Fetal alcohol syndrome (FAS) is a collection of birth defects that occur when a fetus is exposed to alcohol. These range from learning and behavioral difficulties to mental retardation. Death of the fetus is the most extreme outcome. 

A woman who drinks at any point during pregnancy puts the fetus at risk of FAS. Generally, the more alcohol consumed during pregnancy, the greater the risk of FAS and the more severe the symptoms. However, exactly how much alcohol causes defects is not known, and appears to vary from person to person and from pregnancy to pregnancy. 

About 1,200 children are born with FAS every year, according to the American Academy of Family Physicians. The U.S. Department of Health and Human Services estimates that 40,000 are born with some signs of prenatal exposure to alcohol.

FAS is not diagnosed until after a child is born. A medical history may include questions about a mother’s alcohol intake during pregnancy. A physical examination may be conducted to determine the extent of deficiencies, as well as to rule out other potential causes of a child’s symptoms.

Children with FAS will have certain distinctive facial abnormalities, physical growth deficiency (e.g., height and/or weight) as well as central nervous system problems. Children who exhibit some but not all signs required for a diagnosis of FAS may have another type of fetal alcohol spectrum disorder (FASD). FASD is a term used to describe the range of detrimental effects that can occur in an individual whose mother drank alcohol during the pregnancy. It is not intended for use as a clinical diagnosis. 

There is no cure for FAS. Most treatment focuses on addressing the special education or medical needs of children with FAS. However, the physical, mental or behavioral defects in children with FAS are lifelong, irreversible problems. Parents of children with FAS can seek out emotional or respite services that may be available in their communities. They may also help their child by providing a nurturing and supportive home environment.

FAS is completely preventable. Women who are pregnant (or may become pregnant) should eliminate all alcohol consumption for the duration of pregnancy. Abstinence is the only proven method to prevent birth defects as the result of fetal alcohol exposure. Prior to 1973, when FAS was recognized by the scientific community in the United States, women may have been advised that low levels of alcohol during pregnancy were safe. However, it is now understood that no amount of alcohol is safe during pregnancy.

Fetal alcohol syndrome (FAS) is a pattern of permanent physical, mental and behavioral abnormalities that can occur as the result of fetal exposure to alcohol. The damage of FAS is done while a fetus is still developing inside the uterus – when a woman consumes alcohol while pregnant. Alcohol consumed at any time during the course of a pregnancy can affect a fetus.

Within a week of conception, an embryo (fertilized egg at the early stages of development) attaches to the uterine wall, through which it will receive nutrients from the woman’s bloodstream. If there is alcohol in the woman’s bloodstream, it passes through the placenta (protective tissue) and into the fetus’ blood via its umbilical cord.

The first trimester (12 weeks) of pregnancy is a critical period of development. Early on, embryo cells multiply and begin to assume different, specific functions – a stage called differentiation – creating blood cells, kidney cells, nerve cells and more. This is a key developmental stage for facial features, heart and other organs, bones and the central nervous system (CNS). Exposure to alcohol at this stage can be particularly damaging to a fetus. Because the brain continues to develop throughout pregnancy, it may be harmed by exposure to alcohol at any time during the pregnancy.

Exactly how alcohol causes damage to the developing fetus is not clear. Tissue exposed to alcohol may fail to develop normally, may not develop in the appropriate location or may die – all of which can lead to the structural and functional birth defects of FAS. Which organs or systems are affected will depend on the fetal development taking place when alcohol exposure occurs.   

Not all fetuses exposed to alcohol develop birth defects. Heavy drinkers may produce healthy infants, and light to moderate drinkers can give birth to babies with FAS. The amount of alcohol that causes damage is unclear – and appears to vary from person to person. It can depend on the amount consumed, the regularity of consumption, as well as when during the course of a pregnancy alcohol consumption occurs. Women who are pregnant do not need to be heavy drinkers, or drink every day, to cause fetal damage.

FAS is a lifelong condition. Children with FAS display distinctive facial features, physical growth deficiencies and CNS problems. CNS abnormalities can range from mild learning disabilities to severe mental retardation. Mental retardation due to fetal alcohol exposure occurs more often than any other known cause (e.g., Down syndrome, spina bifida or muscular dystrophy).

