Medical / Dental
Medical Treatment Issues
The medical care of the child with fetal alcohol syndrome (FAS) or fetal alcohol syndrome disorder (FASD) is treatment for associated birth defects and intervention for potential cognitive and behavioral abnormalities.As every affected individual is unique, each person’s medical needs are different as well.
It is not uncommon for your child with FASD to want to have an injury just like someone she knows. She may want to hurt herself to try and be like this person. And when she does, you should validate this and take her to the doctor, or put an ice pack or a tensor bandage on the injury. This should prevent her from actually harming herself.
Dental problems occur in the majority of persons with FASD. For children born with Fetal Alcohol Syndrome (FAS), dental anomalies that can occur include cleft palate, over- and underdevelopment of the upper and lower jaw, as well as malformed, missing and/or misaligned teeth.
Other problems that affect dental treatment that can occur with FASD include:
- Weak muscles around the mouth that make it difficult to take food off a fork or spoon or to suck on a straw or the nipple of a bottle
- Unusual taste preferences for salty or spicy food at an inappropriate age
- Cavities occurring at a young age
- Prolonged and excessive drooling
- Weak muscles that prevent the proper placement of food for chewing
- Late loss of baby teeth;
- Late eruption of permanent teeth.
In addition, the patient with FASD may have unusual behavioral patterns and tissue and sensory issues that make dental treatment difficult. Patients with FASD may experience more “loud” sounds than the average person. The sound of the some of the tools used by a dentist or hygienist may seem extremely loud to them. Music headphones can be a great help. The weight of the lead apron used during dental x-rays is very comforting to the patient with FASD, and it may be useful to let her wear it throughout the treatment.
Sensory integration dysfunction of the mouth may create some unusual problems. Ask the dentist to suggest another type of toothpaste if the taste or texture annoys the person with FASD. Baking soda is a good semi-tasteless substitute and brushing with water is better than no brushing at all. There are commercial rinses that contain plaque removers and/or fluoride that would help with your child’s oral hygiene.) Rinsing should be practiced and done often during the day. Flossing or use of the WaterPik may be more comfortable. The mouth may be desensitized with oral massage. Daily massaging with a small portion of a towel or a rubber stimulator will help the individual to become used to objects in the mouth.
Persons with FASD function best with a great deal of structure and routine in the environment. Unfortunately, even when they are scheduled far in advance, visits to doctors and dentists are usually breaks in the normal routine, and therefore they may be upsetting to the individual. This is especially true if he or she is in pain or has a sudden illness.
In order to avoid the anxiety around an unanticipated visit to the dentist or the doctor, parents can try to obtain take photos of the office and staff beforehand. Many health care offices have websites that have pictures you can use for this purpose. Use these to remind your child of previous visits, or to show her pictures of who she will be meeting. Review the photographs each day for about two weeks before a scheduled appointment.
If possible, make the appointment at the quietest time of the day or even after regular hours. For a routine examination, ask the practitioner for a “practice visit.” During this time, have the staff member walk the FASD-affected person through the procedures and use the exact treatment rooms and instruments that will be used during examination and treatment later.
Patients with FASD often need to “unwind” or calm themselves down before treatment begins. This may include walking around the room or fidgeting with their hands. Let you child bring a rubber ball or any other soothing object to squeeze or hold during the visit. Unless the practitioner is examining the person’s eyes, allow him or her to wear dark glasses if they help to reduce discomfort from the glare from overhead lights (such as at the dentist’s office).
Most health care recipients who are affected by FASD should be accompanied to the doctor’s or dentist’s office by a trusted adult who can act as his or her advocate. Usually the advocate is a parent or caregiver, but if the patient is an adult the advocate could be a sibling, spouse, roommate, friend, or coworker.
The advocate should be ready to do the following:
- Review the FASD-affected person’s medication history with the practitioner carefully. It is not unusual for persons with FASD to have extreme reactions to medications. Dentists and specialists should always consult with the person’s parents (guardian or conservator, if applicable) and pediatrician (or primary physician) when administering anesthetics.
- Make sure that the practitioner understands that the patient with FASD is very literal, and will likely become confused if anyone on the staff uses terms such as “(name of instrument or procedure) like this”, and then that instrument or procedure is not used.
- Stress that the practitioner should talk about and show the person the actual instruments and materials that will be used during treatment in order to avoid confusion and misunderstanding.
- Encourage the staff and practitioner to warn the patient about noise and new phases of the procedure. This will reduce tension. Make sure that the practitioner and other staff members understand that they should speak directly to a patient with FASD. Stress that the individual is very visual and often cannot understand if you turn away when you speak. Hand gestures, signing, and visual aids will help them to understand you more clearly.
Sensory integration dysfunction is a neurological condition that causes sights, sounds, and physical sensations to be over or under exaggerated. It is also not uniform in each individual; hypo and hyper sensitivities may exist in different areas on the same individual.
Visually, objects on the wall or hanging from the treatment lamp may be disturbing. Patterned curtains that sway near an air vent may be very distracting. Making the treatment room as plain and uncluttered as possible will help to prevent over-excitement and over-stimulation.
Patient education is a vital segment of good health. Persons with FASD benefit from visual reminders. For examples, a series of photos or hand drawn pictures showing how to to brush and floss can lead them up to an through the daily routine of good oral health. Step by step pictures are the best. Break down the instructions into doable segments; do not combine instructions or make them overly long. Have patients demonstrate their oral hygiene for you. Simply repeating the instruction does not mean that they understand them…remember patients with FASD are visual and literal and need to be very hands-on. It helps to remember that patients with FASD may have an emotional age that is one half of their chronological age..gear your explanations to that emotional level.
Note: There are few FASD-specific web sites that deal with addressing the challenges of medical (including psychiatric and mental health) or dental treatment. This is likely due to the fact that every fetal alcohol-affected person is unique. The links to Internet sites here are targeted toward individuals who have challenges commonly observed in many persons with FASD, such as slow information processing speed, sensory integration problems, impulsiveness, poor memory, problems with understanding, remembering and following multi-step or complex directions, etc.
Special Needs Dentistry: Treating Patients with Fetal Alcohol Spectrum Disorders
Medical Treatment of Adults with FASD
Following Treatment Guidelines for Developmentally Disabled Adults
Dental Hygienist Tips: Caring for the Developmentally Disabled