Fetal Alcohol Syndrome (FAS)

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fetal alcohol syndrome (FAS)

Brain damage and other severe birth defects in a child whose mother abused alcohol during pregnancy. The extent of the damage varies greatly and may be mild to severe. Alcohol exposure during pregnancy is the number-one cause of preventable mental retardation.

Physicians from ancient Greece through the present day recognized that the alcoholism of a pregnant woman was harmful to children born to her, yet it was not until 1973 that Kenneth Jones and David Smith of the University of Washington in Seattle identified the characteristics of fetal alcohol syndrome and perceived it as an actual syndrome.

Study after study suggests that any pregnant woman should avoid alcohol altogether throughout her pregnancy. Alcoholic women who are pregnant and plan to continue their pregnancies should definitely seek prenatal care and treatment so they can recover from alcoholism and avoid the possibility of birth defects in their children. Indeed, any woman who normally drinks alcohol in any quantity whatsoever, including as little as one drink per day, should consult her physician to obtain information and advice about alcohol consumption during pregnancy. Women who suspect they are pregnant should immediately find out whether they are indeed pregnant so they can determine the appropriate course of action.

Associated Negative Conditions

Although it is clear that consumption of alcohol during pregnancy is dangerous to the developing fetus, the negative effects are often confounded or even potentiated by other substances, such as tobacco as well as illegal drugs. In addition, after a child with FAS is born, the environment she or he is brought up in before state or county social workers may become involved is often very negative to the child.

Families who adopt children with FAS should obtain as much information and assistance as possible from social workers, physicians and parent groups. They must understand that tender, loving care, although extremely important, cannot entirely alleviate the damage that occurred in utero to the child. Families should also learn about adoption subsidies and the child's eligibility for Medicaid.

In many cases, an adoptive family will adopt their FAS child through the state social services system, although they may also adopt through a private adoption agency.

Children with fetal alcohol syndrome are often premature and underweight with small heads and are likely to remain unusually small and thin. Many are mentally retarded: The average IQ of the FAS child is 68. They may also experience seizures and a host of other medical and psychological problems that are not outgrown as the child ages. Hyperactivity and a poor attention span are common problems.

Identifiable facial features of children with fetal alcohol syndrome include folds in the eyelids, short noses, thin upper lips, small chins and an overall "flattened" appearance. An estimated 30% of the children also suffer heart defects. Another characteristic of children with FAS is poor muscle coordination, and one-quarter to one-half of the children have heart murmurs. Other problems sometimes seen are cleft palates, hernias, hydrocephalus, kidney problems and defective teeth.

Other characteristics of FAS are growth deficiency and central nervous system dysfunctions that lead to impulsivity, memory problems and learning disorders.

Children with FAS are often retarded, although a low intelligence level is not inevitable. Dr. Ira Chasnoff, a noted expert on FAS, treated twin girls who clearly had FAS, including such symptoms as small head circumference, abnormal facial features, low developmental scores and slow growth. The mother's parental rights were terminated and the girls were adopted into a family that provided opportunities for the children to develop at their own level. At the age of two and one-half, they showed considerable improvement. By the age of 17, they both were enrolled at a public school in a program for gifted students. Of course, it should not be interpreted from this encouraging story that FAS children are exceptionally gifted intellectually. To the contrary, most are below average or of average intelligence.

One study of children who did not meet the requirements of FAS but who had developmental delays when there was a known prenatal exposure to alcohol (PEA), revealed that only 38% of the PEA group had IQ scores at or above average. The study also revealed that only 18% of the FAS children had IQs that were average or above average.

Learning Disabilities

Children with FAS may experience serious shortfalls in learning, partly in arithmetic and, as adults, in managing money. Some studies have indicated that the children of women who were binge drinkers during pregnancy are subsequently more likely to experience difficulty in math and reading and other areas of learning. As a result, the school setting can be a very frustrating environment for the child with FAS, and parents should work to obtain as much academic assistance for the child as possible.

Children who have been diagnosed with FAS are eligible for assistance under the Individuals with Disabilities Education Act (IDEA), and adoptive parents or other caregivers should ensure the child receives this opportunity.

Risk for Social Problems

Some studies have revealed that children with FAS are more likely to become alcoholic adults, experience unplanned pregnancies and become involved in car accidents. These problems could be a function of poor judgment, poor impulse control and lower intelligence, alcohol abuse or other issues.

A study reported in a 1998 issue of Alcoholism: Clinical and Experimental Research on adopted adults ranging from 18 to 45 years included children exposed to alcohol before birth and children who were not. The study concluded that fetal alcohol exposure was a risk factor for adult use of nicotine, alcohol and drug dependence.

Late Diagnosis

Most children with FAS are not diagnosed until after age six. In one study of 400 children and adults with FAS, only 11% had been diagnosed before age six. The average age of diagnosis is age 10 or 11. Part of the reason for this late diagnosis is there is no laboratory test or X ray that will definitely prove a person has FAS. Instead, the diagnosis for this syndrome is based on physical appearance, medical problems, behavioral problems and other issues.

