Foetal Alcohol Spectrum Disorders (FASDs) and Children With Disabilities

Introduction

One of the causes of physical disabilities and learning disabilities in children is Foetal Alcohol Sydrome (FAS).  This is a pattern of disabilities  that can develop in a baby as it grows in the womb.  It happens because the pregnant mother drinks alcohol.   FAS is one of a group of conditions. The whole group is called foetal alcohol spectrum disorders (FASDs). Other conditions within this range are:

  • Alcohol-related birth defects (ARBDs)
  • Partial foetal alcohol syndrome (pFAS)
  • Alcohol-related neuro-developmental disorder (ARND)

Babies born with FAS have a set group of symptoms. These can include different shapes to their faces, restricted development and some mental difficulties. People with the other conditions in the spectrum may not have this exact match of problems. They have some of them, or other problems because of alcohol consumed before their birth.

A baby in the womb (foetus) gets all its nourishment from its mother’s bloodstream. Alcohol in the mother’s blood can pass through the placenta to the baby’s blood. So if a pregnant mother drinks alcohol, it passes through the baby too. Alcohol is a toxic substance, so it can poison the developing foetus. In the nine months in the womb, the baby develops and forms. Poisons in the blood can damage the baby. The damage depends on which part is developing at that time. The brain is continually forming, so it can be damaged at any stage of pregnancy. In the first three months the organs are developing. So, this is the time when the heart, eyes, and kidneys might be harmed. Later, when the foetus is growing fast, alcohol can slow this down.

FAS and FASD only occur in babies born to mothers who drink alcohol during pregnancy. It is not known exactly how much alcohol is safe in pregnancy but heavy drinking and binge drinking are more likely to cause damage to the baby.  Not every mother who drinks heavily in pregnancy has a baby with FAS.  So there seem to be other factors that make it more likely to happen. These may include genetics, mother’s general health and diet, stress, mother’s age and whether the mother smokes or not.

FAS is entirely preventable. Women should be advised that if they are pregnant or planning a pregnancy that they shouldn’t drink alcohol.  It is not known exactly how much alcohol it is safe to drink in pregnancy so it is safest not to drink any at all. However, there is no definite evidence that small amounts of alcohol cause harm. National Institute for Health and Care Excellence (NICE) guidelines in the UK advise that if you are pregnant, do not drink at all if possible.

In the UK nobody is sure exactly how common FAS is. This is because it is difficult to diagnose. Also, there is no system for reporting it. It is known, however, that FAS is one of the most common reasons for children to have mental or behavioural problems.

FAS has three classic groups of abnormality:

(a)  Differences in face shape including:

  • A small head.
  • The groove between the nose and lip is flattened.
  • A thin upper lip.
  • A flat bridge of the nose, which tends to be short and upturned.
  • Drooping eyelids (ptosis).
  • A ‘railroad track’ shape to the outer part of the ears.
  • Small eyes that are closer together.
  • Skin folds of the upper eyelids (epicanthic folds).

(b)  Developmental delay with small size and low weight, with children growing up to be shorter than average adults.

(c)   Mental and behavioural difficulties

These happen because alcohol damages the brain as it forms. They can include:

  • Lower-than-average IQ.
  • Hyperactivity.
  • Difficulty with paying attention.
  • Memory problems.
  • Difficulty with seeing the consequences of one’s own actions.
  • Poor judgement.
  • Impulsive behaviour and not being able to control impulses.
  • Poor problem-solving skills.
  • Difficulty understanding things like time, money, and maths.
  • Difficulty getting on with other people, immature behaviour, aggressive behaviour.
  • Speech and language delay.
  • Problems sucking and feeding in the newborn (and sometimes symptoms of alcohol withdrawal).

There may also be some of the other problems from the whole range of FASD. These include:

  • Poor hearing or vision.
  • Abnormalities of the valves of the heart.
  • Kidney problems or genital abnormalities.
  • Bone and joint problems.

There is no test for FAS. It can only be diagnosed by spotting the typical features. Also by suspecting or knowing the mother may have drunk alcohol during pregnancy. Tests might be done to check there is no other reason for the abnormalities.  Diagnosis can only be undertaken by a trained medical practitioner.   FAS may not be detected at birth but can become apparent later in life and carries lifelong implications.

There is no particular treatment. Babies with FAS and FASD will have the problems for the rest of their lives. However, if the condition is picked up early, they will suffer the effects less. They can be helped and understood.

There is no cure for FAS so babies born with it will be affected throughout their lives and may experience a wide range of difficulties in relation to education, socialising, and behavioural difficulties.   Getting the diagnosis of FAS right is good for the child. If it is known what is wrong with them, they can be helped. If the diagnosis is made early they can access special help. They will have fewer problems if they are in a loving and understanding family. All different agencies working with children and families, including health, social care, schools etc. can help children and adults with FAS.

Further Guidance

Further information and guidance on FAS can be found on the following websites:

The NSPCC has published a report All Babies Count: Spotlight on Drugs and Alcohol which includes research into FAS and is useful reading for practitioners.  Also, the All Party Parliamentary Group for FASD published a report in December 2015 on the picture of FASD in the UK and other related documents.

There are support groups with provide guidance, help and support to families affected by FAS.

 More information on the impact of alcohol and other substance misuse on children, young people and families, including information on agencies and organisations working with adults with alcohol abuse, can be found on the page Working with Families with Multiple Needs.

Community Care published an article on FASDs in September 2016September 2016.