Early Childhood Education

Fetal Alcohol Syndrome (FAS)

Fetal alcohol syndrome (FAS) is one of the main threats to child health. FAS is a set of birth defects associated with prenatal alcohol exposure. This is distinguished from fetal alcohol effect (FAE), which is a less severe manifestation of the same symptoms of FAS. The pertinent questions become the etiology and the relationship between alcohol exposure during pregnancy and birth outcome. In 1968, a French article published by Dr. Paul Lemoine reported on a study of 127 children born to alcoholic parents. These children showed anomalies such as peculiar facial features, psychomotor disturbances, and a high frequency of malformations. Lemoine believed that the similarities between the children’s features could help diagnose maternal alcoholism. However, it was not until five years later that the term “fetal alcohol syndrome” was coined; the credit was given to Dr. Kenneth Jones and Dr. David Smith discovering FAS since the French publication was not well known prior to the publication of their research in the United States (Armstrong, 2003).

There are four main criteria for medical diagnosis of FAS. The first of the criteria is confirmed maternal alcohol exposure. This is characterized by excessive intake of alcohol on a regular basis or episodically. Evidence of such actions can include frequent episodes of intoxication; legal problems related to drinking; development of tolerance or withdrawal from alcohol; social problems related to drinking; or alcohol-related medical problems such as hepatic disease. The second of the criteria is evidence of facial anomalies characteristic of FAS. This includes short palpebral fissures and facial anomalies in the premaxiallary zone such as flat upper lip, flattened philtrum, and flat midface. The newborn’s nose may be short and upturned with a low and broad bridge. The ears may be large, low-set, and rotated posteriorly. Anomalies of the eyes may also be characteristic of FAS (e.g., ptosis, strabismus, microphthalmia, and epicanthic folds). Also, the upper and lower jawbones can be underdeveloped. The third of the criteria is evidence of growth retardation. These growth retardations includes at least one of the following: low birth weight for gestational age, disproportionately low weight for height, or decelerating weight over time that is not due to malnutrition. The final criterion is evidence of central nervous system neurodevelopmental abnormalities. This includes at least one of the following: decreased cranial size at birth, structural brain abnormalities, or neurological hard or soft signs (Armstrong, 2003).

It may not be possible to determine at-risk levels of alcohol consumption since there are other factors that affect pregnancy outcomes. Factors such as genetic susceptibility, pattern of exposure, time of embryo/fetal exposure, and type of alcohol can all affect the outcomes. Environmental and biological factors can work together to produce the effects of FAS on the newborn, which can start while in utero. In utero exposure to alcohol can produce fetal central nervous system depression, bone cell anomalies, as well as symptoms of fetal asphyxia such as decreased blood oxygen content and breathing activity; acidosis; and flattening of EEG activity. In some instances, the alcohol exposure can lead to death (Abel, 1984).

There are several risk factors that contribute to the occurrence of FAS. The pattern of alcohol consumption can affect FAS occurrence. Differences in the susceptibility to alcohol have been proposed for higher incidences of FAS. Poverty can be another major factor that contributes to FAS. Poverty can lead to adverse conditions such as poor maternal nutrition and health and increased stress (e.g., unemployment, martial instability, decreased access to prenatal care), which can interact with alcohol to produce negative pregnancy outcomes. Aside from environmental factors, biological factors such as cellular processing of alcohol can also increase risk in producing a child with FAS (Abel and Hannigan, 1996).

It has been estimated that 2,000-12,000 children are born with FAS every year in the United States. The Center for Disease Control and Prevention has identified rates ranging from nine cases per 10,000 births among whites to six cases per 10,000 births among blacks to 29 9 cases per 10,000 births among American Indians. The range varies because there is no biological marker to diagnose FAS. Facial abnormalities, which are the most distinctive markers of FAS, may change with age, become less noticeable, and some may be harder to distinguish due to racial phenotypes (Armstrong, 2003).

