Fetal alcohol syndrome

Fetal alcohol syndrome (FAS) is a pattern of clinical abnormalities found specifically in some children whose mothers ingested alcohol during pregnancy. Alcohol is a teratogenic drug; that is, it can cause birth defects which manifest as physical malformations of the face and head, growth deficiency, mentalretardation, and--in particular--central nervous system dysfunction. FAS results in more babies being born mentally retarded than any other known factor--including Down's syndrome and spina bifida--yet is completely preventable assimply as abstaining from alcohol during pregnancy. The incidence of fetal alcohol syndrome varies from 1 out of 1,500 to 1 out of 600 live births. Thiswide range is related to differences in drinking practices.

Although FAS sometimes causes fetal death, more often it interferes with thenormal development of the fetus. Although not all children born to alcoholicmothers are affected, every child born with FAS had a mother who drank duringpregnancy. Although use of illicit drugs both alone and in combination withalcohol can cause birth defects, more unborn babies are in greater danger from alcohol use alone than from any illegal drug, even cocaine.

Infants, young children, and young adults whose mothers abused alcohol duringpregnancy and who suffer from FAS display lower than average birthweight andheight, physical problems which may include low muscle tone, abnormally small skull, irregularities of the face including small eye sockets, mid-face hypoplasia (arrested development of the nose, or "flat-face" syndrome), and a very thin upper lip with either an elongated or absent mid-lipline indentation.Neurologic or central nervous system disorders such as hyperactivity, learning and intellectual deficits, distractibility, temper tantrums, short attention and memory span, perceptual problems, impulsive behavior, inability to concentrate, seizures, and abnormal electroencephalogram (EEG, or brain wave patterns) become apparent after the infant stage. Usually, the more severe the physical symptoms of the syndrome, the more severe the intellectual deficits.

Even for FAS-affected children with almost normal intelligence, learning problems become evident by second grade. By grades three and four, affected children experience increasing difficulty with arithmetic, organization, abstractthinking, and attention. Because they have difficulty regulating themselves,children with FAS often develop behavioral problems by the time they reach middle school or junior high, where increased independence of judgement and self-control are expected. Behavioral problems then become social adjustment problems around the time the child leaves school and enters the larger environment. Impaired judgement and decision-making abilities and incompetence in independent living become troublesome by this age.

The affects of FAS range from severe to mild and are linked to the amount andfrequency of alcohol consumed by the pregnant woman, stage of pregnancy in which drinking takes place, and variability--or changing patterns--of alcoholingestion. It appears that higher rates of abnormalities are caused by mothers who binge drink than among women who steadily drink consistent quantities,and in whom the most severe physical manifestations of alcoholism are obvious. Also, drinking in the first three months of pregnancy, often before pregnancy is determined, has more serious consequences than drinking the same quantities later in the pregnancy. The possibility of FAS affecting the child of analcoholic woman is 6%, but the risk increases drastically to 70% for children born after one child is born with FAS. The most severe cases seem to be children of long-term, chronic alcoholic mothers. There is no data so far established which suggests there is a "risk-free" level or period of alcohol ingestion during pregnancy, which means there is always the risk that even one or two drinks will damage the development of the extremely vulnerable fetus.

Until the early 1970s, maternal alcohol use was not even considered a risk tothe unborn child. As late as the 1960s, federally funded studies into prenatal causes of mental retardation and neurologic abnormalities did not even consider alcohol a possibility. Intravenous alcohol drips were even being used to help prevent premature birth. However, by the 1970s, awareness began to grow about the adverse effects of toxic substances and diet during pregnancy: cigarette smoking was known to produce babies of low birth-weight and diminished size; malnutrition in pregnant women seriously impaired fetal development.When the affects of maternal alcohol use on the fetus were discovered, studies were set in motion worldwide to determine its long-term effects. It is nowclear that, even though many infants do not manifest full-fledged signs of FAS, maternal alcohol use causes neurological and behavioral problems which affect the quality of life for the child yet may go relatively unnoticed. Children in this category are diagnosed as having Fetal Alcohol Effect (FAE).

In 1974, the results of one U.S. study were published which compared offspring of 23 alcoholic mothers and 46 non-drinking mothers in matched control groups (participants were from the same general geographic region, socioeconomicgroup, age, race, marital status, etc.). By the age of seven years, childrenof alcoholic mothers earned lower scores on math, reading, and spelling tests, and lower IQ scores (an average of 81 versus 95). Although 9% of the children born to non-drinking mothers tested 71 or lower (the level considered as borderline or actual mental inadequacy), 44% of children of alcoholic mothersfell into this range. Similar percentages of reduced weight, height, and headcircumference were also observed. A 1982 study from Berlin was the first report indicating FAS caused hyperactivity, distractibility, and speech, eating,and sleeping problems, while a 1990 Swedish study found that as many as 10%of all mildly retarded school-age children in that country suffered from FAS.An early study undertaken in Russia in 1974 of siblings born before and after their mothers became alcoholics reported serious disabilities in many children born after, primarily due to central nervous system damage. Fourteen of the 23 children in this category were mentally retarded. A 1988 study confirmed earlier findings that the younger child of an alcoholic mother is more likely to be adversely affected than the older child. In a study which began in 1974 and followed until the age of 11 years, children of "low risk" mothers who simply drank "socially"-most not even consuming one drink a day after becoming pregnant-found deficits in attention, intelligence, memory, reaction time, learning ability, and behavior were often evident. On average, these problems were more severe in children of women who drank through their entire pregnancy than those who stopped drinking.

