By Mayo Clinic Staff
Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. Fetal alcohol syndrome causes brain damage and growth problems. The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are irreversible.
There is no amount of alcohol that's known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.
If you suspect your child has fetal alcohol syndrome, talk to your doctor as soon as possible. Early diagnosis may reduce the risk of problems such as learning difficulties and behavior issues.
The severity of fetal alcohol syndrome symptoms varies, with some children experiencing them to a far greater degree than others. Signs and symptoms of fetal alcohol syndrome may include any mix of physical defects, intellectual or cognitive disabilities, and problems functioning and coping with daily life.
Physical defects may include:
- Distinctive facial features, including wide-set eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
- Deformities of joints, limbs and fingers
- Slow physical growth before and after birth
- Vision difficulties or hearing problems
- Small head circumference and brain size
- Heart defects and problems with kidneys and bones
Brain and central nervous system problems
Problems with the brain and central nervous system may include:
- Poor coordination or balance
- Intellectual disability, learning disorders and delayed development
- Poor memory
- Trouble with attention and with processing information
- Difficulty with reasoning and problem-solving
- Difficulty identifying consequences of choices
- Poor judgment skills
- Jitteriness or hyperactivity
- Rapidly changing moods
Social and behavioral issues
Problems in functioning, coping and interacting with others may include:
- Difficulty in school
- Trouble getting along with others
- Poor social skills
- Trouble adapting to change or switching from one task to another
- Problems with behavior and impulse control
- Poor concept of time
- Problems staying on task
- Difficulty planning or working toward a goal
When to see a doctor
If you're pregnant and can't stop drinking, ask your obstetrician or other health care provider for help.
Because early diagnosis may help reduce the risk of long-term problems for children with fetal alcohol syndrome, let your child's doctor know if you drank alcohol while you were pregnant. Don't wait for problems to arise before seeking help.
If you've adopted a child or are providing foster care, you may not know if your child's biological mother drank alcohol while pregnant — and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has learning and behavioral problems, talk with your child's doctor so that the underlying cause might be identified.
When you're pregnant and drink alcohol:
- Alcohol enters your bloodstream and reaches your developing fetus by crossing the placenta
- Alcohol causes higher blood alcohol concentrations in your developing baby than in your body because a fetus metabolizes alcohol slower than an adult does
- Alcohol interferes with the delivery of oxygen and optimal nutrition to your baby's developing tissues and organs, including the brain
The more you drink while pregnant, the greater the risk to your unborn baby. Your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy, before you may know you're pregnant.
Impairment of facial features, the heart and other organs, including the bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester. That's when these parts of the fetus are in key stages of development. However, the risk is present at any time during pregnancy.
The more alcohol you drink during pregnancy, the greater the chance of problems in your baby. There's no known safe amount of alcohol consumption during pregnancy.
You could put your baby at risk even before you realize you're pregnant. Don't drink alcohol if:
- You are pregnant
- You think you might be pregnant
- You're trying to become pregnant
Problem behaviors not present at birth that can result from having fetal alcohol syndrome (secondary disabilities) may include:
- Attention deficit/hyperactivity disorder (ADHD)
- Conduct disorder, which includes aggression, violation of rules and laws, and inappropriate social conduct
- Alcohol or drug misuse
- Mental health disorders, such as depression, anxiety or eating disorders
- Problems in school, with independent living and with employment
- Inappropriate sexual behaviors
Call your child's doctor for an appointment if you see any signs or symptoms that concern you.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Before your appointment:
- Make a list of any symptoms you've noticed in your child, including any that may seem unrelated to the reason for the appointment.
- Make a list of all medications, vitamins or other supplements that you took during pregnancy, and their dosages.
- Let your child's doctor know if you drank alcohol during your pregnancy, and if so, how much and how often.
- Consider asking a family member or friend to come with you — sometimes it can be difficult to remember all of the information provided to you during an appointment, especially if you've been told that there may be something wrong with your child.
Preparing a list of questions can help you make the most of your time with your child's doctor. For fetal alcohol syndrome, some basic questions to ask your doctor include:
- What's the most likely cause of my child's symptoms?
- Are there other possible causes?
- What kinds of tests does he or she need? Do these tests require any special preparation?
- Will my child's condition improve over time? Will it get worse?
- What treatments are available, and which do you recommend?
- How can I prevent this from happening in future pregnancies?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
- Are there medications that may help, and are there medications that should be avoided?
Don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your child's doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
- When did you first notice your child's symptoms?
- Have these symptoms been continuous or are they only occasional?
- Does anything seem to improve the symptoms?
- What, if anything, appears to worsen the symptoms?
- Did you have any problems during your pregnancy?
- Did you drink alcohol while you were pregnant? If yes, how much and how often?
- Did you use any street drugs during your pregnancy?
If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome. Although doctors can't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of the mother and baby during pregnancy.
Your child's doctor can watch for signs and symptoms of fetal alcohol syndrome in your child's initial weeks, months and years of life. Early diagnosis and provision of services can help improve your child's ability to function.
Diagnosing fetal alcohol syndrome requires expertise and a thorough assessment. To make a diagnosis, doctors assess:
- The occurrence of drinking during the pregnancy
- Physical appearance and distinguishing features
- Physical growth and development
- Brain growth and development
The doctor may also assess:
- Cognitive ability and learning and language development difficulties
- Health issues
- Social and behavior problems
Many features seen with fetal alcohol syndrome may also occur in normal, healthy children or in children with other disorders. If fetal alcohol syndrome is suspected, your pediatrician may refer your child to a developmental pediatrician, a neurologist or another expert with special training in fetal alcohol syndrome for evaluation and to rule out other disorders with similar signs and symptoms.
