Fetal alcohol syndrome

Overview

Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. Drinking alcohol during pregnancy can cause the child to have disabilities related to behavior, learning and thinking, and physical development. The symptoms of fetal alcohol syndrome vary from child to child but are lifelong.

Fetal alcohol syndrome is on the severe end of fetal alcohol spectrum disorders (FASD). FASD is a range of conditions in the child caused by the mother drinking alcohol during pregnancy.

There is no amount of alcohol that's known to be safe to drink during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.

If you suspect your child has fetal alcohol syndrome, talk to your doctor or other healthcare professional as soon as possible. Early diagnosis and treatment may help lessen some issues.

Symptoms

The severity of fetal alcohol syndrome symptoms varies. Some children have far greater problems than others do. Symptoms of fetal alcohol syndrome may include any mix of issues with how the body develops; thinking, learning and behavior; and functioning and coping in daily life.

Physical development issues

How the body develops may include:

• Facial features that are typical of fetal alcohol syndrome. These may include small eyes, a very thin upper lip, a flat nose bridge, and a smooth skin surface between the nose and upper lip.
• Slow physical growth before and after birth.
• Delayed development, including taking longer to reach milestones, such as sitting, talking and walking.
• Vision or hearing problems.
• Smaller than average head and brain size.
• Changes with how the heart, kidneys and bones develop.
• Poor coordination or balance.
• Being jittery or hyperactive.

Learning and thinking issues

Learning and thinking may include:

• Intellectual disability and learning disorders, including trouble with memory, learning new things, focusing and thinking.
• Not understanding the results of choices made.
• Poor judgment skills, such as having a hard time thinking through issues, problem-solving, reasoning and making decisions that affect everyday life.
• Short attention span that affects staying with a task and finishing.
• Poor concept of time, that impacts following schedules, knowing what time to leave in order to arrive on time and understanding how long a task will take.
• Trouble with organizing and planning or working toward a goal, including trouble understanding and following directions.

Social and behavioral issues

Functioning in everyday life, coping and interacting with others may include:

• Challenges in school with attendance, learning, behavior and interacting with others.
• Trouble getting along with others, including struggling with communication and social skills.
• Trouble adapting to change or switching from one task to another.
• Issues with behavior and with controlling emotions and actions.
• Problems managing life skills, such as telling time, self care, managing money and staying safe.
• Being easily influenced by others or taken advantage of.
• Quickly changing moods.

When to see a doctor

If you are pregnant and can't stop drinking alcohol, ask your obstetrician, primary care doctor or other healthcare professional for help. You also may choose to talk to a mental health professional. A social worker can direct you to community programs that offer help, for example, Alcoholics Anonymous.

Because early diagnosis may help lessen the risk of some challenges for children with fetal alcohol syndrome, let your child's healthcare professional know if you drank alcohol while you were pregnant. Don't wait for your child to have issues before seeking help.

If you adopted a child or are providing foster care, you may not know if the biological mother drank alcohol while pregnant. International adoption from some countries may have a higher rate of alcohol use by pregnant mothers. If you have concerns about your child's learning or behavior, talk with your child's healthcare professional to find out what might be causing these problems.

Causes

When you're pregnant and you drink alcohol:

• Alcohol goes into your bloodstream. Inside the womb, the placenta provides oxygen and nutrients to a developing baby. The alcohol reaches your baby by passing through the placenta.
• Alcohol causes a higher blood alcohol level in your developing baby than in your body. That's because a baby breaks down and gets rid of alcohol slower than an adult does.
• Alcohol is toxic to the baby's cells. Exposure to alcohol before birth can harm how the body develops and cause permanent brain damage in the developing baby.

The more you drink while pregnant, the greater the risk to your unborn baby. But any amount of alcohol puts your baby at risk. Your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy, before you may know you're pregnant.

During the first three months of pregnancy, important stages of development happen with the face and organs such as the heart, bones, brain and nerves. Drinking alcohol during this time can cause damage to how body parts develop. And as the baby continues to develop in the womb, it's damaging to drink at any time during pregnancy.

