Sir.—Little et al1 seem to believe that "better communication" between the obstetric and pediatric staffs would somehow result in better diagnosis and treatment of infants with fetal alcohol syndrome (FAS). They do not seem to consider the dilemma of the pediatric clinician in this situation. The clinician is strictly bound first to do no harm. There has to be substantial benefit to justify telling the mother, "You damaged your child." As far as I can determine, since diagnosis is imprecise and judgmental, the relation between the phenotype and the behavior is highly variable, and specific treatment is nonexistent, there is little value in making the diagnosis of FAS.
What is imperative is the sophistication of obstetric services in supporting women during their pregnancies in a way that minimizes consumption of alcohol and other toxic substances and improves nutrition. It is also imperative that pediatricians develop widely available sophisticated
HESS KW. Fetal Alcohol Syndrome: Misplaced Emphasis. Am J Dis Child. 1991;145(7):720–721. doi:10.1001/archpedi.1991.02160070015007
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