What is fetal alcohol syndrome

Fetal Alcohol Syndrome is a pattern of abnormalities like a range of mental and physical disorders on the developing unborn baby whose mother who drank alcohol during pregnancy. These effects range from brain damage and poor growth to birth defects and learning problems ¹. Alcohol is known to be what is called a ‘teratogen’. A teratogen is something from outside the body that can cause malformation and problems with the unborn baby. Fetal alcohol syndrome happens when a woman drinks when she’s pregnant. When a woman drinks alcohol, so does her baby. Even small amounts of alcohol will pass across the placenta and to the fetus. The baby’s liver is not developed enough to be able to process the alcohol. Through a number of biological means, alcohol can affect the size, shape, and function of the cells that form the brain, the heart, the kidneys, and all other body organs and systems of the fetus. The alcohol can damage the baby’s brain and organs and can cause other harm. Because brain growth takes place throughout pregnancy, the sooner a woman stops drinking the safer it will be for her and her baby. There’s no cure or specific treatment for fetal alcohol syndrome. The physical defects and mental deficiencies typically last for a lifetime.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.

• In 2015, the American Academy of Pediatrics stated that consuming alcohol at any time during pregnancy causes increased risk of physical and neurocognitive developmental disorders in a child, and that no amount of alcohol is safe to consume during pregnancy.

“Binge drinking” (having 3 or more drinks at a time) is especially dangerous for your baby. It makes the level of alcohol in your blood very high very quickly. Even if you don’t drink every day, you may put your baby at risk for fetal alcohol syndrome if you binge drink.

Drinking alcohol in the first 3 months of pregnancy is the most dangerous. This is when the baby’s brain starts to develop. Alcohol can interfere with the development and cause birth defects. But drinking at any time during pregnancy is not safe and can harm your baby.

A broader term is Fetal Alcohol Spectrum Disorder is a group of conditions that can occur in a person whose mother drank alcohol during pregnancy — this describes any physical or developmental disorders caused by prenatal alcohol exposure. Fetal Alcohol Spectrum Disorder is completely preventable if a woman does not drink alcohol during pregnancy.

The changes depend on the amount, frequency and the timing of the consumption of alcohol by the mother during pregnancy. The first three months of pregnancy is the time in which vital organs like the heart and the kidney are developing. Drinking alcohol during pregnancy can be dangerous to you and your baby. Babies born to mothers who drink during pregnancy may have serious health problems. Fetal alcohol syndrome is one of these problems. Because no amount of alcohol can be considered safe, pregnant women should avoid all alcohol during the entire pregnancy.

Symptoms of fetal alcohol syndrome baby include:

• Poor growth in the womb.
• Small and underweight at birth.
• Small head and eyes.
• Wide-set and narrow eyes
• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
• Shorter-than-average height
• Heart defects, such as a hole in the heart.
• Delayed development.
• Sleep and sucking problems as a baby.
• Vision or hearing problems.
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty with 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
• Problems with the kidney, or bones

The most serious problem fetal alcohol syndrome can cause is developmental delay. Fetal alcohol syndrome is the leading cause of preventable developmental delays in the United States. Fetal alcohol spectrum is quite a common problem, and is the number one cause of intellectual disability that is not caused by genetic problems. It is also hard to know the exact number of children with fetal alcohol spectrum. Across the world, the number of children reported to be born with fetal alcohol spectrum is between 0.5-5 per 1000 births depending on the country. It is also very different in different parts of each country and can be hard to accurately get the numbers on.

Figure 1. Fetal alcohol syndrome face

As fetal alcohol syndrome babies grow older, these children may have behavior problems. They may experience learning disabilities, trouble with memory and attention, and hyperactivity. Symptoms tend to get worse as the child grows older. The cost factor of raising a child with an fetal alcohol spectrum disorder is significant. Researchers have found that, for a child with identified fetal alcohol syndrome, incurred health costs were nine times higher than for children without an fetal alcohol spectrum disorder. The lifetime cost of caring for a person with fetal alcohol syndrome is estimated to be at least $2 million, and the overall annual cost of fetal alcohol spectrum disorder to the U.S. healthcare system to be more than $6 billion.

Fetal alcohol spectrum disorders last a lifetime. There is no cure for fetal alcohol spectrum disorders, but treatments can help. These include medicines to help with some symptoms, medical care for health problems, behavior and education therapy, and parent training. A good treatment plan is specific to the child’s problems. It should include close monitoring, follow-ups, and changes when needed.

Certain “protective factors” can help reduce the effects of fetal alcohol spectrum disorders and help people who have them reach their full potential. They include

• Diagnosis before 6 years of age
• Loving, nurturing, and stable home environment during the school years
• Absence of violence around them
• Involvement in special education and social services.

