If a baby has exposure to alcohol in the womb, they can develop a range of conditions known as fetal alcohol spectrum disorders (FASDs). The most severe of these disorders is fetal alcohol syndrome (FAS).
FAS is a type of disability, and it does not have a cure. However, with early identification and support, children with FAS can learn important skills that can aid their development.
In this article, we look at why FAS occurs and its symptoms, treatments, and risk factors. We also discuss how people can prevent FAS and when to see a doctor.
FAS occurs when a fetus becomes exposed to alcohol. This exposure typically occurs when a pregnant person drinks alcohol, and it enters the fetus’s bloodstream through the umbilical cord.
As a fetus’s liver is not fully formed, this organ cannot metabolize alcohol. As a result, when a fetus becomes exposed to alcohol, they absorb all of it.
Alcohol is a teratogen, which means that it is toxic to developing babies. Teratogens can interfere with a fetus’s growth and development, particularly that of the central nervous system (CNS), which includes the brain and spinal cord.
Other types of FASD include:
- alcohol-related neurodevelopmental disorder
- alcohol-related birth abnormalities
- neurobehavioral disorder associated with prenatal alcohol exposure
- partial FAS
FAS can cause a range of physical, mental, and behavioral complications. These range from mild to severe and may include:
- low body weight
- below-average height
- poor coordination
- small head size
- small eyes
- abnormal facial features, such as smooth skin between the nose and upper lip
- thin upper lip
- bone deformities, especially in the fingers and limbs
- heart, kidney, or bone problems
- vision or hearing problems
- hyperactive behavior
- sleep problems
- difficulty suckling as a baby
- trouble regulating emotions or behavior
- resistance to change
- inability to empathize or recognize indirect social cues
Learning and cognitive difficulties
- difficulty remembering
- trouble paying attention
- finding school challenging, especially subjects such as math
- intellectual disabilities or low IQ
- speech and language delays
- poor judgment and reasoning skills
- trouble planning or being organized
- difficulty understanding cause and effect
A child with FAS will not necessarily have all of these symptoms. Additionally, many of these symptoms can occur due to other conditions. A healthcare professional specializing in FAS can help determine the cause.
FAS is a lifelong condition. However, early intervention and support often help improve child development.
As FAS can cause a wide range of symptoms, the treatments and therapies that benefit each child will vary. Some of the most common approaches include:
- early intervention services, which teach infants and children below the age of 3 years to walk, talk, and interact with others
- behavior and education therapy programs, which may help with aspects of development, such as social skills, self-regulation, and learning math
- parent training, which can help parents or caregivers understand FAS, how it affects children, and how best to care for them
- family therapy or counseling, if appropriate
Although the authorities have not approved any medications specifically for the treatment of FAS, doctors may use some drugs to treat certain symptoms. For example, stimulants may help with attention or emotional regulation, while neuroleptics may help with aggression.
Some people also use alternative therapies to help reduce or manage FAS symptoms, such as:
- relaxation therapy or meditation
- creative art therapy
- animal-assisted therapy
However, there is a lack of research to confirm the effectiveness of these therapies. Before trying any alternative therapy for FAS, parents or caregivers should speak with the child’s pediatrician or a doctor who specializes in FASDs.
- low self-esteem
- attention deficit hyperactivity disorder (ADHD)
- substance abuse disorders
As a result, they may experience difficulty living independently later in life. Secondary complications that may arise as a result of FAS include:
- low academic achievement
- disrupted or incomplete school experiences
- difficulty staying employed
- trouble with the law and other authorities
- substance abuse problems, such as alcohol or drug use disorder
- inpatient treatment for mental health or substance abuse
However, these complications are not inevitable. Certain protective factors can reduce the impact of the secondary effects of FASDs. They include:
- early diagnosis and intervention
- special education tailored to the child’s needs
- support from social services
- living in a caring, nurturing, loving, and stable home environment during childhood and adolescence
- learning healthy ways to express anger and frustration
- having a home environment free of violence and abuse
Generally, the more alcohol a person consumes during pregnancy, the higher the chance of FAS.
The frequency, strength, and quantity of alcoholic drinks have an effect, as well as the timing of consumption. Drinking alcohol late in a pregnancy increases the likelihood of FAS.
However, while higher amounts of alcohol are more harmful, there is no known amount or type of alcohol that is safe to consume while pregnant. All alcoholic drinks, including wine and beer, have a similar effect on a developing baby.
However, alcohol may affect a fetus more significantly if the pregnant person:
- has malnutrition
- is older
- has a below-average body mass index (BMI)
- has a personal or family history of substance abuse
- has had multiple pregnancies or births
- has a lower ability to process alcohol
Some research suggests that a pregnant person’s environment may also play a role. Living in stressful, isolated, or adverse conditions may increase the chance of FAS.
It is important that both individuals and healthcare professionals understand their role in preventing FASDs.
For people trying to get pregnant
If a person is thinking of having a baby, it is important that they know ahead of time that they will need to avoid alcohol:
- during the months when they are trying to conceive
- during pregnancy
- while breastfeeding
In many cases, this will mean avoiding alcohol for more than a year in total.
For accidental exposure
It takes most people 4–6 weeks to confirm that they are pregnant after having penetrative sex. Therefore, people who are trying to get pregnant may be pregnant for 1 month or more without knowing it.
Sometimes, this means that people drink alcohol without realizing that they are pregnant.
If a person drinks any amount of alcohol during pregnancy, the Centers for Disease Control and Prevention (CDC) recommend that they:
- stop drinking alcohol as soon as they can
- talk with a doctor or prenatal specialist about any concerns
- get regular prenatal checkups
For people struggling with substance abuse
If a person who wishes to get pregnant or is pregnant finds it difficult to stop drinking, it is important that they seek help as soon as they can.
A doctor, counselor, or therapist can create a harm reduction plan and support system to help the person start to reduce their alcohol consumption in a healthy way.
It is essential to speak with a doctor as soon as possible if a child shows signs of FAS. Early identification can improve the outcome for children with FAS and raise their quality of life.
It is best to speak with a doctor who specializes in FAS, such as a developmental pediatrician, clinical geneticist, or child psychologist.
Resources that people can access include:
- CDC list of early intervention services by state, for children under 3 years of age
- Center for Parent Information & Resources, who help parents and caregivers of children with disabilities with their education and development
- American Academy of Pediatrics, who provide resources on FASD for clinicians
If the child is more than 3 years of age, parents or caregivers can talk to a pediatrician and contact any nearby elementary school to ask for an evaluation. If the staff members are not familiar with the evaluation process, the next step is to ask to speak with the district’s special education director.
FAS is a long-term disability that affects children from birth. It occurs when a fetus becomes exposed to alcohol during pregnancy. Early detection and treatment can help children learn vital skills and improve their chances of being able to live independently as adults.
It is never too late to take steps to prevent FAS or to seek help for a child showing symptoms of FAS. People should speak with a doctor or FAS specialist as soon as possible if they have concerns.