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ETCAF: Dépistage et aiguillage

Notions essentielles

  • Toutes les femmes en âge de procréer doivent subir un examen de dépistage de consommation d'alcool à l'aide d'outils de dépistage validés (T-ACE, TWEAK, AUDIT, par ex.) par leur fournisseur de soins de santé. Les femmes à risque de consommation élevée d'alcool doivent faire l'objet d'une intervention précoce de courte durée (counseling, par ex.).
  • Le but du dépistage de l'ETCAF est de déterminer le besoin d'aiguillage et de soutien pour la mère et de faciliter l'aiguillage vers une clinique de diagnostic.
  • Le médecin de famille ou le fournisseur de soins de santé primaires joue le rôle suivant dans le dépistage de l'ETCAF :
    • déceler les patients qui ont des caractéristiques dysmorphiques et/ou des problèmes de développement, d'apprentissage ou de comportement qui peuvent être attribuables à une exposition prénatale à l'alcool;
    • confirmer les antécédents d'alcool;
    • aiguiller le patient vers une équipe de diagnostic pluridisciplinaire spécialisée dans le diagnostic d'un ETCAF.
  • Il faut recommander l'abstinence à toutes les femmes pendant la grossesse.

Dépistage de la consommation d'alcool pendant la grossesse

La Société des obstétriciens et gynécologues du Canada recommande de parler de la consommation d'alcool avec toutes les femmes en âge de procréer. Le dépistage de l'alcool et le soutien des femmes à risque doit être considéré un élément routinier des soins de santé.

Les fournisseurs de soins de santé doivent aviser les femmes qu'une faible consommation d'alcool au début d'une grossesse n'est pas une indication pour interrompre une grossesse.

Les fournisseurs de soins de santé doivent proposer des interventions de courte durée aux femmes à risque de consommation et les femmes enceintes doivent avoir un accès prioritaire à la gestion du sevrage et à d'autres services de traitement.

Directive clinique de consensus sur la consommation d'alcool et la grossesse

Renseignez-vous sur les effets de la consommation d'alcool pendant la grossesse.

Établir qui doit être aiguillé vers une évaluation suivie d'un diagnostic

Remarque : Le dépistage est la première étape du processus de diagnostic. Il n'est pas suffisant pour établir un diagnostic.

Il faut aiguiller vers des services spécialisés en ETCAF pour une évaluation et un diagnostic dans les situations suivantes :

  • les trois traits caractéristiques du visage de l'ETCAF (une saillie lisse entre le nez et la lèvre supérieure, une lèvre supérieure mince, une faible distance entre les coins intérieur et extérieur de l'oeil) sont présents;
  • il y a une indication d'une importante exposition prénatale à l'alcool;
  • il y a un ou plusieurs traits caractéristiques du visage, des déficits de croissance et une exposition connue ou probable d'exposition prénatale à l'alcool;
  • il y a un ou plusieurs traits caractéristiques du visage avec des déficits de croissance prénataux ou postnataux, ou les deux (équivalent ou supérieur au dixième centile), et un ou plusieurs déficits du système nerveux central, et une exposition prénatale à l'alcool connue ou probable.

Renseignez-vous sur le dépistage (en anglais)

Certaines populations doivent recevoir une attention particulière lors du dépistage pour l'ETCAF, y compris :

  • les enfants examinés dans les cliniques de neurologie du développement et/ou d'anomalies congénitales;
  • les enfants dans les programmes d'éducation spéciale;
  • les enfants dans les systèmes d'aide à l'enfance (orphelinats, placement familial, agences de protection de l'enfance/services sociaux);
  • les populations en milieu correctionnel;
  • les jeunes dans les programmes de jeunes contrevenants;
  • les clients du système de soins de santé mentale.

Centres cliniques pour le diagnostic de l'ETCAF

Le Canada FASD Research Network (CanFIND) a compilé une liste des centres cliniques pour le diagnostic en Alberta, en Colombie-Britannique, au Manitoba, en Saskatchewan, au Yukon et dans les Territoires du Nord-Ouest.

Le Fetal Alcohol Spectrum Disorder Ontario Network of Expertise (FASD ONE) fournit des renseignements au sujet des services de diagnostic en Ontario. Ces renseignements sont organisés par région.

Ressources en matière de dépistage

·          National Screening Tool Kit for Children and Youth Identified and Potentially Affected by FASD (Trousse d'outils nationale pour le dépistage des enfants et des adolescents identifiés et potentiellement affectés par l'ensemble des troubles causés par l'alcoolisation foetale, Agence de la santé publique du Canada, 2012). Cette trousse comprend des liens aux outils suivants :

  • Outil de dépistage neurocomportemental (pour jeunes de 6 à 18 ans)
  • Guide des antécédents maternels (pour femmes à risque)
  • Roue de la médecine (pour jeunes de 4 à 14 ans et mères à risque)
  • Formulaire de dépistage et de renvoi pour l'ETCAF destiné aux agents de probation juvénile (pour les adolescents)
  • Test de méconium EEAG (ester éthylique d'acide gras) (pour nouveau-nés et mères à risque)

·          Canadian FASD Screening Toolkit (Motherisk) 

·          Youth Probation Officers' Guide to FASD Screening and Referral (Asante Centre).


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