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:

• Fetal alcohol syndrome —Fetal alcohol syndrome represents the most involved end of the fetal alcohol spectrum disorder. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with fetal alcohol syndrome might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with fetal alcohol syndrome can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with fetal alcohol syndrome often have a hard time in school and trouble getting along with others.
• Alcohol-related neurodevelopmental disorder —People with alcohol-related neurodevelopmental disorder might have intellectual disabilities or behavioral and learning problems caused by drinking alcohol during pregnancy. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
• Alcohol-related birth defects — People with alcohol-related birth defects might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.
• Partial fetal alcohol syndrome — presence of some signs and symptoms of fetal alcohol syndrome caused by drinking alcohol during pregnancy, but the criteria for the diagnosis are not met
• Neurobehavioral disorder associated with prenatal alcohol exposure — A child or youth with neurobehavioral disorder associated with prenatal alcohol exposure will have problems in three areas:
  1. Thinking and memory, where the child may have trouble planning or may forget material he or she has already learned,
  2. Behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and
  3. Trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with neurobehavioral disorder associated with prenatal alcohol exposure, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which American Psychiatric Association ² defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

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.

Fetal alcohol syndrome effects

A diagnosis of fetal alcohol syndrome requires the presence of all three of the following findings:

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

Following is an overview of the diagnostic guidelines for fetal alcohol syndrome. These criteria have been simplified for a general audience. They are listed here for information purposes and should be used only by trained health care professionals to diagnose or treat fetal alcohol syndrome.

Healthcare professionals look for the following signs and symptoms when diagnosing fetal alcohol syndrome:

1. Abnormal facial features
   • A person with fetal alcohol syndrome 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.
2. Growth problems
   Children with fetal alcohol syndrome 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 fetal alcohol syndrome, growth problems resolve themselves early in life.
3. 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:
   • Structural: fetal alcohol syndrome 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.
   • 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.
   • 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 fetal alcohol syndrome, 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)
4. Mother’s Alcohol Use during Pregnancy
   Confirmed alcohol use during pregnancy can strengthen the case for fetal alcohol syndrome diagnosis. Confirmed absence of alcohol exposure would rule out the fetal alcohol syndrome 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.

Fetal alcohol syndrome prognosis

Unfortunately there is no treatment for fetal alcohol syndrome that can cause a total cure. While some of the physical problems, such as heart defects, can be treated surgically, the only way that a child can cope with the effects on the brain are through good support from both their family and health professionals. The outcome is generally worse for those children that are more severely affected. The more support and care that they receive, the better the outcomes will be, and plenty of support is available if needed and can be accessed through your local doctor.

I just found out I am pregnant. I have stopped drinking now, but I was drinking in the first few weeks of my pregnancy, before I knew I was pregnant. What should I do now?

The most important thing is that you have completely stopped drinking after learning of your pregnancy. It is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner you stop drinking the safer it will be for you and your baby. If you drank any amount of alcohol while you were pregnant, talk with your child’s health care provider as soon as possible and share your concerns. Make sure you get regular prenatal checkups.

If I drank when I was pregnant, does that mean my baby will have an fetal alcohol syndrome?

If you drank any amount of alcohol while you were pregnant, talk with your child’s health care provider as soon as possible and share your concerns.
You may not know right away if your child has been affected. Fetal alcohol syndrome include a range of physical and intellectual disabilities that are not always easy to identify when a child is a newborn. Some of these effects may not be known until your child is in school.
There is no cure for fetal alcohol syndrome. However, identifying and intervening with children with these conditions as early as possible can help them to reach their full potential.

Is it okay to drink a little or at certain times during pregnancy?

There is no known safe amount of alcohol use during your pregnancy or when you are trying to get pregnant. There is also no safe time to drink when you are pregnant. Alcohol can cause problems for your developing baby throughout your pregnancy, including before you know you are pregnant.
Fetal alcohol spectrum disorders and fetal alcohol syndrome are completely preventable if a woman does not drink alcohol during pregnancy—so why take the risk?

Is it okay to drink alcohol if I am trying to get pregnant?

You might be pregnant and not know it yet. You probably won’t know you are pregnant for up to 4 to 6 weeks. This means you might be drinking and exposing your baby to alcohol without meaning to. Alcohol use during pregnancy can also lead to miscarriage and stillbirth. The best advice is to stop drinking alcohol when you start trying to get pregnant.

Why should I worry about alcohol use if I am not pregnant and not trying to get pregnant?

If you drink alcohol and do not use contraception (birth control) when you have sex, you might get pregnant and expose your baby to alcohol before you know you are pregnant. Nearly half of all pregnancies in the United States are unplanned. And many women do not know they are pregnant right away. So, if you are not trying to get pregnant but you are having sex, talk to your health care provider about using contraception consistently.

