Fetal alcohol syndrome

Diagnosis

Diagnosing fetal alcohol syndrome involves an exam from a healthcare professional with expertise in the condition. Early diagnosis and services can help improve your child's ability to function.

Making a diagnosis involves:

• Talking about your drinking during pregnancy. Be honest with your healthcare professional about your alcohol use during pregnancy. This can help your obstetrician or other healthcare professional figure out the risk of fetal alcohol syndrome. Although fetal alcohol syndrome can't be diagnosed before birth, the health of the baby and mother can be assessed and watched during pregnancy.
• Watching for symptoms of fetal alcohol syndrome in your child's early weeks, months and years of life. Your child's healthcare professional looks at your child's physical appearance for changes typical of fetal alcohol syndrome. The health professional also watches your child's physical and brain growth and development.

Over time the healthcare professional watches for issues with:

• Physical growth and development.
• Thinking, learning and language development.
• Health.
• Social interaction and behavior.

Many features seen with fetal alcohol syndrome also may occur in children with other conditions. If fetal alcohol syndrome is suspected, your pediatrician or other healthcare professional will likely refer your child to an expert with special training in fetal alcohol syndrome. This may be a developmental pediatrician, a neurologist or another expert. The expert does an evaluation to rule out other conditions with similar symptoms to help make a diagnosis.

Fetal alcohol spectrum disorders

Fetal alcohol spectrum disorders describes the range of conditions in children caused when the mothers drank alcohol during pregnancy. Symptoms vary greatly among children and can include all or a mix of physical, behavioral, and learning and thinking problems.

The range of conditions caused by alcohol exposure before birth includes:

• Fetal alcohol syndrome (FAS). FAS is the severe end of fetal alcohol spectrum disorders. Fetal alcohol syndrome includes problems with behavior, learning and thinking. It also involves physical and growth changes that can affect any part of the body.
• Alcohol-related neurodevelopmental disorder (ARND). ARND includes intellectual disabilities or behavioral and learning problems but doesn't include physical and growth changes.
• Alcohol-related birth defects (ARBD). ARBD includes changes in physical development that are present at birth, such as problems with hearing, vision, and the heart, kidneys and bones. It does not include problems with learning and behavior.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). ND-PAE includes challenges functioning in everyday life. There may be issues with thinking and remembering, behavior concerns, and challenges with day-to-day activities and social interactions.
• Partial fetal alcohol syndrome (PFAS). Also called fetal alcohol effects, this condition includes some symptoms of fetal alcohol syndrome. But the extent of symptoms doesn't meet the guidelines for a diagnosis of fetal alcohol syndrome. PFAS is not common.

If one child in a family is diagnosed with fetal alcohol syndrome, it may be important to evaluate siblings for fetal alcohol syndrome if the mother drank alcohol during these pregnancies.

Treatment

There's no cure or specific treatment for fetal alcohol syndrome. The physical and mental conditions caused by alcohol exposure before birth are lifelong. But early intervention services may help lessen some of the challenges of fetal alcohol syndrome and may help prevent some secondary disabilities.

Intervention services may include:

• Healthcare professionals who can provide care for vision, hearing or heart conditions. Medicines may help with some symptoms.
• Early intervention specialists, such as a speech therapist, physical therapist and occupational therapist, to help with walking, talking and social skills.
• Special services, such as a special education teacher and a psychologist or other mental health professional, to help with learning and behavioral issues.
• Vocational rehabilitation services to help with getting and keeping a job.
• Life skills training professionals to help with independence, such as social skills, coping, communication, problem-solving and decision-making.
• Mental health professionals for parents and the family members to help them cope with a child's behavioral problems.
• Counselors who deal with substance misuse to address alcohol and recreational drug misuse, if needed.

Treatment for alcohol misuse

Treatment for the mother's alcohol misuse can help with better parenting and prevent future pregnancies from being affected. If you know or think you have a problem with alcohol or recreational drugs, ask a healthcare professional or mental health professional for help.

Substance misuse counseling and treatment programs can help with overcoming alcohol or recreational drug use. Joining a support group or 12-step program such as Alcoholics Anonymous also may help.

Coping and support

The challenges that occur along with fetal alcohol syndrome can be difficult to manage for the person with the condition and for the family.

Family support

Children with fetal alcohol syndrome and their families may benefit from the support of professionals and other families who have experience with this condition. Ask your healthcare professional or a social worker or mental health professional for local sources of support for children with fetal alcohol syndrome and their families.

Dealing with behavioral issues

Challenges with behavior often happen in children with fetal alcohol syndrome. To help your child, use these parenting skills:

• Recognize your child's strengths and limitations.
• Set up and keep daily routines.
• Create and enforce simple rules and limits.
• Keep things simple by using clear, specific language.
• Repeat things to reinforce learning.
• Point out acceptable behavior and use rewards to reinforce the behavior.
• Teach skills for daily living and social interaction with others.
• Guard against your child being taken advantage of by others.

Early intervention and a stable, nurturing home are important to protect children with fetal alcohol syndrome from some of the other issues they're at risk of later in life.

Preparing for your appointment

Call your child's doctor or other healthcare professional for an appointment if you have any concerns about your child's growth and development.

You may want to ask a family member or friend to come with you to help remember all the information provided.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've noticed in your child. Include any that may seem unrelated to the reason for the appointment, and when the symptoms began.
• All medicines, vitamins, herbs or other supplements that you took during pregnancy, and their doses. Also, if you drank alcohol during your pregnancy, tell your child's healthcare professional how much you drank and when.
• Questions to ask your child's healthcare professional.

Questions to ask may include:

• What's the most likely cause of my child's symptoms?
• Are there other possible causes?
• Should my child see a specialist?
• Will my child's condition get better over time? Will it get worse?
• What treatments are available, and which do you recommend?
• Are there medicines that can help? Are there medicines that should be avoided?
• How can I prevent this from happening in future pregnancies?
• Do you have any material that can help me learn more? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Did you drink alcohol while you were pregnant? If yes, how much and how often?
• Did you use any recreational drugs during your pregnancy?
• Did you have any problems with your pregnancy?
• When did you first notice your child's symptoms?
• Have these symptoms been ongoing, or do they come and go?
• Does anything seem to make the symptoms better?
• What, if anything, seems to make the symptoms worse?

Be ready to answer questions so that you have time to talk about what's most important to you.