Suspect Nephew has FASD

[PrincessPopple]

Over the years, it’s become increasingly apparent that my DHs nephew (7yo) presents with all the physical features of FASD (as in textbook if you Google them). This is obviously very upsetting, but doesn’t seem something that the extended family (including his parents or grandparents) have explicitly picked up on. Equally, I am assuming the HV didn’t pick it up (although my understanding was that their HV service was very poor and sporadic - DN was tongue tied for several weeks before that was picked up!) I am also not aware that school have, although I don’t know for sure. I am a professional who works in this area though, and it seems increasingly obvious.

As time has gone on, DN has struggled to meet his developmental milestones, is small for his age and struggles a LOT with eating. This causes a lot of stress for his parents and grandparents. My AIBU therefore, is would it be unreasonable to suggest the potential that he may present with FASD to his parents, as something that they might (or might not) want to look into, in order to help them to better understand DNs difficulties and to possibly help him with these, or would it be better to just stay quiet. He’s not my child and the suggestion would likely be hurtful to them?

YABU - say nothing
YANBU - say something

Was the mother known to be drinking durng pregnancy or would your suggestion be the first time such a thing was mentioned?

The most obvious question is is his mother a drinker?

I honestly don’t know for sure, but it definitely would not surprise me. Very much a ‘party girl’ prior to accidentally falling pregnant, and even since having DN, still enjoys going out clubbing with friends (pre- Covid, obviously!)

Unless they ask for your opinion then I'd keep it to yourself, it's unlikely to go over well. If they seek support for his issues then it'll likely get picked up then if the professionals involved at that time suspect it.

What I do know for sure is that she drank and smoked cannabis during her first pregnancy. (We honestly could not be more different as people!)

Only do it if you are happy to lose that relationship and potentially never see your nephew again. You will be accusing the mother of drinking unsuitable amounts during pregnancy and damaging her child. There will be no coming back from that imo.

Good point Foxy.

I wouldn't mention FASD but perhaps/maybe if you were discussing one of his behaviours with the parents in conversation and you get on well you could maybe
drop in that he may benefit from an assessment with gp or SEN at school to rule out 'anything such as ASD, autism, ADHD etc'. I wouldn't say FASD though as you kind of be accusing of drinking during pregnancy wouldn't you!?

you don;t need to be 'a drinker' for a child to have FASD - there is no known level of risk - one drink might be enough to cause damage - I would broach it but it's so tough because (as the responses show) it's seen as blaming the mum

Keep your beak out.

I agree, it would be the end of your relationship with them. And it likely wouldn’t help as I doubt they would accept your diagnosis.

Yes. That’s my fear. I guess I just feel torn morally about whether I should put DN’s needs above my own relationship with my ILs. I guess like Foxy suggested though, any professional worth their salt would, at the very least I would hope, suspect it. Perhaps I should suggest they go to gp re: his eating??

You say accidentally pregnant, how far along was she when she realised? Could you mention it in a way that does place blame?

E.g. 'I know you didn't know you were pregnant straight away, and I've noticed a few FASD markers, do you think it could explain some things?' If she says 'oh no, I knew quite early and didn't drink after that' then drop it, but it might plant the seed if it is the case.

You know how she's likely to react better than us though.

Normally I would say keep your nose out but if you work in that field I think you should say something.

There are genetic conditions that have similar facial features to FASD. Can you suggest that as they are stressed about his difficulties, then they ask for a referral to rule out any causes of delay etc/ get the appropriate support. There is some specific parenting advice for FASD but actually what is needed is to determine what his needs are and support them rather than labelling FASD if parents aren't on board. The presentation re behaviour and learning can be very varied

Stay well out of it. Those signs are indicators of plenty of other things too. I would never forgive you if I were asked that.

Hi Jumps, yes, I’m aware of those (I’m a paediatrician for context), I just need to find a shame-free way of raising this or just minding my own business! Thank you though.

I definitely wouldn’t mention FASD explicitly but if they mention his delayed development you could suggest that they ask for a referral to their child development centre for some investigations.

@PrincessPopple

I honestly don’t know for sure, but it definitely would not surprise me. Very much a ‘party girl’ prior to accidentally falling pregnant, and even since having DN, still enjoys going out clubbing with friends (pre- Covid, obviously!)

Before DS I drank alot. Weekends with friends I'd take my own two bottles - one for afri and one for Sat and then start on the spirits if were still up on either night. After DS the first night we went out we got on at 4 am drunk on cocktails. We now have 3 and o can still easily do a bottle in a single night. I didn't touch a drop through either pregnancy Unless it was an open secret that she ACTUALLY drank during her pregnancy I wouldn't mention FASD. You're likely to cause a rift in the family you can't close.

You can suggest they speak to the GP about his difficulties without mentioning FASD, as others have pointed out there are other conditions that can present in a very similar way to FASD. If it is FASD then it needs to be broached by the professionals in a sensitive, supportive way.

also you don't know what he may have been diagnosed with or what school are doing/saying - it doesn;t sound like they have the relationship with you where they would discuss it

If the development/behaviour is of concern they can get referred onto the local ASD/ADHD etc pathway and it will be identified if it's FASD or something else or just an outlier of NT, I would think. I'm sure you know there is a substantial overlap of FASD symptoms with other conditions.

Very helpful comments, thank you all. I guess it’s clear from these that any input from me would unlikely to be well received and certainly wouldn’t be helpful to DN.

you don;t need to be 'a drinker' for a child to have FASD - there is no known level of risk - one drink might be enough to cause damage

Are you also an expert???

Well as you are a Paediatrician, just suggest that you can see he is struggling in some areas so he would benefit from an assessment by a developmental paediatrician - no need to specifically mention FASD as others have pointed out you are likely to wreck your relationship with them. The developmental paediatrician should pick it up and ask themselves about drinking. Even if they don't, hopefully your nephew will get the help they need