I drank wine during my last pregnancy and my baby turned out fine. Why shouldn’t I drink again during this pregnancy?

Every pregnancy is different. Drinking alcohol might affect one baby more than another. You could have one child who is born healthy and another child who is born with problems.

If a woman has an fetal alcohol spectrum disorder, but does not drink during pregnancy, can her child have an fetal alcohol spectrum disorder? Are fetal alcohol spectrum disorders hereditary?

Fetal alcohol spectrum disorders are not genetic or hereditary. If a woman drinks alcohol during her pregnancy, her baby can be born with an fetal alcohol spectrum disorder. But if a woman has an fetal alcohol spectrum disorder, her own child cannot have an fetal alcohol spectrum disorder, unless she drinks alcohol during pregnancy.

Fetal alcohol syndrome complications

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

• Attention deficit/hyperactivity disorder (ADHD)
• Aggression, inappropriate social conduct, and breaking rules and laws
• Alcohol or drug misuse
• Mental health disorders, such as depression, anxiety or eating disorders
• Problems staying in or completing school
• Problems with independent living and with employment
• Inappropriate sexual behaviors
• Early death by accident, homicide or suicide.

Fetal alcohol syndrome causes

The only thing that predisposes a child to having fetal alcohol syndrome is alcohol consumption during pregnancy. Unfortunately, the time when the child is most at risk is early in the pregnancy, even before the woman’s first period is missed.

When you’re pregnant and you 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 developing baby
• Exposure to alcohol before birth can harm the development of tissues and organs and cause permanent brain damage in your baby

This can mean that damage is being done without the mother even knowing it. The level of damage done to the unborn child depends on the amount of alcohol drunk.

The more alcohol that is drunk during pregnancy the more severe the effects. However, any amount of alcohol puts your baby at risk. There’s no known lower limit of safe alcohol consumption or whether there is a cut off level where it is okay. 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.

Risk factors for fetal alcohol syndrome

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’re pregnant
• You think you might be pregnant
• You’re trying to become pregnant

It is also recommended that the father stop drinking if attempts are being made by the mother to stop drinking, if both partners are actively trying to have a child. This is because alcohol lowers levels of testosterone, reduces the activity of sperm, and can even damage the DNA within the sperm. DNA is what transmits all the information about the father to the baby and so the less damage the better.

Fetal alcohol syndrome prevention

Experts know that fetal alcohol syndrome is completely preventable if women don’t drink alcohol at all 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.

Fetal alcohol syndrome signs and 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 small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
• Be born small.
• 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
• Have trouble following directions and learning how to do simple things.
• Difficulty with reasoning and problem-solving
• Difficulty identifying consequences of choices
• Poor judgment skills
• Jitteriness or hyperactivity
• Have problems eating and sleeping.
• Rapidly changing moods

Social and behavioral issues

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

• Difficulty in school
• Have trouble paying attention and learning 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
• Have trouble getting along with others and controlling their behavior.
• Poor concept of time
• Problems staying on task
• Difficulty planning or working toward a goal
• Need medical care all their lives.
• Need special teachers and schools.

A child with fetal alcohol syndrome can struggle in many areas of life without adequate help. Other than their difference in appearance, there are other less obvious problems, mostly affecting the brain. Children with fetal alcohol spectrum usually have slightly lower IQs than other children, with a greater reduction in those whose parents drank more. They have problems with learning and attention and this can lead to antisocial behavior and aggressiveness. As little as one drink a day can lead to an increase in aggressiveness in children aged six to seven. Fetal alcohol spectrum can even lead to Attention Deficit Disorder when the children reach their teens.

Fetal alcohol syndrome diagnosis

Diagnosing fetal alcohol syndrome can be hard because there is no medical test for fetal alcohol syndrome.

To make a diagnosis of fetal alcohol syndrome, your doctor:

• Discusses drinking during pregnancy. 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.
• Watches for signs and symptoms of fetal alcohol syndrome in your child’s initial weeks, months and years of life. This includes assessing physical appearance and distinguishing features of your baby, such as a low birth weight and a small head and monitoring your child’s physical and brain growth and development.

Your doctor will look at behavioral symptoms, such as attention and coordination. They will ask you if you drank while you were pregnant and if so, how much.

Fetal alcohol syndrome can be difficult to diagnose in childhood because it has similar symptoms to other disorders, such as ADHD (attention deficit and hyperactivity disorder) and Williams syndrome, have some symptoms like fetal alcohol syndrome.

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 syndrome treatment

There is no cure for fetal alcohol syndrome. It lasts a lifetime. As there is no treatment other than supportive care for children with fetal alcohol syndrome, the major way of lessening the impact of fetal alcohol syndrome is to not drink while pregnant.

