It was sheer coincidence that led doctors to discover what was really wrong with Tim. He was diagnosed with attention deficit hyperactivity disorder (ADHD) when he was in first grade. He lied and stole things in school and recalls feeling lonely and frustrated at not being able to “fit in.” When he stole a pocket knife, a weapon, he had to undergo the First Offender’s Program. The counselor suspected something more was wrong with Tim and had him tested.
The result: Tim had been misdiagnosed all along. He did not have ADHD; he had fetal alcohol syndrome. What helped the diagnosis this time around was Tim’s mother admitting that she drank wine regularly during pregnancy.
According to the National Institutes of Health, fetal alcohol syndrome is irreversible; the mental and physical deficiencies associated with the disease have to be managed throughout a person’s lifetime.
Drinking alcohol while pregnant may lead to a child being born with fetal alcohol spectrum disorders, known as FASDs. This term includes a variety of disorders, the symptoms of which can range in severity. Some of them can lead to mental or physical birth defects. FASDs include:
FAS is one of the most severe conditions. Though the symptoms and defects will vary from person to person, they are often permanent. Children born with FAS may have symptoms ranging from communication and learning problems, struggling with attention span, as well as problems with their hearing and vision.
What is Fetal Alcohol Syndrome?
Fetal Alcohol Syndrome is a deficiency in the developmental aspects of an infant caused by exposure to alcohol in utero. Alcohol consumed by the mother during pregnancy can cross the placental barrier and accumulate in the baby’s blood. Alcohol accumulation in the fetus’ blood can damages the developing organs and lead to severe developmental issues.
Fetal alcohol syndrome (FAS) is the name given to the cluster of physical, functional, mental, and developmental deficiencies that an infant may be born with or develop later in life. The sole cause of fetal alcohol syndrome is exposure to alcohol in utero. A mother who drinks alcohol during pregnancy puts her baby at risk of developing FAS.
Alcohol exposure can occur within the first few weeks of a pregnancy, because often women may not know they are pregnant.
Though most studies show alcohol is most harmful within the first three months of pregnancy, The American Academy of Pediatrics has stated that consuming alcohol at any point during a pregnancy can be harmful.
Alcohol can cross the placental barrier and reach the baby’s bloodstream. Because of its smaller body proportions, the fetus is unable to break down alcohol as quickly as an adult. As a result, alcohol remains in its blood for longer and also in higher quantities. Alcohol impairs the normal development of the organs of the unborn baby.
How to Recognize Fetal Alcohol Syndrome
Babies born with FAS usually manifest growth problems, however, some of these may be resolved later on:
- Low birth weight: Children with FAS have lower-than-average (at or below the 10th percentile) weight at birth.
- Retarded growth or failure to thrive: This can be lower-than-average (at or below the 10th percentile) weight, height, or both.
Babies with FAS may exhibit abnormal physical features like the following:
- Smooth ridge between the nose and the upper lip
- Thin upper lip
- Flattened cheeks
- Small jaws
- Wide-spaced eyes
- Drooping eyelids
- Small (at or below the 10th percentile) skull compared to body weight and height
- Structural differences in the brain as evident from CT scans or MRIs
Alcohol exposure in utero impairs the normal development of the central nervous system (CNS), made up of the brain and the spinal cord. Children affected with FAS exhibit one or more the following signs of CNS deficiency:
- Cognitive Deficiency: This includes low IQ that manifests as difficulty learning, grasping and following instructions, and slow reactions. Children with FAS often perform poorly in school; Tim had difficulty learning mathematics.
- Impaired Motor Functionality: This manifests as poor muscle coordination. Children with FAS have difficulty picking up gross motor skills like rolling over, crawling, sitting up, and walking and fine motor skills like grasping objects with the thumb and index finger, transferring objects from one hand to the other, writing and drawing. They may exhibit balance problems or be clumsy. As infants, these children may have had difficulties sucking.
- Executive Functioning Difficulty: These deficiencies include poor organization and planning, poor impulse control, inability to understand and follow multi-step instructions, poor judgment, inability to comprehend cause-effect relationships, poor language comprehension, and impaired memory skills.
- Attention Problems or Hyperactivity: Tim exhibited almost all of the classic signs of an attentional disorder—inattentiveness, impulsivity, being overly active, easily distractibility, trouble calming down, and difficulty completing tasks.
- Problems with Social Skills: Children with FAS may show a lack of empathy, an unusual lack of fear of strangers that is normal in children, and immaturity. Later on, when they grow up, they may also exhibit inappropriate sexual behavior.
The sooner FAS can be diagnosed the better the outcome may be. If you notice your child exhibiting symptoms of FAS, contact your doctor and disclose if you drank during your pregnancy. A physical examination of the baby may show heart problems such as a heart murmur. Other symptoms may start showing as the child develops. These include:
- slow growth rate
- abnormal facial features or bone growth
- hearing and vision problems
- slow language acquisition
- small head size
- poor coordination
The three pillars of a FAS diagnosis are abnormal facial features, slower growth, and central nervous system problems. This last symptom can be either behavioral (hyperactivity, for example) or physical (lack of coordination).
The Long-Term Consequences of FAS Symptoms
Children affected with FAS may go on to develop secondary disorders that stem as a consequence of their primary symptoms. These include:
- Problems in School: Children with FAS may not only struggle to perform academically but may also get into trouble for disobeying authority and/or truancy. They may also find it difficult to make friends because of a lack of empathy that makes it difficult for them to get along with or relate to others.