Risk factors

The more alcohol you drink during pregnancy, the greater the chance of problems in your baby. There's no known safe amount of alcohol to drink during pregnancy, and there's no type of alcohol that is safe.

You could put your baby at risk even before you realize you're pregnant. Don't drink alcohol if:

• You're pregnant.
• You think you might be pregnant.
• You're trying to become pregnant.

Complications

Behavior issues after your child is born can result from having fetal alcohol syndrome. These are called secondary disabilities and may include:

• Attention-deficit/hyperactivity disorder (ADHD).
• Aggression, improper social behavior, and breaking rules and laws.
• Alcohol or recreational drug misuse.
• Mental health conditions, such as depression, anxiety or eating disorders.
• Challenges staying in or completing school.
• Not being able to get along with others.
• Challenges with independent living and getting and keeping jobs.
• Sexual behaviors that are not proper.
• Early death by accident, homicide or suicide.

Prevention

To prevent fetal alcohol syndrome, don't drink alcohol during pregnancy.

Here are some steps to help:

• Don't drink alcohol if you're trying to get pregnant. If you haven't already stopped drinking, stop as soon as you know you're pregnant or if you even think you might be pregnant. It's never too late to stop drinking during your pregnancy. The sooner you stop, the better it is for your baby.
• Don't drink alcohol at any time during your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink at all during pregnancy.
• Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned, and damage from alcohol can happen in the earliest weeks of pregnancy.
• If you have an alcohol problem, get help before you get pregnant. Talk to your healthcare professional or a mental health professional about your drinking. Review how much and how often you drink alcohol so that together you can create a treatment plan to help you quit.

Diagnosis

Diagnosing fetal alcohol syndrome involves an exam from a healthcare professional with expertise in the condition. Early diagnosis and services can help improve your child's ability to function.

Making a diagnosis involves:

• Talking about your drinking during pregnancy. Be honest with your healthcare professional about your alcohol use during pregnancy. This can help your obstetrician or other healthcare professional figure out the risk of fetal alcohol syndrome. Although fetal alcohol syndrome can't be diagnosed before birth, the health of the baby and mother can be assessed and watched during pregnancy.
• Watching for symptoms of fetal alcohol syndrome in your child's early weeks, months and years of life. Your child's healthcare professional looks at your child's physical appearance for changes typical of fetal alcohol syndrome. The health professional also watches your child's physical and brain growth and development.

Over time the healthcare professional watches for issues with:

• Physical growth and development.
• Thinking, learning and language development.
• Health.
• Social interaction and behavior.

Many features seen with fetal alcohol syndrome also may occur in children with other conditions. If fetal alcohol syndrome is suspected, your pediatrician or other healthcare professional will likely refer your child to an expert with special training in fetal alcohol syndrome. This may be a developmental pediatrician, a neurologist or another expert. The expert does an evaluation to rule out other conditions with similar symptoms to help make a diagnosis.

Fetal alcohol spectrum disorders

Fetal alcohol spectrum disorders describes the range of conditions in children caused when the mothers drank alcohol during pregnancy. Symptoms vary greatly among children and can include all or a mix of physical, behavioral, and learning and thinking problems.

The range of conditions caused by alcohol exposure before birth includes:

• Fetal alcohol syndrome (FAS). FAS is the severe end of fetal alcohol spectrum disorders. Fetal alcohol syndrome includes problems with behavior, learning and thinking. It also involves physical and growth changes that can affect any part of the body.
• Alcohol-related neurodevelopmental disorder (ARND). ARND includes intellectual disabilities or behavioral and learning problems but doesn't include physical and growth changes.
• Alcohol-related birth defects (ARBD). ARBD includes changes in physical development that are present at birth, such as problems with hearing, vision, and the heart, kidneys and bones. It does not include problems with learning and behavior.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). ND-PAE includes challenges functioning in everyday life. There may be issues with thinking and remembering, behavior concerns, and challenges with day-to-day activities and social interactions.
• Partial fetal alcohol syndrome (PFAS). Also called fetal alcohol effects, this condition includes some symptoms of fetal alcohol syndrome. But the extent of symptoms doesn't meet the guidelines for a diagnosis of fetal alcohol syndrome. PFAS is not common.

