Assessing Prenatal Alcohol Exposure History for Pediatric Patients: Practices Among U.S. Clinicians

Objectives: The American Academy of Pediatrics recommends clinicians who treat pediatric patients screen for prenatal alcohol exposure (PAE) to facilitate the identification of children with fetal alcohol spectrum disorders and promote timely access to behavioral and cognitive interventions. We evaluated how frequently clinicians inquire about PAE in their pediatric patient interactions and the methods used to ascertain this information.

Methods: We analyzed data from the Fall 2020 DocStyles survey, a web-based survey of primary healthcare professionals (n = 1754). Distributions for frequency of assessing PAE history for five pediatric populations and the methods used were calculated by clinician specialty (family practitioners [FP], pediatricians, and nurse practitioners/physician assistants [NP/PAs]) and overall. Chi-square and Bonferroni post-hoc tests determined whether frequency of assessing PAE history varied by specialty.

Results: Among 779 clinicians serving pediatric patients, approximately 70.5%, 63.0%, and 60.7% reported often/always obtaining PAE history from parents of children with developmental/behavioral issues, adopted/foster children, and newborns, respectively. By contrast, less than half of respondents reported often/always collecting this information from parents of infants (47.6%) and new patients (38.2%). Most respondents reported collecting PAE history through interviews conducted by physicians or physician assistants (69.7%). Obtaining PAE history varied by specialty; pediatricians (71.5%) were more likely to collect PAE history for adopted/foster children when compared to FPs (57.7%, p = 0.003).

Conclusions for practice: PAE history is not routinely obtained for pediatric patients. These findings highlight the need for trainings and practice supports to aid clinicians in identifying and treating children at-risk of FASDs.