Fetal alcohol syndrome

 

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Fetal alcohol syndrome

Overview

Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. Fetal alcohol syndrome causes brain damage and growth problems. The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are not reversible.

There is no amount of alcohol that's known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.

If you suspect your child has fetal alcohol syndrome, talk to your doctor as soon as possible. Early diagnosis may help to reduce problems such as learning difficulties and behavioral issues.

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

·         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, primary care doctor or mental health professional 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 have adopted a child or are providing foster care, you may not know if the 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 problems with learning and behavior, talk with his or her doctor so that the underlying cause might be identified.

Causes

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

The more you drink while pregnant, the greater the risk to your unborn baby. However, any amount of alcohol puts your baby at risk. 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

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

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

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.

Diagnosis

Diagnosing fetal alcohol syndrome requires expertise and a thorough assessment. Early diagnosis and services can help improve your child's ability to function.

To make a diagnosis, 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 and monitoring your child's physical and brain growth and development.

The doctor also may assess for:

·         Cognitive ability and learning and language development difficulties

·         Health issues

·         Social and behavioral problems

Many features seen with fetal alcohol syndrome may also occur 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 birth 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 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 — problems functioning due to neurocognitive impairments, such as problems with mental health, memory, impulse control, communication and daily living skills, caused by drinking alcohol during pregnancy

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.

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 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

Treatment for problems with alcohol

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 also may help.

Coping and support

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.

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.

Preparing for your appointment

Call your child's doctor for an appointment if you have any concerns about your child's growth and development. Also, let your child's doctor know if you drank alcohol during your pregnancy, and if so, how much and how often.

Consider asking a family member or friend to come with you. Sometimes it can be difficult to remember all of the information provided to you during an appointment, especially if you've been told that there may be something wrong with your child.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

·         Any symptoms you've noticed in your child, including any that may seem unrelated to the reason for the appointment, and when the symptoms began

·         All medications, vitamins, herbs or other supplements that you took during pregnancy, and their dosages

·         Questions to ask your child's doctor to help make the most of your appointment time

Basic questions to ask may include:

·         What's the most likely cause of my child's symptoms?

·         Are there other possible causes?

·         Should my child see a specialist?

·         Will my child's condition improve over time? Will it get worse?

·         What treatments are available, and which do you recommend?

·         Are there medications that may help? Are there medications that should be avoided?

·         How can I prevent this from happening in future pregnancies?

·         Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your child's doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over points you want to spend more time on. Your doctor may ask:

·         Did you drink alcohol while you were pregnant? If yes, how much and how often?

·         Did you use any street drugs during your pregnancy?

·         Did you have any problems during your pregnancy?

·         When did you first notice your child's symptoms?

·         Have these symptoms been continuous or are they only occasional?

·         Does anything seem to improve the symptoms?

·         What, if anything, appears to worsen the symptoms?