Until this decade, most studies regarding FAS have been with children. In 1991, a major report done in the United States on FAS among adolescents and adults aged between 12 to 40 years with an average chronological age of 17 yearsrevealed that physical abnormalities of the face and head as well as size andweight deficiencies were less obvious than in early childhood. However, intellectual variation ranged from severely retarded to normal. The average levelof intelligence was borderline or mildly retarded, with academic abilities ranging between the second and fourth grade level. Adaptive living skills averaged that of a seven-year-old, with daily living skills rating higher than social skills.

Accurate diagnosis of FAS is extremely important because affected children require special education to enable them to integrate more fully into society.Because FAS defects can closely mimic those of other birth defects, and because this subject is still relatively new, many physicians are unequipped to recognize FAS-specific birth defects. It is important, therefore, that childrenwith abnormalities, especially whose mothers used alcohol during pregnancy,be fully evaluated by a professional specially trained in birth defects. Themost favorable time frame for accurate diagnosis is between the ages of eightmonths and eight years, although some FAS newborns are so obviously affectedthat the condition can be recognized much earlier.

Early Intervention is critical in determining the outcome for a child with FAS/FAE. The earlier that medical, clinical and educational help is started, the better the outcome. A stable, structured and nurturing environment will boost the child's development.

During the first few years of the child's life, it's important to focus on developing good parent/child relationships while paying attention to development. However, it's not just the child who needs support -- parents are often overwhelmed with the job of caring for a child with FAS. Support and respite services for families can help maintain a solid, stable and beneficial parent/child relationship.

The child with FAS will likely need interventions focusing on all areas of development: behavioral, emotional, social, and sensory. Often, a child with this condition will have either an under-aroused or over-aroused central nervous system (CNS), so they have problems with integrating, organizing and processing sensory information and developing an appropriate social response. Hearing or touch may be overly-responsive to input while smell, taste or balance may be less sensitive than normal. These sensory problems may lead to emotional instability, hyperactivity, behavioral disorganization and learning problems.

It's possible to boost emotional and social development by helping the childto label feelings, showing the child how to express feelings, and helping tofind safe ways to express anger and frustration. Reinforce all positive behavior, since it is very hard for these children to meet adult's expectations, so adapt the environment and your expectations. Medication may help ease problems assocaited with impulsive behavior, hyperactivity, and sleep disorders.

Many children with FAS/FAE need special education because of significant learning disabilities, emotional and behavioral problems or multiple handicaps. Although many of these children share similarities, each should be evaluated on an individual basis. Tests may include speech, language, and cognitive functioning; mental health exams, neurological tests and physical therapy. Thesechildren often respond to positive changes in their environment, such as low-key or soft room color, low lighting (non-florescent), comfortable temperature, structure, space for movement activities, visual organization, calm area,sensory area. Ideally, these children do well with lots of hands-on learningin a small class, with flexible scheduling, consistent adults, realistic expectations, and a focus on development and functional social and life skills, rather than academics.

Alcohol is a legal psychoactive drug with a high potential for abuse and addiction. Because it crosses the placenta (enters the blood stream of the unbornbaby), the level of blood alcohol in the baby is directly related to that ofthe mother, and occurs within just a few short minutes of ingestion. FAS isnow considered to be a serious health problem, one which seems extremely difficult to stem. Even though warnings about alcohol consumption by pregnant women were placed on labels of alcoholic beverages in the early 1980s, more than70,000 children in the ensuing 10 years were born with FAS in the United States alone. The use of alcohol by adolescent women across the nation, and apparently throughout the world, continues to escalate. And, even though there has been an increase in public awareness and education programs regarding the totally preventable incidence of FAS-related birth defects on the life being formed in utero, many women still use and abuse alcohol during pregnancy.

Although heavy alcohol use is known to cause FAS, there is absolutely no guarantee that babies will remain unaffected even by moderate "social" drinking.Genetic differences in an individual's liver function or ability to metabolize alcohol may cause birth defects in one woman who ingests moderate amounts of alcohol while the offspring of another woman who drinks the same amount ormore remain unaffected. The only sure way to prevent FAS is for the mother tototally abstain from alcohol during the entire pregnancy. Women trying to conceive and pregnant women should avoid drinking alcohol. Pregnant alcoholic women should be involved in comprehensive alcohol abuse rehabilitation programs. Some alcoholic women may find support groups to be helpful by providing interaction with others who share similar experiences and problems.

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