Children, families, and educators can be challenged by the effects of FAS on behavioral, psychological, and cognitive processing due to abnormalities in the brain and central nervous system. Central nervous system problems can include hyperactivity, diminished intelligence (average IQ of 70, with a range from 45 to 110), learning disabilities, inappropriate social behaviors, delays in speech and language, impaired hearing, poor eating (leading to failure to thrive) and sleeping patterns, longer reaction time, and delayed developmental milestones. These various problems can be addressed through support systems in place by parents, medical professionals, and early intervention. Interventions can address environmental issues that may complicate matters such as organizing living environments to reduce clutter, which can relax the child. Building consistent daily routines for a child with FAS can also provide alleviations of behavioral problems. Careful, repetitive teaching of appropriate behaviors and clear, immediate rewards can also provide the child with FAS structure to learn appropriate social skills. In order to address learning issues, it may be necessary for parents to collaborate with educators to plan lessons and activities that utilize all the senses for learning (Morse and Weiner, 1996).

Prevention may need to take place on the level of the federal and state governments. The government may step in to regulate the availability of alcohol and educate the consumers of the dangers of drinking while pregnant. States may also need to take responsibility in informing the public of the dangers of drinking while pregnant. The first step to change in the United States came in 1988 in which alcoholic beverages were required to carry health-warning labels of the dangers of drinking while pregnant. Evaluation of the information and education campaigns must also take place to understand the impact of the campaigns of raising awareness of the possible dangers and whether the information had an impact on drinking practices during pregnancy.

Apart from educational campaigns, benefits can be observed from initiating counseling for pregnant women on the effects of alcohol use on the unborn child and the repercussions after the child is born. Dr. Henry L. Rosett initiated the first program of this type at Boston City Hospital in 1974. Women who attended the prenatal clinic were interviewed during their first visit to record diet, smoking, and alcohol/drug habits. Those classified as heavy drinkers were then encouraged to return to the clinic for counseling. The counseling approached the women to stress the positive side of abstaining or decreasing alcohol consumption rather than emphasizing the negative effects. As seen, it is necessary to focus prevention and intervention on the level of the family, environment, and community in order to improve recovery and abstinence (Rosett et al., 1978).

Legal issues arise in cases that surround the issue of FAS. One legal issue surrounds the idea of exposing the fetus to alcohol as a type of child abuse and neglect. The question arises around the issue of maternal rights in comparison to fetal rights. Questions also arise in the obligations of the obstetricians who treat pregnant patients with potential alcohol problems. Is an obstetrician obligated to advise pregnant women not to drink if he suspects alcoholism? Can the doctor be charged with negligence if he fails to warn his patient? During such difficult legal circumstances, the court may become arbiters in deciding the extent and quality of prenatal care.

Many children with FAS require early intervention and special education services. Children with FAS have various needs that must be met: learning disabilities, emotional problems, behavioral issues, or multiple conditions. Assessments may be needed in speech and language, occupational therapy, and cognitive functioning to measure a child’s strengths and deficits. Children with the condition may have various educational issues such as hyperactivity, distractibility, poor memory, decreased cognitive abilities, and poor social skills. Up to the age of 3, early intervention services can be used by families of children with FAS. The staff works with the families to create an Individualized Family Services Plan (IFSP) to describe the child’s needs and the services the child and family will receive in order to address those needs. Once a child becomes school-aged, educational staff works with families to develop an Individualized Education Program (IEP) to meet the individual needs of the child with FAS. The curriculum should include hands-on learning, multiple modes of learning, flexibility of scheduling, and consistency in teaching to promote sensory development and social and life skills development in addition to meeting academic goals agreed upon by the teacher and family.

Further Readings: Abel, E. L. (1984). Fetal alcohol syndrome and fetal alcohol effects. New York: Plenum Press; Abel, E. L., and J. H. Hannigan(1996). Risk factors and pathogenesis. In H. L. Spohr and H. C. Steinhausen, eds., Alcohol, pregnancy and the developing child. New York: Cambridge University Press, pp. 63-75; Armstrong, E. M. (2003). Conceiving risk, bearing responsibility: Fetal alcohol syndrome & the diagnosis of moral disorder. Baltimore: The Johns Hopkins University Press; Morse, B. A., and L. Weiner (1996). Rehabilitation approaches for fetal alcohol syndrome. In H. L. Spohr and H. C. Steinhausen, eds. Alcohol, pregnancy and the developing child. New York: Cambridge University Press, pp. 249-268; Rosett, H. L., E. M. Ouellette, L. Weiner, and E. Owens (1978). Therapy of heavy drinking during pregnancy. Obstetrics and Gynecology 51, 41-46.

Web Site: National Organization on Fetal Alcohol Syndrome (NOFAS), http://www. nofas.org/.

Sonia Susan Issac