Fetal Alcohol Syndrome

Definition

Fetal alcohol syndrome (FAS) is defined as the most severe form of fetal

alcohol spectrum disorder, or FASD. It is characterized by abnormalities

in facial features, slowed growth, and abnormalities in the structure and

functioning of the brain and spinal cord.

Description ’s ability to learn,’s learning and behavioral problems persist over his or her lifetime,’s facial features usually become less noticeable as he or she

Demographics

Researchers estimate that about 1 percent of the general U.S. population

is affected by fetal alcohol spectrum disorders and that 40,000 babies are

born every year with some kind of birth defect caused by the mother

drinking. However, fetal alcohol syndrome itself is the only disorder in

this group that has been formally defined by the Centers for Disease

Control and Prevention (CDC) and by the International Classification

of Diseases (ICD). Fetal alcohol syndrome is estimated to occur in one

or two out of every 1,000 live births in the United States. The rate may

be higher in some countries where binge drinking is common. The cost

of treating one child with FAS is estimated to be $2 million over his or

her lifetime. The cost of FAS to the American public runs to more than

$321 million each year.

As far as is known, FAS affects boys and girls equally and affects children

of all races equally. The primary risk factor is the amount and frequency

of the mother

being over age thirty, a history of heavy drinking, and low social or economic

status. Smoking and the use of other drugs can worsen the effects

of alcohol on the fetus.

’s’s drinking. Other risk factors in mothers include

Causes and Symptoms

Fetal alcohol syndrome occurs as the result of a woman drinking alcohol

during her pregnancy. Alcohol is a teratogen, which means that it is a

substance that causes birth defects. Although heavy or binge drinking

increases the risk of having a child with FAS, even moderate or occasional

drinking can affect the unborn baby. In addition,

it does not matter what type of alcoholic

beverage is consumed. Beer or wine can harm

the baby as much as whiskey or other forms of

distilled alcohol. It also does not matter whether

the mother drinks throughout her pregnancy or

only during a brief period. Alcohol can affect

the baby

pregnancy.

The ways in which alcohol affects the development

of the baby before birth are not fully

understood. What is known is that the fetus

depends on the mother

from its bloodstream as well as her own. It is

thought that alcohol and a chemical called acetaldehyde,

which is formed during the body

digestion of alcohol, disrupt the process of cell

reproduction and tissue formation in the baby

body. In addition, these chemicals interfere with

the transfer of vitamins, minerals, and other

nutrients from the mother

thus starving the baby of nutrients that are vital

to healthy growth. Last, alcohol and acetaldehyde

interfere with the oxygen supply to the baby.

Some pregnancies end in miscarriage if the

mother is a heavy drinker. A child with FAS may

also be born prematurely or die of sudden infant

death syndrome (SIDS).

The symptoms of FAS at birth may include

withdrawal syndrome if the mother had been

drinking heavily shortly before delivery. Newborns suffering from

alcohol withdrawal may be hyperactive, restless, or suffer from seizures.

The physical and developmental symptoms are described in the next section

because they are used to diagnose the disorder.

’s development at any point during’s liver to clear alcohol’s’s’s body to the baby,

Diagnosis

Diagnosis of fetal alcohol syndrome is usually based on a combination of

the mother

the child. The Institute of Medicine (IOM) has established the following

guidelines for diagnosing fetal alcohol syndrome:

•

indentation between the nose and the mouth); a thin red border

along the upper lip; and an abnormally short distance between the

inner and outer corners of the eye. Other facial features may

include flattening of the middle part of the face, drooping of the

eyelids, and unusually small eyes. Although these facial features

do not look like major deformities to most people, they tell the

doctor that the child

Facial features that include a smooth upper lip (lacking the normal’s brain has not developed normally.

•

below the tenth percentile in weight or height for his or her age.

Evidence of slow growth either before or after birth. The child is

•

include an abnormally small head, developmental delays, learning

difficulties, seizures or epilepsy, mental retardation, hyperactivity,

irritability in infancy, and poor judgment or impulse control in later

childhood. Many children with fetal alcohol syndrome do not learn

to communicate normally with others. They may also have problems

with memory and with paying attention. Some have difficulties

with writing or other skills involving hand-to-eye coordination.

Evidence of abnormalities in the central nervous system. These may

•

Children with FAS may have one or more of the following physical

features or characteristics even though these are not used to diagnose the

syndrome:

Confirmed or suspected drinking by the mother.

