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Fetal Alcohol Syndrome
Fetal alcohol syndrome (FAS) is defined as the most severe form of fetal
alcohol spectrum disorder, or FASD. It is characterized by abnormalities
in facial features, slowed growth, and abnormalities in the structure and
functioning of the brain and spinal cord.
Fetal alcohol syndrome is a disorder that affects a child
to pay attention, and to control his or her behavior as well as to grow
normally. It is the leading known cause of mental retardation in North
America. Children with FAS are undersize and underweight for their age,
and they have smaller than average heads as well as certain facial features
associated with the disorder. The physical features of FAS are usually evident
at birth, but problems with learning and other abnormalities in
brain development may not be detected until the child starts school. The
while the child
grows into adolescence and adulthood.
s ability to learn,s learning and behavioral problems persist over his or her lifetime,s facial features usually become less noticeable as he or she
Researchers estimate that about 1 percent of the general U.S. population
is affected by fetal alcohol spectrum disorders and that 40,000 babies are
born every year with some kind of birth defect caused by the mother
drinking. However, fetal alcohol syndrome itself is the only disorder in
this group that has been formally defined by the Centers for Disease
Control and Prevention (CDC) and by the International Classification
of Diseases (ICD). Fetal alcohol syndrome is estimated to occur in one
or two out of every 1,000 live births in the United States. The rate may
be higher in some countries where binge drinking is common. The cost
of treating one child with FAS is estimated to be $2 million over his or
her lifetime. The cost of FAS to the American public runs to more than
$321 million each year.
As far as is known, FAS affects boys and girls equally and affects children
of all races equally. The primary risk factor is the amount and frequency
of the mother
being over age thirty, a history of heavy drinking, and low social or economic
status. Smoking and the use of other drugs can worsen the effects
of alcohol on the fetus.
ss drinking. Other risk factors in mothers include

Causes and Symptoms
Fetal alcohol syndrome occurs as the result of a woman drinking alcohol
during her pregnancy. Alcohol is a teratogen, which means that it is a
substance that causes birth defects. Although heavy or binge drinking
increases the risk of having a child with FAS, even moderate or occasional
drinking can affect the unborn baby. In addition,
it does not matter what type of alcoholic
beverage is consumed. Beer or wine can harm
the baby as much as whiskey or other forms of
distilled alcohol. It also does not matter whether
the mother drinks throughout her pregnancy or
only during a brief period. Alcohol can affect
the baby
The ways in which alcohol affects the development
of the baby before birth are not fully
understood. What is known is that the fetus
depends on the mother
from its bloodstream as well as her own. It is
thought that alcohol and a chemical called acetaldehyde,
which is formed during the body
digestion of alcohol, disrupt the process of cell
reproduction and tissue formation in the baby
body. In addition, these chemicals interfere with
the transfer of vitamins, minerals, and other
nutrients from the mother
thus starving the baby of nutrients that are vital
to healthy growth. Last, alcohol and acetaldehyde
interfere with the oxygen supply to the baby.
Some pregnancies end in miscarriage if the
mother is a heavy drinker. A child with FAS may
also be born prematurely or die of sudden infant
death syndrome (SIDS).
The symptoms of FAS at birth may include
withdrawal syndrome if the mother had been
drinking heavily shortly before delivery. Newborns suffering from
alcohol withdrawal may be hyperactive, restless, or suffer from seizures.
The physical and developmental symptoms are described in the next section
because they are used to diagnose the disorder.
s development at any point durings liver to clear alcoholsss body to the baby,

