Fetal Alcohol Syndrome Fetal Alcohol Syndrome (FAS) is a condition affecting children born to women who drink heavily during pregnancy. There are three criteria used to describe the effects of prenatal alcohol exposure and to make a diagnosis of FAS. The first of these is a pattern of facial anomalies, these features include: ? Small eye openings ? Flat cheekbones ? Flattened groove between nose and upper lip ? Thin upper lip These characteristics can gradually diminish as the child ages, but it is important to note that diagnosis does not change because of this. The second criteria is growth deficiencies: ? Low birth weight ? Decelerating weight over time, not due to malnutrition ? Disproportional low weight to height ? Height and weight below the tenth percentile The third criteria used to diagnosis FAS are brain injury. This includes: ? Decreased head size ? Behavioral and/or cognitive problems such as: mental handicap; learning difficulties; problems with memory; problems with social perception ? Neurological problems (impaired motor skills, poor coordination, hearing loss) A person diagnosed with FAS may show one or more characteristics listed above, and there is a great variability in the outcome.
( McCreight, 1997) Partial FAS is the recommended term used to describe the cluster of problems facing those who have some of the characteristic facial abnormalities associated with FAS, and one other component of FAS such as: growth deficiency; behavioral and cognitive problems or brain injury. This is only of course if it is known that there was significant prenatal exposure to alcohol. (Abel, 1984) Fetal Alcohol Effects (FAE) a term no longer used, refers to the cognitive and behavioral problems that may affect those with Partial FAS. FAE has often been used indiscriminately to label individuals with these problems, whether it not it was known they had been exposed to alcohol in the uterus. It is now recommended that the term FAE no longer be used, instead the more specific terms Partial FAS (PFAS) be used when applicable.
( Blume, 1996) Neonatal Abstinence Syndrome NAS describes the presence of withdrawal symptoms in infants exposed to one or more drugs during pregnancy. These drugs may include: alcohol, narcotics, sedatives, anti-convulsants and others. Some of the symptoms of NAS include wakefulness, irritability, diarrhea, vomiting, respiratory distress and lack of sucking. (Abel, 1966) Alcohol-related birth defects that may be present to those born with FAS can easily be identified because of the cluster of characteristic features involving facial appearance, growth and brain damage. Children born to mothers that drink heavily in pregnancy may also have serious congenital birth defects such as : ? Heart defects; ? Kidney and other internal organ problems; ? Skeleton abnormalities; ? Cleft palate and other facial abnormalities; ? Vision and hearing problems.
These are known as alcohol-related birth defects (ARBD). The range of these birth defects is likely due to such factors as: 1. variations in the timing of alcohol use; 2. variations in the amount of alcohol used; 3. use of one or more substance that can cause birth defects; 4.
and many other individual and genetic factors. ( Villarreal, 1992.) It is not known how much alcohol a woman can safely drink. However, it is known that the more alcohol a pregnant woman consumes, the greater the range and severity of problems to the developing fetus. Drinking alcohol regularly, or daily during pregnancy is considered to be of high risk. Drinking alcohol to the point of intoxication on an occasion is also a risk. There is no “safe” time period during pregnancy to consume alcohol.
There are critical periods during pregnancy for the development and growth of all body systems. Different FAS features may be linked with the period in which alcohol is heavily consumed. This underlines the benefits of stopping or reducing alcohol use at any one point possible during pregnancy. (Davis, 1984) Other factors such as malnutrition, smoking, and the use of other drugs increase the risk of FAS. The mothers overall health, age and exposure to environmental toxins such as lead, mercury, and stressful life events associated with poverty and including physical abuse may also increase the risk of FAS. It is not known how much of a contributor these other factors make, but addressing these related health issues may have a significant bearing on the prevention of FAS.
(Kleinfeld, 1993) The risk of FAS is higher for those who already have a child affected with FAS. It is also higher when the mother has a long history of alcohol misuse and has not accessed routine health and prenatal care. A range of resiliency factory also influences the risk of having a child affected by FAS. There is some indication that men’s use of alcohol and other drugs can affect the viability of sperm. It is also clear that men’s drinking can have an impact on that of their partners.
Thus, fathers play an important role in encouraging and supporting their partners to reduce their alcohol and other drug use, both before and during pregnancy. (Blume, 1992) Estimates of incidence for full FAS range from one in 500 births to one in 3,000 births, with the rate for other alcohol related effects estimated at five to ten times higher. Prevalence of FAS and other alcohol related effects in high-risk populations such as First Nation communities may be as high as one in five. ( Streissguth, 1998) FAS is the leading known cause of mental handicap in children, even greater than Down’s Syndrome or spina bifida. FAS is also the leading cause of preventable birth defects in developed countries.
