The clinical features and hospitalization rates of children with full or incomplete fetal alcohol syndrome (FAS) were compared in retrospective case-controlled studies of affected Northern Plains American Indian children attending Aberdeen Area Indian Health Service hospitals, South Dakota. Forty-three children with FAS and 35 with incomplete FAS were identified from 1981 to 1993, using the International Classification of Diseases diagnostic criteria. Compared to controls, FAS and incomplete FAS children had significantly more facial dysmorphic features, growth deficiency, CNS dysfunction, muscular and cardiac problems and were hospitalized more frequently with otitis media, pneumonia, FAS, dehydration, anemia, failure to thrive, and feeding problems. Case children were hospitalized more days and were placed in foster care more often than control children. In order of decreasing frequency from 90% to 20%, the manifestations of CNS dysfunction were behavior problems, developmental delay, language delay, microcephaly, seizures, irritability, attention deficit disorder, hyperactivity, hearing loss, and learning disabilities. The most frequent facial dysmorphic features included a long, flat philtrum, low nasal bridge, short palpebral fissures, thin upper lip, ear malformations, flattened maxilla, short, upturned nose, and epicanthal folds. The frequencies of CNS dysfunction and dysmorphic features were lower in the incomplete FAS patients than in those with the full syndrome, except for ADHD, learning disabilities, mental retardation, flat philtrum, and low nasal bridge, which occurred with the same respective frequencies. 
COMMENT. Fetal alcohol syndrome diagnosis should meet all 5 of the following criteria: 1) prenatal alcohol exposure, 2) FAS suspected by physician, 3) one or more typical facial features, 4) growth deficiency, and 5) CNS impairment . Children meeting only 1 to 4 of these criteria are defined as incomplete FAS. Children with FAS have numerous health, learning, and social needs. The diagnosis of FAS becomes more difficult as the child grows older since the pronounced growth retardation and dysmorphisms of early childhood tend to diminish with age. FAS in adolescence was studied in 44 patients followed for 10-14 years . Although manifestations were less obvious, a characteristic “juvenile” pattern of FAS was recognized that included microcephaly, growth retardation, cognitive deficits, behavioral problems, and craniofacial dysmorphisms. (see Progress in Pediatric Neurology III, PNB Publ, 1997;524-525, for further articles on FAS).