Diagnosis of fetal alcohol syndrome is usually based on a combination of
the mother
the child. The Institute of Medicine (IOM) has established the following
guidelines for diagnosing fetal alcohol syndrome:
indentation between the nose and the mouth); a thin red border
along the upper lip; and an abnormally short distance between the
inner and outer corners of the eye. Other facial features may
include flattening of the middle part of the face, drooping of the
eyelids, and unusually small eyes. Although these facial features
do not look like major deformities to most people, they tell the
doctor that the child
Facial features that include a smooth upper lip (lacking the normals brain has not developed normally.
below the tenth percentile in weight or height for his or her age.
Evidence of slow growth either before or after birth. The child is
include an abnormally small head, developmental delays, learning
difficulties, seizures or epilepsy, mental retardation, hyperactivity,
irritability in infancy, and poor judgment or impulse control in later
childhood. Many children with fetal alcohol syndrome do not learn
to communicate normally with others. They may also have problems
with memory and with paying attention. Some have difficulties
with writing or other skills involving hand-to-eye coordination.
Evidence of abnormalities in the central nervous system. These may
Children with FAS may have one or more of the following physical
features or characteristics even though these are not used to diagnose the
Confirmed or suspected drinking by the mother.
Cleft palate
Heart defects
Nearsightedness or other eye disorders
Hearing loss
Abnormal curvature of the spine
Unusual creases on the palms of the hands that resemble hockey
Joints that are easily dislocated

Treatment of children with FAS includes treatment for birth defects at
the time of birth and educational or medical treatments for learning problems
or behavioral disorders as the child grows older. Behavioral
disorders may be treated with medications, psychotherapy, or a combination
of both.
Adults who care for or teach children with FAS should provide structure
and be consistent in their behavior toward them. These children do
best with routines that vary as little as possible so that they learn to see
the world as a predictable place. Instructions should be brief and repeated
frequently because such children have difficulty paying attention.
The prognosis of a child diagnosed with fetal alcohol syndrome
depends on the type and severity of the child
age at which treatment begins. Some doctors think that early diagnosis
is helpful because it gets the child into treatment more rapidly.
One study followed a group of people with FAS who were between
the ages of twelve and fifty-one. Researchers reported the following longterm
consequences of the disorder:
s symptoms as well as the
95 percent had mental health problems.
center, or a psychiatric hospital.
55 percent had spent time in prison, a drug or alcohol treatment
60 percent had been in trouble with the law.
82 percent were unable to live independently.
70 percent had problems holding a job.
60 percent had problems with drugs or alcohol.
FAS can be prevented if a pregnant woman avoids alcoholic beverages.
The Institute of Medicine (IOM) recommends a prevention program
on three levels: public education aimed at all women of childbearing age;
selected screening programs aimed at women who drink heavily and may
become pregnant; and prevention and intervention aimed at women who
are heavy drinkers and have already had a child with FAS. This third level
of prevention would include treatment for alcohol dependence combined
with case management.
The Future
It is likely that the number of children affected by fetal alcohol syndrome
will increase in the United States over the next few decades. Reasons for
this include the easy availability of alcohol, the increasing breakdown of
families and the growing number of single mothers, and the difficulty of
putting preventive measures in place.
infant death syndrome
Alcoholism; Developmental disability; Prematurity; Sudden
For more information
Kleinfeld, Judith, ed.
with Fetal Alcohol Syndrome
Stewart, Gail B.
Fantastic Antone Grows Up: Adolescents and Adults. Fairbanks, AK: University of Alaska Press,Fetal Alcohol Syndrome. Detroit, MI: Lucent Books, 2005.
Carroll, Linda.
York Times
([accessed April 2, 2008).
Alcohols Toll on Fetuses: Even Worse Than Thought.New, November 4, 2003. Available online at http://query.nytimes
National Institute on Alcohol Abuse and Alcoholism (NIAAA).
(reprinted 2006; accessed October 28, 2008).
Nemours Foundation.
kidshealth.org/parent/medical/brain/fas.html (reviewed June 2008; accessed
October 28, 2008).
When You AreDrinking Can Hurt Your Baby. Available online at http://pubsFetal Alcohol Syndrome. Available online at http://
s drinking history (if known) and a physical examination of
 WORDS TO KNOWAcetaldehyde: A colorless liquid chemical that is
produced when the body begins to digest
alcohol. A chemical that causes hangovers after
heavy drinking, it also contributes to fetal alcohol
Binge drinking: A period of heavy drinking that
lasts for two days or longer.
Case management: An approach to healthcare
based on personalized services to patients.
Syndrome: A group of signs or symptoms that
occur together and characterize or define a particular
disease or disorder.
Teratogen: Any substance that causes birth
defects in children. Alcohol is a teratogen.