It is estimated that 1 in 3,000 children are problematically exposed to alcohol antenatally (in Western countries). Prenatal exposure to alcohol can cause a spectrum of disorders. One of the most severe effects of drinking during pregnancy is foetal alcohol syndrome (FAS). FAS is the most common reason for disability and retardation in the unborn child and one of the leading known preventable causes of learning difficulties, developmental delay and birth defects in children.

It was originally thought that malnutrition might be responsible for these defects. However, the pattern of malformation associated with FAS is not seen in children born to malnourished women, and alcohol has been found to be acutely toxic to the foetus independently of the effects of malnutrition. There is no scientific proof as to the level of alcohol that would need to be consumed for fetal alcohol syndrome to be a potential problem for the foetus, but most health and social care experts suggest that women should not drink at all during pregnancy. Weeks 10-20 of the pregnancy are believed to be a particularly high risk period for the mother-to-be.

FAS is characterized by

1. abnormal facial features,
2. growth deficiencies, and
3. central nervous system (CNS) problems.

People with FAS may have problems with learning, memory, attention span, communication, vision, and/or hearing. These problems often lead to difficulties in school and problems getting along with others. FAS is a permanent condition. It affects every aspect of an individual's life and the lives of his or her family.

Foetal Alcohol Effects

FAS is the severe end of a spectrum of effects that can occur when a woman drinks excessively during pregnancy. Many women who drink excessively during childbirth do not produce babies with full-blown FAS, but these babies may still have a recognisable alcohol related birth defect.

Many terms have been used to describe children who have some, but not all, of the clinical signs of FAS. Three terms are fetal alcohol effects (FAE), alcohol-related neuro-developmental disorder (ARND), and alcohol-related birth defects (ARBD).

• FAE has been used to describe children who have all of the diagnostic features of FAS, but at mild or less severe levels.
• Those with ARND may have functional or mental problems linked to prenatal alcohol exposure. These include behavioural and/or cognitive abnormalities. Examples are learning difficulties, poor school performance, and poor impulse control. They may have difficulties with mathematical skills, memory, attention, and/or judgment.
• Those with ARBD may have problems with the heart, kidneys, bones, and/or hearing.

The full syndrome has been found in babies born to mothers who drink four to five drinks a day, or who go on binges of extreme alcohol consumption. But, this is just the tip of the iceberg. Some babies are born with defects when the mother consumes much less than four or five drinks a day.

What signs are there of FAS, FAE or ARND?

Children with FAE or ARND may have some of the following characteristics or exhibit some of the following behaviours:

1. Small for gestational age or small in stature in relation to peers (especially weight and /or length below the 10th percentile);
2. Facial abnormalities such as small eye openings;
3. Poor coordination;
4. Hyperactive behaviour;
5. Learning disabilities;
6. Developmental disabilities (e.g., speech and language delays);
7. Learning difficulties or low IQ;
8. Problems with daily living;
9. Poor reasoning and judgment skills;
10. Sleep and sucking disturbances in infancy.

Children with FAS are at risk for psychiatric problems, criminal behaviour, unemployment, and incomplete education. These secondary conditions are problems that an individual is not born with, but might acquire as a result of FAS. These conditions can be very serious, yet there are protective factors that have been found to help individuals with these problems. For example, a child who is diagnosed early in life can be placed in appropriate educational classes and given access to social services that can help the child and his or her family.

Children with FAS who receive special education are more likely to achieve their developmental and educational potential. In addition, children with FAS need a loving, nurturing, and stable home life in order to avoid disruptions, transient lifestyles, or harmful relationships. Children with FAS who live in abusive or unstable households or become involved in youth violence are much more likely to develop secondary conditions than children with FAS who have not had such negative experiences.