If one child in a family is diagnosed with fetal alcohol syndrome, it may be important to evaluate siblings for fetal alcohol syndrome if the mother drank alcohol during these pregnancies.

Treatment

There's no cure or specific treatment for fetal alcohol syndrome. The physical and mental conditions caused by alcohol exposure before birth are lifelong. But early intervention services may help lessen some of the challenges of fetal alcohol syndrome and may help prevent some secondary disabilities.

Intervention services may include:

• Healthcare professionals who can provide care for vision, hearing or heart conditions. Medicines may help with some symptoms.
• Early intervention specialists, such as a speech therapist, physical therapist and occupational therapist, to help with walking, talking and social skills.
• Special services, such as a special education teacher and a psychologist or other mental health professional, to help with learning and behavioral issues.
• Vocational rehabilitation services to help with getting and keeping a job.
• Life skills training professionals to help with independence, such as social skills, coping, communication, problem-solving and decision-making.
• Mental health professionals for parents and the family members to help them cope with a child's behavioral problems.
• Counselors who deal with substance misuse to address alcohol and recreational drug misuse, if needed.

Treatment for alcohol misuse

Treatment for the mother's alcohol misuse can help with better parenting and prevent future pregnancies from being affected. If you know or think you have a problem with alcohol or recreational drugs, ask a healthcare professional or mental health professional for help.

Substance misuse counseling and treatment programs can help with overcoming alcohol or recreational drug use. Joining a support group or 12-step program such as Alcoholics Anonymous also may help.

Coping and support

The challenges that occur along with fetal alcohol syndrome can be difficult to manage for the person with the condition and for the family.

Family support

Children with fetal alcohol syndrome and their families may benefit from the support of professionals and other families who have experience with this condition. Ask your healthcare professional or a social worker or mental health professional for local sources of support for children with fetal alcohol syndrome and their families.

Dealing with behavioral issues

Challenges with behavior often happen in children with fetal alcohol syndrome. To help your child, use these parenting skills:

• Recognize your child's strengths and limitations.
• Set up and keep daily routines.
• Create and enforce simple rules and limits.
• Keep things simple by using clear, specific language.
• Repeat things to reinforce learning.
• Point out acceptable behavior and use rewards to reinforce the behavior.
• Teach skills for daily living and social interaction with others.
• Guard against your child being taken advantage of by others.

Early intervention and a stable, nurturing home are important to protect children with fetal alcohol syndrome from some of the other issues they're at risk of later in life.

Preparing for an appointment

Call your child's doctor or other healthcare professional for an appointment if you have any concerns about your child's growth and development.

You may want to ask a family member or friend to come with you to help remember all the information provided.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've noticed in your child. Include any that may seem unrelated to the reason for the appointment, and when the symptoms began.
• All medicines, vitamins, herbs or other supplements that you took during pregnancy, and their doses. Also, if you drank alcohol during your pregnancy, tell your child's healthcare professional how much you drank and when.
• Questions to ask your child's healthcare professional.

Questions to ask may include:

• What's the most likely cause of my child's symptoms?
• Are there other possible causes?
• Should my child see a specialist?
• Will my child's condition get better over time? Will it get worse?
• What treatments are available, and which do you recommend?
• Are there medicines that can help? Are there medicines that should be avoided?
• How can I prevent this from happening in future pregnancies?
• Do you have any material that can help me learn more? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Did you drink alcohol while you were pregnant? If yes, how much and how often?
• Did you use any recreational drugs during your pregnancy?
• Did you have any problems with your pregnancy?
• When did you first notice your child's symptoms?
• Have these symptoms been ongoing, or do they come and go?
• Does anything seem to make the symptoms better?
• What, if anything, seems to make the symptoms worse?

Be ready to answer questions so that you have time to talk about what's most important to you.