PMC3432341_01
(a) Foetal alcoholic syndrome: face, note the short palpebral fissures, flat nasal bridge and small nose, strikingly featureless philtrum and poorly formed upper lip. (b) Severe malnutrition and growth restriction in foetal alcoholic syndrome. Initially all treatments failed to establish adequate nutrition and growth, including insertion of a gastrostomy and total parenteral nutrition, due to persistent severe vomiting. After 6 months of age, a fundoplication was performed, and gradually enteral nutrition could be reestablished. The child has caught up weight and growth into the percentiles but is still dependent on gastrostomy feeding at present (4 years and 10 months of age).
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PMC3432341_01_CRIM.PEDIATRICS2012-509253.001.jpg
fig1
On examination she had several distinctive features with a wide anterior fontanelle, large mouth and tongue, short anteverted nose, flat nasal bridge, long smooth philtrum, thin tented upper lip (Figure 1(a)), short neck, widely spaced nipples, mild camptodactyly of the left fifth finger and deep palmar crease on the right hand (Figure 2(a)), wide sandal gap on both feet (Figure 2(b)), and deep sacral crease. Her growth was falling further away from her centiles (Figure 1(b)), and she was extensively investigated.
(a) Foetal alcoholic syndrome: right hand, note the "hockey stick" appearance of the deep palmar crease. (b) Feet, note the wide 1-2 sandal gap bilaterally.
CRIM.PEDIATRICS2012-509253.002.jpg
PMC3432341_01_CRIM.PEDIATRICS2012-509253.002.jpg
fig2
On examination she had several distinctive features with a wide anterior fontanelle, large mouth and tongue, short anteverted nose, flat nasal bridge, long smooth philtrum, thin tented upper lip (Figure 1(a)), short neck, widely spaced nipples, mild camptodactyly of the left fifth finger and deep palmar crease on the right hand (Figure 2(a)), wide sandal gap on both feet (Figure 2(b)), and deep sacral crease.