•

Cleft palate

•

Heart defects

•

Nearsightedness or other eye disorders

•

Hearing loss

•

Abnormal curvature of the spine

•

sticks

Unusual creases on the palms of the hands that resemble hockey

•

Joints that are easily dislocated

Treatment

Treatment of children with FAS includes treatment for birth defects at

the time of birth and educational or medical treatments for learning problems

or behavioral disorders as the child grows older. Behavioral

disorders may be treated with medications, psychotherapy, or a combination

of both.

Adults who care for or teach children with FAS should provide structure

and be consistent in their behavior toward them. These children do

best with routines that vary as little as possible so that they learn to see

the world as a predictable place. Instructions should be brief and repeated

frequently because such children have difficulty paying attention.

Prognosis

The prognosis of a child diagnosed with fetal alcohol syndrome

depends on the type and severity of the child

age at which treatment begins. Some doctors think that early diagnosis

is helpful because it gets the child into treatment more rapidly.

One study followed a group of people with FAS who were between

the ages of twelve and fifty-one. Researchers reported the following longterm

consequences of the disorder:

’s symptoms as well as the

•

95 percent had mental health problems.

•

center, or a psychiatric hospital.

55 percent had spent time in prison, a drug or alcohol treatment

•

60 percent had been in trouble with the law.

•

82 percent were unable to live independently.

•

70 percent had problems holding a job.

•

60 percent had problems with drugs or alcohol.

Prevention

FAS can be prevented if a pregnant woman avoids alcoholic beverages.

The Institute of Medicine (IOM) recommends a prevention program

on three levels: public education aimed at all women of childbearing age;

selected screening programs aimed at women who drink heavily and may

become pregnant; and prevention and intervention aimed at women who

are heavy drinkers and have already had a child with FAS. This third level

of prevention would include treatment for alcohol dependence combined

with case management.

The Future

It is likely that the number of children affected by fetal alcohol syndrome

will increase in the United States over the next few decades. Reasons for

this include the easy availability of alcohol, the increasing breakdown of

families and the growing number of single mothers, and the difficulty of

putting preventive measures in place.

SEE ALSO

infant death syndrome

Alcoholism; Developmental disability; Prematurity; Sudden

For more information

BOOKS

Kleinfeld, Judith, ed.

with Fetal Alcohol Syndrome

2000.

Stewart, Gail B.

Fantastic Antone Grows Up: Adolescents and Adults. Fairbanks, AK: University of Alaska Press,Fetal Alcohol Syndrome. Detroit, MI: Lucent Books, 2005.

PERIODICALS

Carroll, Linda.

York Times

.com/gst/fullpage.html?res=9C05EEDF1E30F937A35752C1A9659C8B63

([accessed April 2, 2008).

“Alcohol’s Toll on Fetuses: Even Worse Than Thought.” New, November 4, 2003. Available online at http://query.nytimes

WEB SITES

National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Pregnant

.niaaa.nih.gov/publications/DrinkingPregnancy_HTML/pregnancy.htm

(reprinted 2006; accessed October 28, 2008).

Nemours Foundation.

kidshealth.org/parent/medical/brain/fas.html (reviewed June 2008; accessed

October 28, 2008).When You Are… Drinking Can Hurt Your Baby. Available online at http://pubsFetal Alcohol Syndrome. Available online at http://’s drinking history (if known) and a physical examination of WORDS TO KNOWAcetaldehyde: A colorless liquid chemical that is
produced when the body begins to digest
alcohol. A chemical that causes hangovers after
heavy drinking, it also contributes to fetal alcohol
syndrome.
Binge drinking: A period of heavy drinking that
lasts for two days or longer.
Case management: An approach to healthcare
based on personalized services to patients.
Syndrome: A group of signs or symptoms that
occur together and characterize or define a particular
disease or disorder.
Teratogen: Any substance that causes birth
defects in children. Alcohol is a teratogen.

Fetal alcohol syndrome is a disorder that affects a child

to pay attention, and to control his or her behavior as well as to grow

normally. It is the leading known cause of mental retardation in North

America. Children with FAS are undersize and underweight for their age,

and they have smaller than average heads as well as certain facial features

associated with the disorder. The physical features of FAS are usually evident

at birth, but problems with learning and other abnormalities in

brain development may not be detected until the child starts school. The

child

while the child

grows into adolescence and adulthood.

Fetal Alcohol Syndrome