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Definition

fetal alcohol syndrome

ABBR: FAS

Birth defects (including prominent intellectual disabilities) in infants born to mothers who consumed large amounts of alcoholic beverages during gestation. Characteristic findings in the infant include a small head with multiple facial abnormalities: small eyes with short slits; a wide, flat nasal bridge; a midface that lacks a groove between the lip and the nose; and a small jaw related to maxillary hypoplasia. Affected children often exhibit persistent growth retardation, hyperactivity, and learning deficits. They may show signs and symptoms of alcohol withdrawal shortly after birth. SYN: fetal alcohol effects.

Incidence: FAS is present in between 1 to 3 child births per 1000.

Causes: FAS is caused by consumption of alcohol on a daily basis (or in binges) before or during pregnancy.

Symptoms and Signs: Birth defects that result from FAS are marked by abnormalities in growth, central nervous system function, and facial characteristics. Facial abnormalities detected at birth may become less obvious as the child continues to grow. Much more serious, however, are the developmental delays that affect the child's behaviors, social skills, and learning. Included are hyperactivity, poor social skills and judgment, impulsiveness, poor ego or self-image, sensory processing problems, and high levels of anxiety. Mental retardation due to the abnormal migration of neural and glial cells during cell differentiation may be the cause of an IQ below 79 at age 7. It may seriously impair the child’s potential. Poor fine motor function (weak grasp and poor hand -to-mouth coordination) adds to the child's functional defects.

Prevention: Maternal counseling should emphasize that when the mother drinks, her baby also drinks, as alcohol crosses into the baby's bloodstream and affects its developing organs and tissues. No amount of alcohol is known to be safe for the developing fetus; thus, all health care providers should make ongoing efforts to educate women who are planning pregnancy or are pregnant to abstain completely from alcohol. They should suggest effective contraception and referral to abstinence treatment programs to individuals with known alcohol problems. The father's drinking does not directly affect his unborn child; however, his drinking may influence his partner to drink.

Patient Care: Initial infant care is related to clinical problems that include increased respiratory effort, poor sucking ability, irritability, and hypotonia. A patent airway is maintained, and the infant's respiratory effort is monitored with ventilatory assistance provided if required. Seizure activity must be assessed, treated, and prevented with medical management. The infant's weight and fluid balance are assessed and recorded. The mother is taught feeding techniques that promote the infant’s taking and retaining nutrients sufficient for growth. If necessary, the infant's nares and mouth are suctioned, and gavage feedings are provided.

Family members are taught about the child's special needs. They are helped to recognize and eventually accept the child's impairments and to be aware of their effects on the child's future. Parents and other family members are encouraged to voice their concerns. A social worker evaluates the parents' needs and refers them to appropriate community resources and national support organizations. Including the child in the mother's support program improves results for both of them.

Prevalence: The prevalence of fetal alcohol spectrum disorders in the U.S. in 2017 was approx. 1–5%.