If a child is born with fetal alcohol syndrome, there are many services available to help with any problems they may have. While there may not be a cure for fetal alcohol syndrome, the more help they receive the better. Their treatment involves providing them with good medical and dental care. This includes eyeglasses or hearing aids, if needed. Some behavioral symptoms can be managed with medicine. Children can be placed in special school programs to treat behavior or development issues.

Early intervention services may help reduce some of the effects of fetal alcohol syndrome and may prevent some secondary disabilities. 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 behavioral issues
• Medications to help with some symptoms
• Medical care for health problems, such as vision problems or heart abnormalities
• Addressing alcohol and other substance use problems, if needed
• Vocational and life skills training
• Counseling to benefit parents and the family in dealing with a child’s behavioral problems

If your child is younger than 3 years old, contact your local early intervention system (https://www.cdc.gov/ncbddd/actearly/parents/states.html). Find your state’s early intervention contact information here (https://www.cdc.gov/ncbddd/actearly/parents/states.html).

If your child is 3 years old or older, contact your local public school system (more information here http://www.parentcenterhub.org/ei-overview/). Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Treatment for mothers with alcohol problems

Treating the mother’s alcohol use problem can enable better parenting and prevent future pregnancies from being affected. 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, ask about 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 (http://www.aa.org/) also may help.

What is Early Intervention for fetal alcohol syndrome?

Early Intervention

• Is the term used to describe the services and supports that are available to babies and young children with developmental delays and disabilities and their families.
• May include speech therapy, physical therapy, and other types of services based on the needs of the child and family.
• Can have a significant impact on a child’s ability to learn new skills and overcome challenges and can increase success in school and life.
• Programs are available in every state and territory, see each program’s contact information for your state here http://www.parentcenterhub.org/preschoolers/ and here (https://www.cdc.gov/ncbddd/actearly/parents/states.html). These publicly funded programs provide services for free or at reduced cost for any child who is eligible.

How do I find out if my child is eligible for services?

Eligibility for early intervention services is based on an evaluation of your child’s skills and abilities.

If you, your child’s doctor, or other care provider is concerned about your child’s development, ask to be connected with your state or territory’s early intervention program to find out if your child can get services to help. If your doctor is not able to connect you, you can reach out yourself. A doctor’s referral is not necessary.

• If your child is under age 3: Call your state or territory’s early intervention program (https://www.cdc.gov/ncbddd/actearly/parents/states.html) and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”
• If your child is age 3 or older: http://www.parentcenterhub.org/preschoolers/

Living with fetal alcohol syndrome

The psychological and emotional problems associated with fetal alcohol syndrome can be difficult to manage for the person with the syndrome and for the family.

Most babies born with fetal alcohol syndrome will not have normal brain development. They will need ongoing therapy or special services. The outlook for them depends on how severe their problems are. The best parents can do is get them diagnosed early. This will allow doctors to create specialized plans for their development and education. In addition to early diagnosis, research shows that children also do best if they:

• Are raised in a stable home.
• Are not exposed to violence.
• Receive special education and social services.

Older children and adults with fetal alcohol syndrome can also face challenges. According to the National Institute for Alcohol Abuse and Alcoholism, people with fetal alcohol syndrome or other Fetal Alcohol Spectrum Disorder problems can have trouble with:

• Learning and remembering.
• Paying attention.
• Understanding and following directions.
• Controlling emotions and impulses.
• Communicating and socializing.
• Performing daily life activities, such as bathing, dressing, eating, or telling time.

They are also more likely to have mental health disorders, including:

• ADHD.
• Depression and anxiety.
• Hyperactivity and impulse control.
• Substance abuse disorders.

Remember that no amount of alcohol is safe in pregnancy. Quit drinking if you are trying to get pregnant or if you think you’re pregnant. If you can’t quit drinking by yourself, get help right away.

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 syndrome. Ask your health care provider, social worker or mental health professional for local sources of support for children with fetal alcohol syndrome and their families.

Dealing with behavioral problems

As a parent of a child with fetal alcohol syndrome, you may find the following suggestions helpful in dealing with behavioral problems associated with the syndrome. Learning these skills (sometimes called parent training) can include:

• Recognizing your child’s strengths and limitations
• Implementing daily routines
• Creating and enforcing simple rules and limits
• Keeping things simple by using concrete, specific language
• Using repetition to reinforce learning
• Pointing out and using rewards to reinforce acceptable behavior
• Teaching skills for daily living and social interactions
• Guarding against your child being taken advantage of by others because many children with fetal alcohol syndrome are at risk of this

Early intervention and a stable, nurturing home are important factors in protecting children with fetal alcohol syndrome from some of the secondary disabilities they’re at risk of later in life.

1. Bower C, Elliott EJ (2016) Australian guide to the diagnosis of FASD. Perth, WA: Telethon Kids Institute.[↩]
2. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Washington, DC: American Psychiatric Association; 2013.[↩]