The use of the word fetal in FASD has led to the misunderstanding that children will 'grow out of it'. In fact FASD are life-long conditions and, although the difficulties for these children will change over time, they and their families will always struggle with life and learning.
The clinical features of FAS are grouped into four areas known as the four digit code:
- pre and post-natal growth retardation - children are light in weight, short in length and have a smaller than normal head circumference
- facial features: including mid-facial flattening, smaller than normal opening to the eye (measured from one corner to the other), absent philtrum (the ridges between the nose and the upper lip) and thin upper lip
- moderate-to-severe learning difficulties (see entry Learning Disability)
- a history of maternal alcohol consumption.
However, commonly the first sign of pre-natal alcohol exposure is a range of behavioural problems which may start with difficulties in feeding and sleeping. Major issues include problems with memory and an inability to plan and carry out tasks. In older children and adults, mental health problems and trouble with the law are common particularly in looked after children.
Added to the behavioural problems many of these children and young people experience physical problems which may go unrecognised. These include higher than normal rates of congenital heart defects, hypothyroidism, joint problems eg arthritis, sensory-motor problems. Some of these problems such as chronic ear infections, if unidentified, may affect hearing and in turn lead to problems at school.