FAS can lead to additional problems as children get older. These include:

• Incomplete education (e.g., as the result of suspension, expulsion, dropping out)
  
  
• Arrest, imprisonment
  
  
• Mental health disorders (e.g., attention deficit hyperactivity disorder, conduct disorder, depression)
  
  
• Substance abuse
  
  
• Inappropriate sexual behavior (e.g., inappropriate advances, touching)
  
  
• Unemployment
  
  
• Inability to live independently

The U.S. Department of Health and Human Services (Substance Abuse and Mental Health Services Association) estimates that 40,000 babies are born every year in the United States with some signs of prenatal exposure to alcohol.

Approximately 1,200 children are born with full-blown FAS, according to the American Academy of Family Physicians. The exact number of children considered to have FAS may vary because the syndrome is not consistently identified.

Fetal alcohol spectrum disorders (FASD) is the term used to describe the entire range of effects that can occur due to alcohol consumption during pregnancy. FASD disabilities range from mild to moderate to severe.

The types of FASD include:

• Fetal alcohol syndrome (FAS). Characterized by distinctive facial features, physical growth deficiencies and central nervous system (CNS) problems. Next to death, FAS is the most severe collection of abnormalities that can occur as the result of alcohol consumption during pregnancy.
  
  
• Alcohol-related neurodevelopmental disorder (ARND). Involves CNS deficiencies. This may include impairment of motor skills (e.g., poor hand-eye coordination) and cognitive abilities (e.g., learning disabilities, difficulties with memory, attention and judgment). Children with ARND are likely to display behavioral problems (e.g., poor school performance, impulsivity) as a result of these impairments. ARND does not include the facial abnormalities and physical growth deficiencies typically associated with FAS.
  
  
• Alcohol-related birth defects (ARBD). Structural or functional defects of the body that occur as the result of fetal alcohol exposure. Children with ARBD may have problems with the heart, kidneys, bones, hearing, vision or a combination thereof. ARBD does not include the facial abnormalities, physical growth deficiencies or CNS problems typically associated with FAS.
  
  
• Partial fetal alcohol syndrome (PFAS). Children who have some but not all signs of FAS. PFAS includes signs of facial abnormality, growth deficiency and CNS or cognitive impairment. PFAS is sometimes referred to as atypical FAS.  

Another term, fetal alcohol effects (FAE), was previously used to describe signs of fetal alcohol exposure that were usually less severe and less noticeable than FAS signs. In 1996, the National Academy of Sciences (Institute of Medicine) recommended that FAE be replaced with the more specific ARND and ARBD designations.

Certain signs of fetal alcohol syndrome (FAS) may be difficult to determine at birth. Some FAS facial abnormalities (e.g., a small, upturned nose) may be difficult to distinguish from normal facial features. Also, some signs are not noticeable until a child gets older (e.g., impaired motor skills, learning difficulties).

Parents who believe their infant may have been exposed to alcohol during pregnancy should consult their pediatrician. Signs that an infant may have FAS or another type of fetal alcohol spectrum disorder include:

• Small head circumference
• Low birthweight
• Slow development
• Poor sucking
• Poor sleep-wake cycles
• Sensitivity to light, noises and touch
• Extreme irritability or fussiness
• Dysfunction of the eustachian tubes in the ear

Signs of fetal alcohol syndrome (FAS) may appear as specific types of problems at different times throughout a child’s life. Parents who suspect their child has FAS should contact their pediatrician. Early diagnosis can help reduce long-term difficulties children with FAS may face.

Signs of FAS (or another fetal alcohol spectrum disorder) that may be noticeable in early childhood include:

• Poor memory capability
  
  
• Hyperactivity (e.g., being easily distracted)
  
  
• Lack of fear (e.g., does not recognize signs of danger)
  
  
• No sense of boundaries (e.g., may appear much too friendly with strangers)
  
  
• Naivety (e.g., too trusting, difficulty understanding the motives of others)
  
  
• Need for excessive physical contact

Signs of fetal alcohol exposure that may be noticeable in middle childhood include:

• Short attention span
  
  
• Motor skill problems (e.g., poor hand-eye coordination)
  
  
• Difficulty reading
  
  
• Falling behind in schoolwork
  
  
• Behavior problems (e.g., temper tantrums, defiance, lying, stealing)
  
  
• Social difficulties (e.g., immaturity, over friendliness, difficulty with life skills and changes in routine)
  
  
• Low self-esteem (as a result of recognizing they are different from their peers)

Signs of fetal alcohol exposure – such as impulsivity, learning disabilities or learning difficulties, and naivety – often lead to additional problems as children get older. Adolescents with fetal alcohol syndrome (FAS) have high rates of being suspended, being expelled and dropping out of high school. Teens with FAS may have difficulty controlling anger and frustration, or they may be easily manipulated into criminal behavior. They have high rates of arrest and incarceration. They are at a high risk of developing mental health disorders, including substance abuse. Teenagers born to women who consume alcohol during their pregnancy also are at increased risk of developing drinking problems by the time they are 21 years old, a new study finds. Many with FAS will be unable to live independently.