The human cost for each child born with FAS are high. ? To both birth parents and foster parents, an FAS child may prove to be very challenging and special programs may not be available. ? Many of those affected by FAS may require foster home and/or group home placement over the course of their life lives. ? Many youth and adults affected by FAS come in contact with the corrections system ? Those affected by FAS have learning disabilities and behavioral problems that often require extensive and specialized help Diagnosis of FAS is difficult for many reasons. There are no standard tests to detect FAS and the range of characteristics is diverse. Many of the characteristics are not only distinctive of FAS, but other disorders as well.
Symptoms vary widely in severity among FAS-affected individual and may change with age. In infancy, central nervous system impairments and facial abnormalities due to FAS may be difficult to identify. (McCreight, 1997) Diagnosis involves the disciplinary work-up, including assessment of language, motor coordination, growth and development patterns, craniofacial features, as well as a psychological assessment and identification of the mother’s alcohol and drug use. Assessment of vision, hearing and dental problems can assist in planning an intervention program. Assessment of the child’s strength, special interest, and abilities should also be included.
( Abel, 1996 ) Without identification or diagnosis, parenting a child with FAS is like trying to find your way around Saskatoon with a map of Prince Albert. An early diagnosis can support parents in: ? Understanding the child’s needs and challenges an in establishing realistic expectations; ? Taking care of themselves- respite care, support groups; ? Ensuring careful monitoring of the child health issues as they develop; ? Validating the experience of the person affected with FAS and supporting his/her self awareness and growth; ? Supporting the establishment of realistic expectation and goals for each child by educators; ? Supporting a respectful interaction between parents and teachers and health professionals. All of these benefits of diagnosis and early intervention can prevent or lessen the impact of “secondary disabilities” such as mental health problems, alcohol and other drug problems, school problems, etc. When used positively, a diagnosis can validate and individual problems and support the intervention needed to maximize his/her abilities. It can also lead to identifying and supporting women at risk to prevent FAS and other alcohol related effects in future children.
( Davis, 1994) Without understanding the impact of FAS, it is easy to think the affected person is being “difficult” rather than being “unable to process and remember” information. It is also important to note that those affected by FAS are all different, and may show some or all of these characteristics in varying degrees: ? Easily distracted by sounds or movement; ? Impulsive; ? Hyperactive; ? Short attention span and poor concentration; ? Trouble with expressing feelings to others; ? Problems adapting to normal stresses of day-to-day living; ? Difficulty incorporating change in routine; ? Limitations in ability to generalize. These characteristics can also make those affected by FAS prone to “secondary disabilities” such as having trouble with the law, problems with employment and housing, mental health and alcohol and drug problems. While it is easy to focus on only the difficulties, individuals with FAS also exhibit positive characteristics such as being happy, friendly, spontaneous, trusting, loving, determined, caring, helpful, affectionate, creative, and artistic. Some people with FAS are mentally retarded and some are not. People with FAS can have normal or above average intelligence.
While there is injury to the brain, each affected person will have specific area strength and weaknesses. (Davis, 1994) Brain injury can lead to behavioral problems because people with brain injuries do not process information in the same way that other people do. Children with brain injuries are challenging to raise, and their parents need help and support–not criticism FAS lasts a lifetime, even though the manifestations and types of problems can change with age. Knowing this, a person can never give up on a child with FAS. Instead, they need to understand the needs of those affected with FAS and learn how to help them. Many people view children affected with FAS as being unmotivated, but the explanation lies in memory problems, and the inability to solve problems effectively, or simply a state of being overwhelmed.
To deal with these and other problems it is important that a variety of agencies be involved in the intervention is lieu of a single agency. Research is needed on all aspects of FAS – epidemiology prevention, early intervention and treatment. (Blume, 1992) FAS is related to use of alcohol during pregnancy, not to race or ethnicity. The levels and cultural values related to drinking vary across First Nation communities and thus the prevalence of FAS varies as well. Whether we choose to acknowledge it or not, alcohol plays a strong role in the lives of many First Nations people. FAS may be 100 percent preventable, but alcohol is so much a part of our culture that proactive prevention activities must continue.
A drinking problem is never easy to stop and quite often a pregnancy does not make it any easier for the struggling alcoholic to cease drinking while pregnant. These women need support, respect, understanding and caring assistance. Alcohol and drugs are available everywhere in our society, even in supposed protective environments. Instead of imposing solutions on a woman, it is important to support her as she works toward a chosen and suitable change for herself and her children. Medicine.