Fetal alcohol spectrum disorders
The range of consequences from drinking alcohol during pregnancy are collectively called fetal alcohol spectrum disorders, as not all signs and symptoms are present in all children with the disorder. This range includes:
- Alcohol-related neurodevelopmental disorder — intellectual disabilities or behavioral and learning problems caused by drinking alcohol during pregnancy
- Alcohol-related birth defects — physical defects caused by drinking alcohol during pregnancy
- Fetal alcohol syndrome — the severe end of the fetal alcohol spectrum disorders, which includes both neurodevelopmental disorder and birth defects caused by drinking alcohol during pregnancy
- Partial fetal alcohol syndrome — presence of some of the signs and symptoms of fetal alcohol syndrome caused by drinking alcohol during pregnancy, but the criteria for the diagnosis are not met
If one child in a family is diagnosed with fetal alcohol syndrome, it may be important to evaluate his or her siblings to determine whether they also have fetal alcohol syndrome, if the mother drank alcohol during these pregnancies.
There's no cure or specific treatment for fetal alcohol syndrome. The physical defects and mental deficiencies typically persist for a lifetime.
However, early intervention services can help reduce some of the effects of fetal alcohol syndrome and prevent some of the secondary disabilities that result. Intervention services may involve:
- A team that includes a special education teacher, a speech therapist, physical and occupational therapists, and a psychologist
- Early intervention to help with walking, talking and social skills
- Special services in school to help with learning and behavior issues
- Counseling to benefit parents and the family in dealing with a child's behavior problems
- Medications to help with some symptoms
- Medical care for health problems, such as heart abnormalities
- Treatment of the mother's alcoholism to enable better parenting and prevent future pregnancies from being affected
Treatment for problems with alcohol or other substances
If you know or suspect you have a problem with alcohol or other substances, ask a medical or mental health professional for advice. If you've given birth to a child with fetal alcohol syndrome, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol or other substances. Joining a support group or 12-step program such as Alcoholics Anonymous may help.
The psychological and emotional problems associated with fetal alcohol syndrome can be difficult to manage for the person with the syndrome and for the family.
Children with fetal alcohol syndrome and their families may benefit greatly from the support of professionals and other families who have experience with this syndrome. Ask your health care provider for local sources of support for children with fetal alcohol syndrome and their families.
Dealing with behavior problems
As a parent of a child with fetal alcohol syndrome, you may find the following suggestions helpful in dealing with behavior problems associated with fetal alcohol syndrome. Learning these skills (sometimes called parent training) can include:
- Recognizing your child's strengths and limitations
- Implementing daily routines
- Creating and enforcing simple rules and limits
- Keeping things simple by using concrete, specific language
- Using repetition to reinforce learning
- Pointing out and using rewards to reinforce acceptable behavior
- Guarding against your child being taken advantage of by others because many children with fetal alcohol syndrome are vulnerable
- Teaching your child skills for daily living
- Carefully choosing whom you ask to care for your child when you can't be there, because some behaviors may be difficult to manage
A stable, nurturing home is the single most important factor in protecting children with fetal alcohol syndrome from some of the secondary disabilities they're at risk of later in life.
Doctors haven't identified a safe level of alcohol that a pregnant woman can consume. But experts do know that fetal alcohol syndrome is completely preventable if women don't drink alcohol during pregnancy.
These guidelines can help prevent fetal alcohol syndrome:
- Don't drink alcohol if you're trying to get pregnant. If you haven't already stopped drinking, stop as soon as you know you're pregnant or if you even think you might be pregnant. It's never too late to stop drinking during your pregnancy, but the sooner you stop, the better it is for your baby.
- Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink during pregnancy.
- Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned, and damage can occur in the earliest weeks of pregnancy.
- If you have an alcohol problem, get help before you get pregnant. Get professional help to determine your level of dependence on alcohol and to develop a treatment plan.
June 02, 2014
- Fetal alcohol spectrum disorders (FASDs). Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/fasd/index.html. Accessed March 6, 2014.
- Alcohol during pregnancy. March of Dimes. http://www.marchofdimes.com/pregnancy/alcohol-during-pregnancy.aspx#. Accessed March 6, 2014.
- Effects of alcohol on a fetus. Substance Abuse and Mental Health Services Administration. http://fasdcenter.samhsa.gov/grabGo/factSheets.aspx. Accessed March 6, 2014.
- Jansson LW. Infants of mothers with substance abuse. http://www.uptodate.com/home. Accessed March 6, 2014.
- Landgraf MN, et al. The diagnosis of fetal alcohol syndrome. Deutsches Arztebaltt International. 2013;110:703.
- Ungerer M, et al. In utero alcohol exposure, epigenetic changes and their consequences. Alcohol Research: Current Reviews. 2013;35:37.
- Coriale G, et al. Fetal alcohol spectrum disorder (FASD): Neurobehavioral profile, indications for diagnosis and treatment. Rivista di psichiatria. 2013;48:359.
- Petrenko CL, et al. Prevention of secondary conditions in fetal alcohol spectrum disorders: Identification of systems-level barriers. Maternal and Child Health Journal. In press. Accessed March 6, 2014.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. March 17, 2014.
- Tervo RC (expert opinion). Mayo Clinic, Rochester, Minn. April 11, 2014.