Parents may find it extremely difficult to provide adequate care for their adolescent with FAS. Parents should contact their physician or available community resources for information and support. For more information, see Treatment options for fetal alcohol syndrome.

The signs of fetal alcohol syndrome (FAS) can range from mild to severe, depending on the level of exposure to alcohol. Generally, the more alcohol a woman consumes during pregnancy, the greater the risk of FAS and the more severe the signs in a child.

FAS results in a range of physical, mental and behavioral disabilities, which are present at birth. Some signs are easily identifiable, but others may not become apparent until a child is older.   

Signs associated with physical growth deficiencies as a result of FAS include:

• Low birthweight
• Decreased length
• Failure to thrive

Distinctive facial features are characteristic of children with FAS. These facial features may also be noticed in children unaffected by FAS. These signs include:

• Smooth philtrum (underdeveloped vertical groove between the nose and upper lip)
• Significantly thin upper lip
• Small eye openings
• Flattened cheekbones
• Small lower jaw
• Short, upturned nose

Signs of structural damage due to central nervous system (CNS) abnormalities include:

• Small head circumference at birth
• Underdeveloped brain
• Diminished muscle tone

Signs of functional damage due to CNS abnormalities include:

• Impaired motor skills (e.g., poor eye-hand coordination, difficulty tying shoes)
• Lack of imagination or curiosity
• Poor reasoning and judgment skills
• Decreased IQ
• Speech and language difficulty
• Learning difficulties (e.g., memory, problem solving, learning disabilities)
• Mental retardation

The learning difficulties of FAS may center on a child’s inability to generalize, make inferences, and understand causes and effects. For example, a child with FAS may be told not to play in the street near home – but may fail to understand this could also mean not to play in the street near school, too. Children with FAS may not understand similarities or differences between items, and have difficulty sorting or classifying objects.

Signs of behavioral problems associated with FAS include:

• Hyperactivity
• Difficulty concentrating
• Impulsiveness
• Anxiety
• Difficulty relating to others
• Lack of age-appropriate communication skills
• Social withdrawal
• Teasing and bullying behavior

Birth defects that can occur as a result of fetal alcohol exposure include:

• Heart defects
• Joint, limb and finger abnormalities
• Organ dysfunction (e.g., lung, kidney)
• Hearing problems and vision problems
• Cleft palate

Fetal alcohol syndrome (FAS) cannot be diagnosed before birth. During pregnancy, signs of prenatal growth deficiency may be identified with an ultrasound, and prenatal cardiac problems may be identified with an echocardiogram (device using sound waves to create a moving image of the heart).

Parents who believe their child has FAS should contact their physician. Early diagnosis may help reduce long-term difficulties a child may face due to FAS (e.g., difficulty in school, problems with the law, substance abuse). A physician can identify special schools or community services that may help parents of children with FAS.

Parental concerns about FAS should be brought to the physician’s attention. A physician may take a detailed medical history to identify all potential health risks to the child. This may include questions about the mother’s alcohol consumption during pregnancy.

A physical examination of the child will be performed, including a search for signs of FAS. A physician may attempt to identify the extent of any deficiencies. This may include vision tests and hearing tests, as well as ultrasound examination of the heart and kidneys. Children suspected of having FAS may also undergo various tests to analyze intelligence and language capabilities. A mental health evaluation may also be performed to identify signs of mental health disorders (e.g., depression, anxiety, panic attacks, mood instability) that may accompany FAS.

In addition, a physician may attempt to rule out other potential causes for a child’s defects or deficiencies. A genetics specialist may be recommended to determine whether a hereditary condition exists that may explain a child’s symptoms.

