have unplanned pregnancies and have been binge drinking as well as middle class women who drink wine regularly needs to take place.

It was asked whether FASD/FAS are a result of sustained or just occasional alcohol intake. The Committee were advised that this is variable from individual to individual however for a child to have the facial features associated with FASD/FAS alcohol is consumed by the mother in the first 12 weeks of the pregnancy. The physical effects on a child due to alcohol consumption within the first 12 weeks is a concern as many women may be unaware they are pregnant during those weeks and drink alcohol.

The Committee were advised that this is a long term project and once children from the database are investigated then there is potential for a wider regional approach to take place.

RESOLVED

(i)            That the Committee notes the actions and comments outlined in the report.