What is fetal alcohol spectrum disorder (FASD)?

Fetal alcohol spectrum disorder (FASD) is the general term used to describe the range of adverse fetal effects associated with prenatal alcohol exposure. Fetal alcohol spectrum disorder includes recognized patterns of alcohol-related fetal effects, including abnormalities that are physical, mental, or behavioral (or a combination of those abnormalities), and learning disabilities. Fetal alcohol syndrome (FAS) is the effect that has the most explicit clinical diagnostic criteria, based on a specific constellation of physical, behavioral, and cognitive abnormalities.

How common is it?

Exact data are difficult to obtain, but Centers for Disease Control and Prevention studies identified 6 to 9 cases of FAS per 1,000 live births in the United States. As a group, FASD occurs at up to 5% of US births, correlated by women reporting continued use of alcohol during pregnancy. The FASD diagnosis remains among the most commonly identified causes of developmental delay, intellectual disability, and school function difficulties, but it is also regarded as vastly under-recognized.

What are some characteristics of children who have FASD or of FASD as children present with it?

• How prenatal exposure to alcohol affects growing fetuses varies greatly. The amount, timing, and repetition of alcohol exposure, as well as the susceptibility of the fetus, can contribute to the variability of the findings. Some children are more severely affected than others, and each one is affected in different ways. Some common findings include
  • Characteristic growth issues, such as a small head, a small body size, and smaller measurements of certain facial features
  • A higher chance of attention difficulties, hyperactivity, and learning problems
  • Difficulty understanding, remembering, solving problems, or following directions
  • Difficulty communicating with others
  • Difficulty controlling emotions, impulses, and behavior
  • Trouble learning self-care activities

Who might be on the treatment team?

The diversity of FASD manifestations calls for tailoring treatment to meet individual and family needs and to address possible lifelong disabilities, across the life span. Some common team members interacting with the pediatrician/primary care provider in the medical home include

• Genetics, neurology, neuropsychological, and developmental service providers
• Early intervention service providers, specifically physical, occupational, and speech-language therapists
• Home-visiting, social work, and community support service providers
• Behavioral therapists
• Educational specialists

What adaptations may be needed?

Dietary Considerations

Special feeding techniques might help infants with FASD who are growing slowly.

Physical Environment and Other Considerations

• Infants with FASD may be irritable and not tolerate stimulation well. A quiet, soothing atmosphere might be beneficial.
• Children with FASD may benefit from structure and positive reinforcement. Use simple, straightforward instructions and repeat them as often as necessary.

What should be considered an emergency?

No medical emergencies are associated with FASD.

What are some related Quick Reference Sheets?

Autism Spectrum Disorder (ASD)

What are some resources?

• American Academy of Pediatrics: www.healthychildren.org, www.aap.org
  • “Fetal Alcohol Spectrum Disorders,” www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders.aspx
  • Williams JF, Smith VC, American Academy of Pediatrics Committee on Substance Abuse. Fetal alcohol spectrum disorders. Pediatrics. 2015;136(5):e1395
• Centers for Disease Control and Prevention: www.cdc.gov, 1-800-CDC-INFO (1-800-232-4636)
  • “Fetal Alcohol Spectrum Disorders (FASDs),” www.cdc.gov/ncbddd/fasd
  • “Fetal Alcohol Spectrum Disorders (FASDs) Data and Statistics,” www.cdc.gov/ncbddd/fasd/data.html
  • “Fetal Alcohol Spectrum Disorders: Regional Training Centers,” www.cdc.gov/ncbddd/fasd/documents/flyerfasd_rtcs.pdf
• National Organization on Fetal Alcohol Syndrome: www.nofas.org, 1-800-66-NOFAS (1-800-666-6327)
• Medline Plus: “Fetal Alcohol Spectrum Disorders,” www.nlm.nih.gov/medlineplus/fetalalcoholspectrumdisorders.html

Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.

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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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