- Development of Psychotic Disorders: If not managed well, attention problems can go on to become attention deficit disorder while poor judgment and impulse control can lead to conduct disorders. Besides, after years of trying to fit in, children with FAS can develop anxiety, depression, and psychosis.
- Trouble with the Law: Poor impulse control, lack of sound judgment, inability to understand cause-effect relationships, and lack of control over emotions and behavior can make a person afflicted with FAS prone to violence. Furthermore, their traits also make these people gullible and prone to manipulation. They may be persuaded into committing crimes.
- Development of Substance Abuse Disorders: More than a third of people with FAS go on to develop substance abuse disorders.
- Difficulty Holding on to a Job and/or Living Independently: Cognitive deficiencies, poor problem-solving skills, vulnerability to deception and manipulation, and a propensity to defy authority, make wrong choices, and land on the wrong side of law make it difficult for a person with FAS to hold on to a job and/or live independently.
- Inappropriate sexual activity
- Early death by accident, suicide or homicide
Is the reversible?
Fetal alcohol syndrome is irreversible. All the deficiencies caused by this condition will have to be managed throughout a person’s lifetime. However, there are medications and therapies readily available to help a person cope with Fetal Alcohol Syndrome.
Treating Children with FAS
The symptoms and long-term consequences of FAS sound ominous. But children born with FAS are not doomed for life if they are diagnosed early and their symptoms managed effectively. Children with FAS are able to live and function independently if they go through a special educational system where they are taught the necessary life skills. Early intervention treatment services can help reverse some developmental disorders. Medication may relieve some symptoms of FAS while behavioral therapy can help them master their emotions and impulses and learn social skills.
The prognosis for FAS improves dramatically if
- The condition is diagnosed before 6 years of age.
- Treatment and therapy start as early as possible.
- The child is brought up in a loving, stable, and violence-free environment that does not stress an already vulnerable nervous system.
The environment that children with FAS grow up in is of the utmost importance. These children are more likely to develop substance abuse problems as well as anger issues later on in life. This risk is heightened if they are exposed to it in the home. To counteract the risk of such issues developing they need a stable, healthy, loving home. They benefit from a reward system for positive behavior, simple rules and a clear and easy routine. Children with FAS are more sensitive to change and disruption in their routine, which is why stability is so important for proper development.
Though some medications address the symptoms of FAS, there is no medication to treat the syndrome itself. Medication to treat some of the symptoms may include:
- stimulants to help with focus and behavioral problems
- Neuroleptics to help with anxiety and violent tendencies
- antianxiety drugs
In dealing with their child’s syndrome, some parents choose to explore alternative options with their children. These methods range outside of the western idea of medicine. Some have found alternative movement techniques helpful such as yoga and exercise, as well as healing practices such as acupuncture or massages.
If you suspect that your child has FAS, get a confirmation from a specialist, like a child psychologist or a developmental pediatrician. The National Organization on Fetal Alcohol Syndrome (NOFAS) lists a National and State Resource Directory to help you find specialists in your area.
Or you can have your child evaluated for FAS by calling your state’s public early intervention system or the local public school system.
Tim was fortunate to receive early intervention treatment services. He now holds an associate degree in communications technology and works full time at a local software development company. He is in a loving relationship, enjoys hanging out with his friends watching baseball, and is working for a higher degree. He is working toward living independently; he is almost there!
Is There a Safe Limit for Drinking During Pregnancy?
According to the American Association for Pediatric Ophthalmology and Strabismus, FAS is the leading preventable cause of birth defects and neurological and developmental disabilities in the U.S. There are 6-9 cases of FAS per 1,000 births.
Yet, women continue to drink during pregnancy. According to the findings of a study by the Centers for Disease Control and Prevention (CDC), 1 in 10 pregnant women reported drinking and 1 in 33 reported binge drinking during the past month. In the same study, pregnant women reported binge drinking an average of 4.6 times during the past month.
It could be that women think a few drinks here and there won’t harm their babies. BUT, there is NO safe limit for drinking during pregnancy.
Keep in mind the following:
- Even a single drink is harmful because the white matter in the fetus brain is extremely sensitive to alcohol.
- The baby’s brain and spinal cord develop throughout the nine months of pregnancy. So whenever you drink during your pregnancy, you risk damaging these vital systems of your baby.
- Women planning to get pregnant are at an increased risk of delivering babies with FAS if they continue to drink after they stop using contraceptives. That’s because many women don’t realize they are pregnant till several weeks or a few months have elapsed from the time they conceived.
What is the best way to Prevent Fetal Alcohol Syndrome?
The best way to prevent fetal alcohol syndrome is to avoid consuming any alcoholic beverages during the period of pregnancy. Even a single drink can be dangerous to the developing organs of the baby. Women who are trying to get pregnant should stop drinking immediately, as excessive drinking during the early phases of pregnancy can be dangerous. Consider giving up alcohol during your childbearing years. If you are having unprotected sex, the chance of an unplanned pregnancy rises as does your risk of drinking before you are aware of your pregnancy. If you have an existing alcohol problem, it is important to seek help before you become pregnant.
FAS sets a child up for a life of challenges and adversities for no fault of his. FAS not only causes physical birth defects but also impairs the child mentally. Prenatal exposure to alcohol damages the central nervous system, so the child suffers from cognitive deficits, emotional shortcomings, behavioral maladjustments, and psychotic disorders. Fortunately, early diagnosis and prompt interventional treatment can manage and even reverse some symptoms and help a child learn the life skills necessary to function independently in life and reach full potential.