FETAL ALCOHOL SPECTRUM DISORDERS

Symptoms

The severity of fetal alcohol syndrome symptoms varies, with some children experiencing them to a far greater degree than others. Signs and symptoms of fetal alcohol syndrome may include any mix of physical defects, intellectual or cognitive disabilities, and problems functioning and coping with daily life.

Physical defects

Physical defects may include:

• Distinctive facial features, including wide-set eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
• Deformities of joints, limbs and fingers
• Slow physical growth before and after birth
• Vision difficulties or hearing problems
• Small head circumference and brain size
• Heart defects and problems with kidneys and bones

Brain and central nervous system problems

Problems with the brain and central nervous system may include:

• Poor coordination or balance
• Intellectual disability, learning disorders and delayed development
• Poor memory
• Trouble with attention and with processing information
• Difficulty with reasoning and problem-solving
• Difficulty identifying consequences of choices
• Poor judgment skills
• Jitteriness or hyperactivity
• Rapidly changing moods

Social and behavioral issues

Problems in functioning, coping and interacting with others may include:

• Difficulty in school
• Trouble getting along with others
• Poor social skills
• Trouble adapting to change or switching from one task to another
• Problems with behavior and impulse control
• Poor concept of time
• Problems staying on task
• Difficulty planning or working toward a goal

When to see a doctor

If you're pregnant and can't stop drinking, ask your obstetrician or other health care provider for help.

Because early diagnosis may help reduce the risk of long-term problems for children with fetal alcohol syndrome, let your child's doctor know if you drank alcohol while you were pregnant. Don't wait for problems to arise before seeking help.

If you've adopted a child or are providing foster care, you may not know if your child's biological mother drank alcohol while pregnant — and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has learning and behavioral problems, talk with your child's doctor so that the underlying cause might be identified.

Causes

When you're pregnant and drink alcohol:

• Alcohol enters your bloodstream and reaches your developing fetus by crossing the placenta
• Alcohol causes higher blood alcohol concentrations in your developing baby than in your body because a fetus metabolizes alcohol slower than an adult does
• Alcohol interferes with the delivery of oxygen and optimal nutrition to your baby's developing tissues and organs, including the brain

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

Impairment of facial features, the heart and other organs, including the bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester. That's when these parts of the fetus are in key stages of development. However, the risk is present at any time during pregnancy.

Diagnosis

If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome. Although doctors can't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of the mother and baby during pregnancy.

Your child's doctor can watch for signs and symptoms of fetal alcohol syndrome in your child's initial weeks, months and years of life. Early diagnosis and provision of services can help improve your child's ability to function.

Diagnosing fetal alcohol syndrome requires expertise and a thorough assessment. To make a diagnosis, doctors assess:

• The occurrence of drinking during the pregnancy
• Physical appearance and distinguishing features
• Physical growth and development
• Brain growth and development

The doctor may also assess:

• Cognitive ability and learning and language development difficulties
• Health issues
• Social and behavior problems

Many features seen with fetal alcohol syndrome may also occur in normal, healthy children or in children with other disorders. If fetal alcohol syndrome is suspected, your pediatrician may refer your child to a developmental pediatrician, a neurologist or another expert with special training in fetal alcohol syndrome for evaluation and to rule out other disorders with similar signs and symptoms.

Fetal alcohol spectrum disorders

The range of consequences from drinking alcohol during pregnancy are collectively called fetal alcohol spectrum disorders, as not all signs and symptoms are present in all children with the disorder. This range includes:

• Alcohol-related neurodevelopmental disorder — intellectual disabilities or behavioral and learning problems caused by drinking alcohol during pregnancy
• Alcohol-related birth defects — physical defects caused by drinking alcohol during pregnancy
• Fetal alcohol syndrome — the severe end of the fetal alcohol spectrum disorders, which includes both neurodevelopmental disorder and birth defects caused by drinking alcohol during pregnancy
• Partial fetal alcohol syndrome — presence of some of the signs and symptoms of fetal alcohol syndrome caused by drinking alcohol during pregnancy, but the criteria for the diagnosis are not met

If one child in a family is diagnosed with fetal alcohol syndrome, it may be important to evaluate his or her siblings to determine whether they also have fetal alcohol syndrome, if the mother drank alcohol during these pregnancies.

Preventions

Doctors haven't identified a safe level of alcohol that a pregnant woman can consume. But experts do know that fetal alcohol syndrome is completely preventable if women don't drink alcohol during pregnancy.

These guidelines can help prevent fetal alcohol syndrome:

• 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, but the sooner you stop, the better it is for your baby.
• Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink 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 can occur in the earliest weeks of pregnancy.
• If you have an alcohol problem, get help before you get pregnant. Get professional help to determine your level of dependence on alcohol and to develop a treatment plan.

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 consumption during pregnancy.

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

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

Complications

Problem behaviors not present at birth that can result from having fetal alcohol syndrome (secondary disabilities) may include:

• Attention deficit/hyperactivity disorder (ADHD)
• Conduct disorder, which includes aggression, violation of rules and laws, and inappropriate social conduct
• Alcohol or drug misuse
• Mental health disorders, such as depression, anxiety or eating disorders
• Problems in school, with independent living and with employment
• Inappropriate sexual behaviors

Treatment

There's no cure or specific treatment for fetal alcohol syndrome. The physical defects and mental deficiencies typically persist for a lifetime.

However, early intervention services can help reduce some of the effects of fetal alcohol syndrome and prevent some of the secondary disabilities that result. Intervention services may involve:

• A team that includes a special education teacher, a speech therapist, physical and occupational therapists, and a psychologist
• Early intervention to help with walking, talking and social skills
• Special services in school to help with learning and behavior issues
• Counseling to benefit parents and the family in dealing with a child's behavior problems
• Medications to help with some symptoms
• Medical care for health problems, such as heart abnormalities
• Treatment of the mother's alcoholism to enable better parenting and prevent future pregnancies from being affected

Treatment for problems with alcohol or other substances

If you know or suspect you have a problem with alcohol or other substances, ask a medical or mental health professional for advice. If you've given birth to a child with fetal alcohol syndrome, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol or other substances. Joining a support group or 12-step program such as Alcoholics Anonymous may help.