To diagnose FAS, a physician must document:

• Presence of at least the following facial abnormalities:
  
  
• • Smooth philtrum (underdeveloped vertical groove between the nose and upper lip)
    
  • Significantly thin upper lip
    
  • Small eye openings
    
    
• Prenatal or postnatal height or weight deficiency
  
  
• Central nervous system abnormality that includes:
  
  
• • Structural defects (e.g., small head circumference); and
    
  • Neurologic defects (e.g., seizures, motor control difficulty); or
    
  • Functional defects (e.g., decreased IQ, delayed development)

Children who do not exhibit all signs necessary for a diagnosis of FAS may be identified as having another type of fetal alcohol spectrum disorder. However, because these usually do not include the distinctive physical features of FAS, they may go undiagnosed or misdiagnosed.

There is no cure for fetal alcohol syndrome (FAS). The physical, mental and behavioral defects caused by FAS are irreversible and last a lifetime.

Early diagnosis and treatment of FAS may focus on accommodating a child’s special needs. For example, children may be able to better deal with their learning disabilities or difficulties through special education programs. Children with mental retardation as a result of FAS may require long-term home or residential care. Eyeglasses or hearing aids may be necessary for children with vision difficulties or hearing problems. Counseling, advocacy and vocational training are sometimes used to reduce the likelihood of additional problems associated with FAS (e.g., mental health disorders, unemployment, legal problems). Medications are sometimes used to treat certain emotional or behavioral effects of FAS, such as hyperactivity, impulsive behavior or sleep disorders. Surgery may be required for heart defects.

Parents of children with FAS are encouraged to become familiar with resources available in the community, including family support groups. This may provide information about their child’s condition as well as emotional support.

The most important care a parent can provide a child with FAS is a stable, nurturing home environment. Children with FAS should be taught living skills in a supportive environment where acceptable behavior is rewarded. This can help children with FAS avoid complications later in life (e.g., dropping out of school, substance abuse, problems with the law). In addition, children with FAS may be unusually naive – parents may need to protect their child from those who might take advantage of them.

Additional tips for parents of children with FAS include:

• Maintain consistent daily routines.
• Keep rules simple.
• Limit stimulation.
• Use specific language and real-life (nonabstract) examples.
• Provide multisensory (visual, auditory and touch) learning opportunities.
• Keep expectations realistic.
• Provide supervision.

Fetal alcohol syndrome (FAS) is prevented by avoiding alcohol during pregnancy. The exact amount of alcohol necessary to cause FAS is not known. The only guaranteed way to prevent birth defects as the result of alcohol exposure is to abstain from all alcohol for the duration of the pregnancy.

Despite a number of prevention efforts, including point-of-sale warning signs and bottle labeling, more than half the women of childbearing age (between 15 and 44 years) consume alcohol. Over 12 percent of women who are not using birth control and are at risk of becoming pregnant are drinking alcohol at levels that exceed seven drinks per week or four or more drinks per occasion, according to the National Institutes of Health. Many women who are pregnant continue to drink alcohol. Surveillance data indicate that 10 percent of pregnant women drink some alcohol and 2 percent are binge drinking.

In addition, many pregnancies are unplanned. Many women may not realize they are pregnant – especially during the first three to six weeks of pregnancy. Thus, any sexually active woman who is not taking measures to prevent pregnancy should avoid the use of alcohol to prevent FAS.

Pregnant women who are unable to stop drinking should contact their physician for help.

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to fetal alcohol syndrome (FAS) may be helpful:

1. I drank alcohol before I realized I was pregnant. What are the chances my baby will have FAS or a fetal alcohol spectrum disorder?
   
   
2. What should I know about the difference between FAS and fetal alcohol spectrum disorders?
   
   
3. Can I safely drink any alcohol while pregnant?
   
   
4. What tests can you perform during my pregnancy that may indicate whether my developing fetus has FAS?
   
   
5. What tests can you perform once my baby is born that will identify FAS?
   
   
6. What specific signs of FAS should I look for in my infant?
   
   
7. What specific signs of FAS should I look for in my toddler?
   
   
8. What specific signs of FAS should I look for in older children?
   
   
9. My teenager is particularly difficult, and I drank during pregnancy. Could these problems be related to FAS?
   
   
10. Our child has FAS. How do we provide appropriate care? How will our child’s needs change throughout life?
    
    
11. What type of additional problems is our child with FAS at risk of developing? How can we help prevent those problems?
    
    
12. Do you know of any emotional or respite support available to parents of children with FAS?
    
    
13. I'm pregnant and unable to stop drinking. What can I do?