Fetal exposure to alcohol during the first trimester affects the development of the facial features. The areas most affected are the eyes and midface. The three facial features are:
- Small palpebral fissures: short horizontal length of the eye opening, defined as the distance from the endocanthion to the exocathanion
- Smooth philtrum: diminished or absent ridges between the upper lip and nose
- Thin upper lip: with small volume
Most people with FASD do not have the three sentinel facial features.
More detailed information on assessing sentinel facial features can be found in Section C and Appendix C and Appendix D of the Australian Guide to the diagnosis of FASD.
Growth assessment is an important aspect of any paediatric examination and impairment may reflect a teratogenic insult, genetic or other prenatal or postnatal factors. However, growth impairment is no longer considered diagnostic of FASD due to the range of factors which can influence growth in an individual in combination with prenatal alcohol exposure. Recent evidence and clinical experience suggest that growth impairment is neither sensitive nor sufficiently specific to indicate a FASD diagnosis.
More detailed information on growth assessment can be found in Section D of the Australian Guide to the diagnosis of FASD.