Fetal Alcohol Spectrum Disorders (FASD)

"Fetal alcohol spectrum disorders (FASD)" is an umbrella term. It describes the wide range of effects that can result from prenatal alcohol exposure.

These effects can look very different from one child to another. Some children may have physical differences. Others may have challenges with learning, behavior or development. Many have a mix. The severity can range from mild to more serious.

There’s no safe amount of alcohol use during pregnancy. Even small amounts can lead to FASD. But it’s never too late to stop drinking. Fetal brain growth occurs throughout your pregnancy. So, stopping alcohol use during pregnancy can have a positive impact on your baby’s health.

What are the different types of fetal alcohol spectrum disorders?

The effects of FASD range in severity from mild to serious. The main types are:

• Fetal alcohol syndrome (FAS): FAS may be the most well-known. But it’s far less common than the other types. FAS causes growth problems and distinct facial features. It also causes issues with your child’s central nervous system.
• Partial fetal alcohol syndrome (pFAS): In pFAS, children may have some of the same physical features of FAS, but not all of them. People with pFAS also have issues with how their central nervous system works.
• Alcohol-related neurodevelopmental disorder (ARND): If your child has ARND, they may have learning disabilities and/or behavioral issues. They may also have developmental delays. But they won’t have the full facial features and growth issues of FAS.
• Alcohol-related birth defects (ARBD): ARBD refers to physical differences involving your child’s organs or bones. This type can appear alone. Or your child may have features of other types of FASD, as well.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): This type causes behavioral and thinking-related challenges. Your child may have trouble with memory and controlling their emotions. They may also find it hard to perform daily activities.

FASD symptoms

Fetal alcohol spectrum disorder symptoms vary from child to child. Some children show physical signs. Others have mostly behavioral or learning challenges. Some symptoms can be mild. Others are more severe.

FASD facial features

Most children with FASD don’t have noticeable facial differences. If they do, they may have three distinct features:

• Smooth philtrum: The ridge between your child’s nose and upper lip looks flat or smooth.
• Thin vermillion border: Your child’s upper lip looks very thin.
• Short palpebral fissures: Your child’s eye openings are smaller than average.

Growth and other physical differences

Depending on the FASD type, your child may show various physical signs, including:

• Small head size
• Shorter-than-average height
• Low body weight
• Vision or hearing problems
• Problems with their heart, kidneys or bones

Thinking, learning and behavioral challenges

Problems with your child’s central nervous system can affect how they think, learn and behave. Symptoms may include:

• Learning disabilities
• Speech and language delays
• Intellectual disability
• Trouble paying attention
• Problems controlling their emotions
• Trouble communicating or developing social skills
• Sensory processing issues (difficulty managing certain forms of touch, textures or sounds; seeking out more touch, texture, sounds or movement)

Day-to-day challenges

Your child may struggle with everyday tasks, like:

• Feeding or bathing themselves
• Telling time or counting money
• Staying safe and understanding risks
• Managing school, medical and social challenges

What causes fetal alcohol spectrum disorder?

FASD happens when a fetus is exposed to alcohol during pregnancy. When someone drinks during pregnancy, the alcohol in their blood can pass through the umbilical cord and reach the fetus. The fetus’s brain and organs are very sensitive. So, alcohol can affect how the fetus grows and develops.

Alcohol doesn’t affect all babies. But it’s impossible to know which babies will experience the effects of alcohol exposure and which won’t. That’s why there’s no safe amount of alcohol use during pregnancy. Even small amounts can cause harm. And all kinds of alcohol can be harmful. Wine, beer and liquor all carry risks.

There’s also no safe time to drink during pregnancy. It can affect development at any stage, even before someone realizes they’re pregnant.

Risk factors

Anyone who drinks alcohol during pregnancy can have a baby with FASD. But some situations can increase your chances. Many of these factors involve stress, reduced support or limited access to healthcare. They aren’t about placing blame. These factors help your healthcare provider understand your needs and provide better care. Risk factors include:

• Poor maternal nutrition
• Use of other substances during pregnancy
• Other children with FASD
• Advanced maternal age

Groups that have been found to have higher rates of FASD than the general population are children:

• In foster or adoptive care
• Getting mental health care
• Involved in the juvenile justice system

All children exposed to alcohol prenatally are at risk for FASD.

Complications of FASD

People with FASD can face challenges throughout their lives. Many of these problems are called secondary conditions. That means you develop them later because of the issues FASD causes. Complications of FASD may include:

• Mental health conditions: These may include a substance use disorder, depression or ADHD.
• Challenges in school: These include suspensions, skipping school and getting along with classmates.
• Trouble with the law: There may be problems with law enforcement due to impulsivity or manipulation by others.
• Inappropriate sexual behaviors: These include unwanted advances or inappropriate touching.
• Problems with independence: That means being able to hold a job, live alone or manage daily responsibilities.

How is fetal alcohol spectrum disorder diagnosed?

Diagnosing FASD can be challenging. There’s no medical test — like a blood test or an imaging scan — that can confirm it. Instead, healthcare providers put together many pieces of information to make a diagnosis.

Each type of FASD has specific diagnostic criteria. But they all start with a provider asking about alcohol use during pregnancy. They’ll also look for key features of FASD, including:

• Central nervous system problems
• Growth issues
• Distinct facial features

The provider will also try to rule out other health conditions that have similar signs and symptoms. Depending on the type, the provider may make referrals to specialists. Early diagnosis can help ensure the best treatment and support.

How is FASD treated?

There’s no cure for FASD. The changes in your child’s brain caused by alcohol exposure can’t be reversed. But there are many treatment options available. Your child’s providers will put together a treatment plan to meet their specific needs.

Medications

There aren’t any medications specifically approved for FASD. But certain medicines can help manage behavioral and emotional symptoms. These include:

• Stimulants
• Antidepressants
• Antipsychotics
• Anti-anxiety medicines

Behavioral and educational interventions

Behavior and education therapies are a big part of FASD treatment. These therapies may include:

• Training to improve attention, memory and impulsive behavior
• School-based interventions, including special teaching strategies and computer-based learning tools
• Mobile apps and caregiver-support tools designed for families affected by FASD

Parent and caregiver training

Parent training helps families understand their child’s brain-based challenges. It teaches them practical ways to consistently support their child. These include:

• Focusing on strengths and talents
• Using clear language and simple routines
• Providing structure and visual aids
• Using positive reinforcement
• Supervising closely

Social, emotional and community support

Mental health therapy and social services help address challenges, including:

• Trouble with school
• Behavioral issues
• Transitioning to adolescence

Your child may need lifelong support as their needs change over time.

What is the outlook (prognosis) for someone with FASD?

Fetal alcohol spectrum disorders are lifelong conditions. The challenges people face vary widely. Some people can live independently with support. But others need ongoing help throughout adulthood. Prognosis depends on the type of FASD, age of diagnosis and treatment.

Factors that may lead to better long-term outcomes include:

• Diagnosis before age 6
• Access to special education and social services
• A stable, nurturing home environment
• Mental health care

Can FASD be prevented?

FASD can be a preventable disease. It only occurs when a developing fetus has prenatal alcohol exposure. If there’s no exposure, FASD can’t occur. Ways to prevent FASD include:

• Avoiding alcohol if you’re pregnant or trying to become pregnant
• Stopping alcohol use at any time during your pregnancy
• Seeking support if you need help quitting
• Using birth control if you drink alcohol and don’t want to get pregnant