Fetal Alcohol Syndrome (FAS)

Fetal alcohol syndrome (FAS) is a set of birth defects that affect a child's growth and behavior. One of the most common defects is facial abnormalities, although other defects may have a greater impact on the individual's health. These defects occur as a result of exposure to alcohol while in the uterus.

Women have been advised not to drink during pregnancy for generations. In the nineteenth and twentieth centuries, physicians undertook studies of children born to alcoholic mothers. A study of major importance was conducted in 1973, when researchers first used the term fetal alcohol syndrome to describe abnormalities in children born to alcoholic mothers. Since 1973, the lifelong effects of prenatal alcohol exposure have been recorded in detail. There is no doubt that drinking alcohol during pregnancy is extremely harmful to the fetus, leading to permanent damage.

The Occurrence of FAS

An estimated 1 in 500 to 1 in 2,000 babies are born with FAS. New studies by the Centers for Disease Control (CDC) suggest that rates of any alcohol consumption during pregnancy declined between 1995 and 1999, while rates of binge and frequent drinking during pregnancy remained high, despite public-health information designed to prevent FAS. In other words, more women who drink occasionally are stopping alcohol use during pregnancy, but binge drinkers are not. Some estimate that FAS is now the leading cause of mental retardation in the United States, surpassing Down's syndrome and spina bifida.

The Physical Effects of FAS

Scientist believe that alcohol consumption in any amount during pregnancy may pose risks for the fetus. Individuals react very differently to alcohol. As a result, it is difficult, if not impossible, to predict which women will have a child with FAS.

Drinking alcohol during the first trimester (the first three months of pregnancy) creates the risk of major physical abnormalities and central nervous system damage. Drinking during the second trimester (the middle three months) leads to an increased rate of miscarriage, damage to the brain and spinal cord, and less noticeable physical abnormalities. Drinking during the third trimester (final three months) can lead to pre- and postnatal growth retardation (slowing of growth before and after birth) and brain and spinal cord damage.

The common facial abnormalities of FAS include: short eye-slit fissures; a long, smooth upper lip groove; and a thin upper lip. Other common physical problems include heart malformations and defects; a hollow at the lower part of the chest; permanent curving of one or more fingers; fusion of bones at the elbow; scoliosis (curvature of the spine); kidney malformations; and cleft lip and palate (abnormal openings in the lips and/or roof of the mouth).

FAS affects children's height, weight, and head circumference. Many children with FAS are short and thin prior to puberty. As girls enter puberty, they remain short but frequently gain weight and appear plump. Boys seem to remain fairly short and slender.

Children with damage to their central nervous system as a result of fetal alcohol syndrome frequently have problems with thinking and memory, sleep disturbances, delayed development, hyperactivity or distractibility, a short attention span, an inability to understand cause and effect, lower levels of academic achievement, and impulsiveness.

Social and Educational Issues

Ages Birth to 5 Years. Babies with FAS startle more than normal babies, have poor sleep patterns, do not suck as well, and are excessively active. Babies and toddlers are delayed in walking, talking, and toilet training. They are irritable, have difficulty in following directions, and are unable to adapt to changes. The damage done to the brain makes it problematic for children with FAS to learn in a timely and consistent fashion.

Newborns and infants with FAS often have trouble feeding. When this is coupled with a mother who abuses substances, medical crises can result. Many children with FAS are removed from the care of the biological mother owing to abuse, neglect, or the death of the mother. When the child remains with his or her mother, the child's health must be monitored to prevent such crises. In addition, social-service personnel must ensure that the home is safe and stable, and that the parents and other family members are receiving substance-abuse treatment and parenting training as necessary.

Ages 6 to 11 Years. As the children get older, they may have trouble understanding the consequences of behavior and social rules and expectations. Children with FAS may become less able to function in school as they get older. Difficulties with abstract thinking skills, required in such third- and fourth-grade tasks as multiplication and division, also become more noticeable. As a result, educators and caregivers of children with FAS must set reasonable expectations and goals, set clear limits on behavior, give structure to leisure time, and continue to educate parents about their children's particular needs.

Ages 12 to 17 Years. Adolescents with FAS may become depressed , have suicidal thoughts and attempt suicide, and have trouble expressing their feelings and needs. Their intellectual growth generally stops at this point. Adolescents with FAS may do better in vocational and daily-living skills training than in traditional school settings. Caregivers need to increase the youths' responsibilities in keeping with their skills and abilities.

Ages 18 through Adulthood. Difficulties in comprehending social rules and expectations, aggressive and unpredictable behavior, and depression may lead adults with FAS to suicide attempts, antisocial behavior, criminal activity, or hospitalization. They may become withdrawn and often have trouble learning job skills and/or holding onto a job. They may need a guardian to help them manage their money. Residence in communal living arrangements may be necessary.

Conclusion

FAS is a preventable birth defect. Once it exists it has lifelong consequences. As early in childhood as possible, caregivers of children with FAS should plan for future vocational, educational, and residential needs. Education on the harmful effects of alcohol use, focusing on young women and men of childbearing years, is critical to help prevent, or at least reduce, this significant public-health problem.

see also Alcohol: History of Drinking; Attention-Deficit/ Hyperactivity Disorder; Babies, Addicted and Drug-Exposed; Child Abuse and Drugs; Conduct Disorder.