Many people mistakenly believe that FAS is easy to diagnose in a child but experts report that diagnosis can be very difficult.

Wrote pediatrician Jerri Ann Jenista in an article about FAS, "Kids with FAS, for the most part, don't look 'funny.' As a matter of fact, many of them are quite cute and attractive, especially in the toddler years. It is the pattern of features that makes the diagnosis. In different persons, some features will be more prominent that in others. For example, one child may have severe growth and developmental retardation, while another child may have a 'textbook' face and near-normal growth and behavior."

According to Jenista, diagnosis may be very difficult even for experts and she cites a major FAS diagnostic clinic at the University of Washington in Seattle that publishes a 100-page manual to aid physicians in diagnosing FAS.

No More "Fetal Alcohol Effect"

In the recent past, many physicians have identified children with "Fetal Alcohol Effect" when the biological mother was a heavy drinker, but the diagnosis of FAS was not clear-cut. However, most physicians have abandoned this diagnosis, seeing it as meaningless and believing the child either has FAS or does not.

Sometimes the placing agency may be unaware that the child has FAS because the symptoms are so mild and/or because they did not realize the birthmother was an alcoholic. Adopting parents should be sure to ask agency social workers to ask the biological mother about her drinking habits.

If the child was abandoned in an orphanage, then there will be no information on the birthmother; however, the orphanage should maintain some medical information from the time the child entered the orphanage that can be made available to prospective parents.

In many cases, an adoptive family will adopt their FAS child through a state social services system, although they may also adopt through a private adoption agency in the United States or another country.

However, if birthmothers in the other country have alcohol problems, then their offspring may suffer from FAS. Some evidence indicates that children from orphanages in the former Soviet Union are at high risk for FAS, while generally children from countries such as China are at a much lower risk.

It is possible that Fetal Alcohol Syndrome may be more of a problem for groups that have a high rate of alcohol consumption. The late Dartmouth professor and adoptive father Michael Dorris, who was also an American Indian, wrote sensitively of his own experiences in adopting a son with fetal alcohol syndrome in his book The Broken Cord. Dorris believed the rate of fetal alcohol syndrome was a serious problem among some tribes and was also an often unrecognized problem among all races in the United States. (American Indians do have a higher rate of alcoholism than other ethnic or racial groups.)

Dorris also discussed what should or could be done to help pregnant women who continue to abuse alcohol and described the relative merits of incarceration, enforced sterilization when a mother bears more than one child with fetal alcohol syndrome and other possible solutions. Dorris, who was a supporter of legal abortion, argued that the child is unfairly damaged for life by the alcohol consumption of his or her birthmother.

Groups such as the American Civil Liberties Union fight against constraints on drug or alcohol-abusing pregnant women, fearing that the number of constraints could greatly increase and inhibit the pregnant woman's freedoms and also fearing that pregnant women with such problems will be less likely to seek treatment if they fear imprisonment or other actions. (See also ALCOHOL ABUSE AND ADOPTED PERSONS DRUG ABUSE; GENETIC PREDISPOSITIONS.)

Nancy L. Day, Gale Richardson, Nadine Robles, Usha Sambamoorthi, Paul Taylor, Mark Scher, David Stoffer, Dorcie Jasperse and Marie Cornelius, "Effect of Prenatal Alcohol Exposure on Growth and Morphology of Offspring at 8 Months of Age," Pediatrics 85 (May 1990): 748-752.

Michael Dorris, The Broken Cord (New York: Harper & Row, 1987).

Robert O'Brien and Morris Chafetz, M.D., The Encyclopedia of Alcoholism (New York: Facts On File, 1991).

Jenista, Jerri Ann. M.D., "Fetal Alcohol Syndrome (FAS): Diagnostic Dilemma," Adoption/Medical News 4, no. 1 (January 1998).

P. Minugh, et al, "Drinking of Alcoholic Beverages-Health Aspects, Health Behavior-Surveys," American Journal of Drug and Alcohol Abuse 24, no. 3 (August 1998): 483-498.

Laura J. Ronge, "Early Fetal Alcohol Diagnosis Helps Patient Over Lifetime" AAP News (October 1998): 14-15.

Ann Streissguth, Fetal Alcohol Syndrome: A Guide for Families and Communities (Baltimore, Md.: Paul Brookes Publishing Company, 1997.)

Naimah Z. Weinburg, "The Adverse Effects that Parental Alcohol Use May Have on Children Are Numerous, Pervasive, Costly and Often Enduring," Journal of the American Academy of Child & Adolescent Psychiatry 36, no. 9 (September 1997): 1177-1187.

William R. Yates, et al., "Effect of Fetal Alcohol Exposure on Adult Symptoms of Nicotine, Alcohol, and Drug Dependence," Alcoholism: Clinical and Experimental Research 22, 4 (1998): 914-920.

Find more information on fetal alcohol syndrome (FAS)

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