Carolynne Pinder Child Development Nurse Practitioner Pam Schultz adapted Feb 2013

 In 1973, Jones and Smith (1) coined the term "fetal alcohol syndrome" (FAS) to describe a pattern of abnormalities observed in children born to alcoholic mothers. JONES, K.L., & Smith, D.W. Recognition of the fetal alcohol syndrome in early infancy. Lancet 2: , 1973.

Fetal alcohol syndrome is growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy. PubMed April 2012 Fetal Alcohol Syndrome is the biggest cause of non-genetic mental handicap in the western world and the only one that is 100% preventable. FASaware April 2012

 FASD is an umbrella term describing the range of birth defects which can occur in an individual whose mother drinks alcohol during pregnancy. FASAware 2012

 FAS Full fetal alcohol syndrome  PFAS Partial fetal alcohol syndrome  ARBD Alcohol related birth defects  ARND Alcohol related neurodevelopmental disorders BMA 2007

 As the fetal brain develops throughout the whole pregnancy, children with Fetal Alcohol Spectrum Disorder often have permanent and irreversible brain injury as a direct consequence of alcohol consumed at any point in the pregnancy. FASAware 2012

 It is estimated that one in every 100 children are born each year in the UK with Fetal Alcohol Spectrum Disorder. FASAware 2012  This number is greater than the combined numbers of children born in any year with Down’s syndrome, cerebral palsy, cystic fibrosis and spina bifida.

 The world-wide incidence in 1987 of fetal alcohol syndrome (FAS) was 1.9 per 1000 live births. Drug Alcohol Depend.Drug Alcohol Depend Jan;19(1):51-70.

 The life-long implications of Foetal Alcohol Spectrum Disorder are often compounded by secondary disabilities in adulthood such as mental health problems, drug addiction and involvement in criminal activity, with mental health problems escalating during adulthood – 23% of adults with Foetal Alcohol Spectrum Disorder have attempted suicide whilst as many as 43% have considered it. (These figures can be found on the internet at over.to/FAS/fasconf.htm)

 Intellectual disability; lowered IQ  Memory disorders  Learning disorders  Attention disorders  Sensory disorders  Speech and language disorders  Mood disorders  Behavioural disorders  Autistic-like behaviours  Sleep disorders.

 Often the condition goes undiagnosed, or is misdiagnosed, for example as Autism or Attention Deficit Hyperactivity Disorder (ADHD), and this can lead to secondary disabilities which can include:

 Loneliness  School expulsions  Addictions  Chronic unemployment  Promiscuity  Unplanned pregnancies  Poverty  Criminality  Prison  Homelessness  Depression and suicide

 What does a child with Fetal Alcohol Syndrome look like?

 one sign that a child may have FAS is the presence of a smooth Philtrum (which is the crevasse between your nose and your upper lip). Another physical sign may be a thin upper lip.On the chart below, “1-2″ show a “deep philtrum and a full upper lip,” “3″ is an “average Philtrum and Upper Lip” and “4-5″ show a “smooth Philtrum and thin upper lip.”

 An epicanthal fold is skin of the upper eyelid -- from the nose to the inner side of the eyebrow -- that covers the inner corner (canthus) of the eye.  The presence of an epicanthal fold is normal in people of Asiatic descent. An epicanthal fold is also common in children with Down syndrome. Epicanthal folds may also be seen in young children of any race before the bridge of the nose begins to elevate.

 Down syndrome  Fetal alcohol syndrome  Turner syndrome Turner syndrome  Phenylketonuria (PKU) Phenylketonuria  Williams syndrome Williams syndrome  Noonan syndrome Noonan syndrome  Rubinstein-Taybi syndrome Rubinstein-Taybi syndrome  Blepharophimosis syndrome

 Of low birthweight  Over-sensitive to light, noise and touch  Irritable  Unable to suck effectively  Slow to develop  Vulnerable to ear infections  Affected by poor sleep/wake cycles  Too stiff or too floppy  Resistant to accepting new situations.

 Poor muscle development and movement skills  Coordination and balance  Language  Learning new skills that other children find easy  Remembering  Hyperactivity (they find it difficult to sit still)  Lack of a sense of fear  Understanding boundaries  Their need for lots of physical contact  Missing typical development milestones such as walking, toilet training, emotional development, etc.

 Older children with FASD may experience all of the difficulties above, but also have problems with:

 Distraction (they respond to everything happening around them)  Impulsiveness (they do not think before they act)  Paying attention, concentrating and understanding what they hear  Accepting changes in routine  Planning and problem solving  Understanding why something happened (cause and effect)

 Learning from experience  Responding to requests and questions  Understanding their own feelings and the feelings of others  Adapting to the normal stresses of day-to-day living  Relating to other people (friends and strangers)  Sensory overload (become confused by too much noise, movement, light, smells)  Talking and listening (they may only understand one in three words)

 Thinking and doing things in the right order  Understanding abstractions (e.g. maths, money, time)  Inconsistent performance (i.e. ‘on’ and ‘off’ days)  Age appropriate behaviour (i.e. they may act younger than their age)  Lying to fit in and gain approval (e.g. saying they understand an instruction when they do not).

 Alcohol also damages other body organs (e.g. eyes, ears, heart, limbs, kidneys and/or other organs) causing ongoing health problems for the child. Their brain damage may also cause seizures and interrupted sleep patterns.  It is important for children with FASD to have regular medical check-ups

 All healthcare professionals as a part of routine clinical care should provide ongoing advice and support to expectant mothers at every stage of pregnancy and this should include the risks of maternal alcohol consumption.

 Women who are pregnant, or who are considering a pregnancy, should be advised not to consume any alcohol.

 SpectrumDisorders_tcm pdf SpectrumDisorders_tcm pdf  JONES, K.L., & Smith, D.W. Recognition of the fetal alcohol syndrome in early infancy. Lancet 2: ,  Drug Alcohol Depend Jan;19(1): Drug Alcohol Depend.  