Fetal alcohol spectrum disorders (FASD) is the term used to describe the range of disorders that arise in children after exposure to alcohol during pregnancy. This article is going to provide you with an overview of the diagnosis, signs, symptoms and management of FASD.
Fetal alcohol spectrum disorders are entirely avoidable and the most common preventable cause of birth defects and brain damage in children. The disorders in order of most to least severe are:
* Fetal alcohol syndrome (FAS)
* Partial fetal alcohol syndrome (pFAS)
* Alcohol related neurodevelopmental disorders (ARND)
* Alcohol related birth defects (ARBD).
The extent of the disorder varies according to the time, dose and pattern of maternal alcohol consumption.
Alcohol Consumption in Pregnancy
It is unknown how much alcohol, if any, is safe to consume during pregnancy. There is no known ‘safe threshold’ and even small amounts of alcohol can impair fetal brain development. Alcohol is a teratogenic and a neurotoxin. A teratogen is a substance that causes birth defects and a neurotoxin causes brain damage.
The more alcohol a pregnant woman drinks, the higher the risk of damage to herself and to the developing baby. This is especially so for women who binge drink during pregnancy. When a pregnant woman drinks, alcohol crosses the placenta and produces the same blood alcohol level in the fetal circulation. The most critical time that alcohol can damage fetal development is during the first trimester, specifically between three and six weeks, this is the time when organs are forming. Excessive consumption of alcohol during pregnancy increases the risk of miscarriage, stillbirth and premature birth.
Current national guidelines recommend that total abstinence from alcohol be observed in women trying to conceive, during pregnancy and in breast feeding women. Women who discover they are pregnant and have consumed small amounts of alcohol are reassured that the risks to the baby is minimal, provided they discontinue or reduce drinking alcohol immediately. Pregnant women who find it difficult to stop drinking alcohol require support and treatment.
Signs and Symptoms
Children with fetal alcohol spectrum disorders are usually small in stature, have facial anomalies or are affected by vision and hearing problems. Other symptoms include poor memory, hyperactivity and impaired motor skills. Babies may have a low birth weight, be sensitive to light and noise and fail to thrive. Specific facial features include a smooth or flattened philtrum (the groove between the nose and upper lip), and a thinned upper lip. Other signs include skin folds covering the inner corners of the eyes, upturned nose, flat nasal bridge and underdeveloped ears.
Children exposed to alcohol during pregnancy are likely to have issues with learning, recall, attention span, communicating, mathematics and behaviour. The structure and function of the developing brain is literally damaged by alcohol. Difficulties are encountered with arithmetic associated with handling money, reasoning, learning from previous experiences, understanding consequences of actions and socialising with other people. Other behavioural symptoms include confusion, irritability and poor impulse control. Severely affected adults have these problems too and have issues managing bills or making purchases and maintaining employment.
Undiagnosed or misdiagnosed people are more likely to develop mental health issues, not complete schooling, be unemployed or homeless and develop substance abuse. Lesser known are the positive features of FASD, people with the disorder tend to be loyal, affectionate, friendly, artistic and good with animals or plants.
The sooner the diagnosis is made, the better the outcome for the child, and possibly for the birth mother. Screening tools and extensive multidisciplinary behavioural and physical assessment are used to diagnose which of the fetal alcohol spectrum disorders the infant or child is suspected of having. A diagnosis for the child is also diagnostic for the birth mother and possibly other family members.
It is critical that clinicians are adequately trained in recognising the disorders to prevent under reporting or misdiagnosis. Affected children are commonly misdiagnosed with attention deficit disorder, attention deficit hyperactivity disorder or Asperger syndrome. Although forms of FASD are incurable, a prompt and correct diagnosis allows for suitable interventions and improved quality of life for the child and primary care givers. Secondary disabilities occur if the disorder goes undetected or mistreated. Features of secondary disability include dependent living, addiction and mental illness.
The diagnosis should prompt the initiation of appropriate referral, interventions, support and counselling. Support for school aged children is provided in the form of specific education programs, tutors and a structured environment. Repetition, consistency, providing ideas in a concrete form, supervision and modelling are all crucial components of a management program. Adults are provided with vocational support and possibly require prolonged care. Follow up is an integral part of care, particularly the management of alcohol use in the birth mother.
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