fetal alcohol syndrome

Source: National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.

Fetal alcohol spectrum disorders are 100% preventable

FASDs are 100% preventable if a woman doesn't drink alcohol while she is pregnant. Learn more about the cause, signs, and treatments and what you can do if you think your child might have an FASD.

Cause and Prevention

FASDs are caused by a woman drinking alcohol during pregnancy. There is no known amount of alcohol that is safe to drink while pregnant. There is also no safe time to drink during pregnancy and no safe kind of alcohol to drink while pregnant.

Signs and Symptoms

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
Small head size
Shorter-than-average height
Low body weight
Poor coordination
Hyperactive behavior
Difficulty paying attention
Poor memory
Difficulty in school (especially with math)
Learning disabilities
Speech and language delays
Intellectual disability or low IQ
Poor reasoning and judgment skills
Sleep and sucking problems as a baby
Vision or hearing problems
Problems with the heart, kidneys, or bones

Diagnosing Fetal Alcohol Spectrum Disorders

Healthcare professionals look for the following signs and symptoms when diagnosing FAS:

Abnormal facial features
A person with FAS has three distinct facial features:
- Smooth ridge between the nose and upper lip (smooth philtrum)
- Thin upper lip
- Short distance between the inner and outer corners of the eyes, giving the eyes a wide-spaced appearance.
Growth problems
Children with FAS have height, weight, or both that are lower than normal (at or below the 10th percentile). These growth issues might occur even before birth. For some children with FAS, growth problems resolve themselves early in life.
Central nervous system problems
The central nervous system is made up of the brain and spinal cord. It controls all the workings of the body. When something goes wrong with a part of the nervous system, a person can have trouble moving, speaking, or learning. He or she can also have problems with memory, senses, or social skills. There are three categories of central nervous system problems:
1. Structural
  FAS can cause differences in the structure of the brain. Signs of structural differences are:
  - Smaller-than-normal head size for the person’s overall height and weight (at or below the 10th percentile).
  - Significant changes in the structure of the brain as seen on brain scans such as MRIs or CT scans.
2. Neurologic
  There are problems with the nervous system that cannot be linked to another cause. Examples include poor coordination, poor muscle control, and problems with sucking as a baby.
3. Functional
  The person’s ability to function is well below what’s expected for his or her age, schooling, or circumstances. To be diagnosed with FAS, a person must have:
  - Cognitive deficits (e.g., low IQ), or significant developmental delay in children who are too young for an IQ assessment.
    
    Or
  - Problems in at least three of the following areas:
    - Cognitive deficits (e.g., low IQ) or developmental delays
      Examples include specific learning disabilities (especially math), poor grades in school, performance differences between verbal and nonverbal skills, and slowed movements or reactions.
    - Executive functioning deficits
      These deficits involve the thinking processes that help a person manage life tasks. Such deficits include poor organization and planning, lack of inhibition, difficulty grasping cause and effect, difficulty following multistep directions, difficulty doing things in a new way or thinking of things in a new way, poor judgment, and inability to apply knowledge to new situations.
    - Motor functioning delays
      These delays affect how a person controls his or her muscles. Examples include delay in walking (gross motor skills), difficulty writing or drawing (fine motor skills), clumsiness, balance problems, tremors, difficulty coordinating hands and fingers (dexterity), and poor sucking in babies.
    - Attention problems or hyperactivity
      A child with these problems might be described as “busy,” overly active, inattentive, easily distracted, or having difficulty calming down, completing tasks, or moving from one activity to the next. Parents might report that their child’s attention changes from day to day (e.g., “on” and “off” days).
    - Problems with social skills
      A child with social skills problems might lack a fear of strangers, be easily taken advantage of, prefer younger friends, be immature, show inappropriate sexual behaviors, and have trouble understanding how others feel.
    - Other problems
      Other problems can include sensitivity to taste or touch, difficulty reading facial expression, and difficulty responding appropriately to common parenting practices (e.g., not understanding cause-and-effect discipline).
Mother’s Alcohol Use during Pregnancy
Confirmed alcohol use during pregnancy can strengthen the case for FAS diagnosis. Confirmed absence of alcohol exposure would rule out the FAS diagnosis. It’s helpful to know whether or not the person’s mother drank alcohol during pregnancy. But confirmed alcohol use during pregnancy is not needed if the child meets the other criteria.

Summary: Criteria for FAS Diagnosis
A diagnosis of FAS requires the presence of all three of the following findings:

All three facial features
Growth deficits
Central nervous system problems. A person could meet the central nervous system criteria for FAS diagnosis if there is a problem with the brain structure, even if there are no signs of functional problems.

Treatment for Children with FASDs

FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child's development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Get Help!

If you think your child might have an FASD, talk to your child's doctor and share your concerns. Don't wait!

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS).

Posted September 8, 2003
Updated: September 8, 2009