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. 2013 Oct 18;110(42):703–710. doi: 10.3238/arztebl.2013.0703

Table. Key recommendations on diagnosis of fetal alcohol syndrome (FAS).

Diagnostic recommendation Evidence level Grade of recommendation
R 1:
For FAS to be diagnosed, abnormalities should be present in all four diagnostic categories:
1. Growth abnormalities
2. Facial abnormalities
3. Abnormalities of the central nervous system (CNS)
4. Confirmed or unconfirmed intrauterine alcohol exposure.
Whenever the health/support services are contacted, a child with abnormalities in any one of these categories should be investigated (or referred for investigation) of the other three diagnostic categories.		 Expert consensus
R 2:
For fulfillment of the criterion "growth abnormalities," at least one of the following abnormalities, adapted to gestational age, age, and sex, should be documented at any given time:
1. Birth weight or body weight ≤ 10 th percentile
2. Birth length or body length ≤ 10 th percentile
3. Body mass index ≤ 10 th percentile		 2 A: Strong consensus
R 3:
For fulfillment of the criterion "facial abnormalities," all three facial anomalies should be documented at any given time:
1. Short palpebral fissure length (≤ 3 rd percentile)
2. Smooth philtrum (lip-philtrum guide grade 4 or 5)
3. Thin upper lip (lip-philtrum guide grade 4 or 5)		 1 A: Strong consensus
R 4:
For fulfillment of the criterion "abnormalities of the central nervous system (CNS)," at least one of the following should be documented:
1. Functional CNS abnormalities
2. Structural CNS abnormalities		 Expert consensus
R 5:
For fulfillment of the criterion "functional CNS abnormalities," at least one of the following abnormalities, inappropriate for age and not solely explained by family background or social environment, should be documented:

  1. Global intelligence at least two standard deviations below the norm (IQ <70) or significant combined developmental retardation in children under 2 years of age

  2. performance at least two standard deviations below the norm in at least three of the following areas or in at least two of these areas in combination with epilepsy:

    • speech

    • fine motor skills

    • visuospatial perception or spatial-constructive skills

    • learning ability or retentiveness

    • executive functions

    • arithmetic skills

    • attention

    • social skills or behavior

 2–4 B: Consensus
R 6:
For fulfillment of the criterion "structural CNS abnormalities," the following abnormality, adapted to gestational age, age, and sex, should be documented at any given time:
Microcephaly ≤ 10 th percentile / ≤ 3 rd percentile		 2 B: Strong consensus
R 7:
If abnormalities are present in all three of the other diagnostic categories, FAS should be diagnosed even if consumption of alcohol by the mother during pregnancy is not confirmed.		 3 A: Consensus