An infant brought to the clinic is diagnosed with failure to thrive (FTT), persistent growth deficiency of the head, and delayed development. Some unusual facial abnormalities are noted. The mother has a history of consuming large amounts of alcohol. The PNP suspects fetal alcohol syndrome (FAS) and refers the infant:

• A. For consultation with an endocrinologist
• B. For consultation with a neurologist
• C. For a genetic workup
• D. To a First Steps or Birth to Three Program

Answer: (D)

The key idea is that early intervention is the most effective first step when a newborn shows growth, neurodevelopmental delays, and facial features associated with fetal alcohol exposure. Fetal alcohol syndrome often causes multisystem problems, including failure to thrive, microcephaly, and developmental delays, and there is no specific genetic test to diagnose it. The best response is to enroll the infant in an early intervention program, such as First Steps or Birth to Three, which provides a comprehensive, family-centered approach from birth to age three.

These programs offer a multidisciplinary evaluation and services tailored to the child’s needs, including physical, occupational, and speech therapy, feeding support, and developmental services, often delivered in the home or community. The goal is to support the child’s development as early as possible and to assist the family in managing care and accessing resources.

Consultations with a neurologist or endocrinologist can be important for addressing specific medical issues that arise, but they do not address the broad developmental needs of a young child with suspected FAS. A genetic workup is not indicated here, since FAS results from maternal alcohol exposure, not a hereditary condition.