Fetal Alcohol Spectrum disorders
Also known as: Fetal Alcohol Effects; Fetal Alcohol syndrome
Fetal Alcohol Spectrum Disorders (FASD) is a diagnosis which describes a range of features from the severe end of the spectrum – Fetal Alcohol Syndrome (FAS), to the minor individual anomalies that are associated with pre-natal alcohol exposure.
Debate continues as to whether light drinking in pregnancy is risky for the foetus. However given individual sensitivities to alcohol the wisest course is not to drink during pregnancy. The official position of most of the UK countries, the National Health Service and the relevant Royal Colleges is that the safest option is no drinking in pregnancy.
Medical text written March 2018 by Dr Moira Plant, Emeritus Professor of Alcohol Studies, University of the West of England, Bristol, UK.
Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.
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.
Pre-natal alcohol exposure. The severity of the syndrome relates to the frequency of drinking, the amount drunk on each occasion and the stage of pregnancy. The first trimester where organ development and brain growth occur is the most sensitive time for the fetus. However, harm can occur at any stage of pregnancy.
Factors that influence how seriously the baby may be affected include poor nutritional status, use of tobacco or other drugs and lower socio-economic status.
The use of the 4-Digit Code (see above) is the most recognised means of diagnosis with the severity of the facial features being a marker to the severity of brain damage. However more than 70% of children born with pre-natal alcohol exposure do not have these facial features. As the children get older many of them lose the characteristic facial features thus making diagnosis difficult. It is often a diagnosis of exclusion.
There is no treatment for FASD. Addressing individual issues such as learning and behavioural problems can be a great help. There are changes over time with these problems and approaches will differ depending on severity of the disorder and age. Awareness of some of the accompanying physical conditions may ensure treatment for these is instigated and will help with such aspects as reducing the number of school days lost. A stable environment and a consistent approach are important and support for the child, the parents and siblings is vital.
None known at this time.
There is no diagnostic test at this time. However, a clear drinking history from the mother and advice to stop drinking is important. Monitoring for general pre-natal growth may help.
National Organisation for FASD
The Organisation is a Registered Charity in England and Wales No. 1101935, established in 2003. It provides information on Fetal Alcohol syndrome (FAS) and Fetal Alcohol Spectrum disorder (FASD), links families where possible, runs family activity days, conferences and training sessions, has a library of resources and publishes a regular newsletter.
Group details last updated August 2021.
The Organisation is a Registered Charity in Scotland No. SC043581. The organisation offers information and awareness about the lifelong risks of prenatal exposure to alcohol. They provide Information, support and advocacy to families caring for a child affected by FASD, strategies for managing FASD and advice and training to reduce FASD secondary disabilities. They also provide training for professionals involved with individuals affected by FASD and partnership with other agencies to prevent FASD and secondary disabilities.
Group details added March 2018.