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Fetal Alcohol Syndrome Fetal Alcohol Syndrome is an increasing problem in our world today. At least 5, 000 infants are born each year with FAS, or about one out of every 750 live births, which is an alarming number. In the United States there has been a significant increase in the rate of infants born with FAS form 1 per 10, 000 births in 1979 to 6. 7 per 10, 000 in 1993 (Chang, Wilkins-Haug, Berman, Goetz 1). In a report, Substance Abuse and the American Woman, sent out by the Center on Addiction and Substance Abuse, at least one of every five pregnant women uses alcohol and / or other drugs during pregnancy (http: / web).
Fetal Alcohol Syndrome (FAS) refers to a group of physical and mental birth defects that are the direct consequence of a womans consumption of alcohol during her pregnancy. It is a series of both mental and physical birth defects ranging from mental retardation, growth deficiencies, central nervous system dysfunction, craniofacial abnormalities and behavioral maladjustments. FAS is the leading known cause of mental retardation, above both Spina Bifida and Downs Syndrome according to the Journal of the American Medical Association in 1991 (web). There is a lack of knowledge and medical training concerning Fetal Alcohol Syndrome, which increases the occurrence and treatment of this terrible disease. There are many terrible effects of Fetal Alcohol Syndrome.
In the Institute of Medicines article, The Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment, they report that alcohol produces the most serious neuro behavioral effects in the fetus compared to other drugs such as cocaine, heroin, and marijuana (web). There is a wide range of effects and disorders that are a result of Fetal Alcohol Syndrome. Fetal Alcohol Syndrome causes physical, mental and emotional effects, which are irreversible. As stated before FAS is the leading cause of mental retardation.
There may be mild to severe growth retardation including decreased birthweight and head circumference in addition to continued growth retardation for height, weight and head circumference. Children with FAS fail to ever catch up in growth during the preschool years and have a tendency to remain thin even though there is adequate nutrition. These children often have anomalies and deformed facial features such as short palpebral fissures, flat mid face, thin upper lip, indistinct philtres, epicanthus folds, low nasal bridge, minor ear anomalies, micrognathia, strabismus, ptosis of the upper eyelid, narrow receding forehead, and a short upturned nose (Hess and Kenner 2). In broader terms the face of a FAS child includes a small head; a small maxilla which is the upper jaw; short, upturned nose; smooth philtres which is a groove in the upper lip; smooth and thin upper lip; and small slightly narrow eyes with noticeable epicanthus folds (web). In the American Journal of Public Health and article called Tobacco and alcohol use during pregnancy and risk of oral clefts, described a study conducted to examine the relationship between alcohol consumption during the first trimester of pregnancy and oral clefts (Lorente, Cordier, Goujard and Ayme 1). First of all during the 6 th through the 13 th weeks of pregnancy, the roof and upper front of the mouth are developed by fusion of soft tissue and bony processes.
Interruption or of this development may result in a group of disorders referred to as clefts. Proper eating and speech production relies on the normal development of the lip and hard and soft palates. Cleft lip and palates cause trouble with chewing, drinking, and swallowing behaviors and may require special attention. In the study the researchers found an increased risk of cleft palate associated with alcohol consumption during the first trimester (Lorente, Cordier, Goujard and Ayme 1).
Mental Retardation is also a severe and common effects of Fetal Alcohol syndrome including central nervous system (CNS) neurodevelopmental abnormalities and behavioral or cognitive disabilities. CNS abnormalities in FAS children may be defined as hyperactivity, fine and gross motor development delays, or incoordination, impaired language development, impulsivity, problems with memory, poor judgement, poor problem solving, learning problems, destructibility, seizures, and structural abnormalities of the brain or indications of the deficient brain growth. Many children with FAS do not have the ability to understand cause and effect relationships and long term consequences (Hess and Kenner 3). A few of the disorders a child with FAS may suffer from are Reactive Disorder, Attention Deficit Disorder, Autism, Tourettes Syndrome, Language Disorders, Sensory Development Disorder and Pervasive Development Disorder (web). Recently researchers have discovered how consumption of alcohol while pregnant damages the brain of the fetus, conveyed in this statement by a researcher, This is the first time weve had and understanding of the mechanism by which alcohol can damage the fetal brain. Its a mechanism that involves interfering in the basic transmitter systems in the brain, which literally drives the nerve cells to commit suicide (web).
The brain is most sensitive to the damage of alcohol during a period called synaptogenesis, when the brain is rapidly developing, which begins during the third trimester of pregnancy and continues throughout early childhood. Researchers have found that alcohol affects two brain chemicals, glutamate and GABA, which aid in communication between different parts of the brain. Alarmingly researchers found that just one episode of drunkenness during the third trimester is enough to damage the fetish brain (web). Other physical Defects include cardiac, skeletal, renal, ocular, auditory, dental, and immune anomalies and low birth weight. Ventricular septal defect and atrial septal defect are just two of the cardiac anomalies that may occur. Children with FAS may have auditory anomalies including hearing deficits, chronic ear infections that can last into adulthood, delayed auditory function, sensori neural hearing loss, intermittent conductive hearing loss, and central hearing loss.
Several visual disorders commonly linked to FAS include strabismus, optic nerve hypoplasia, and posterior haze of the cornea. TMJ and Malocclusion are two of the death-facial disorders in which a FAS child may suffer. FAS has also been discovered to effect the immune system, not much is known but there appears to be a link between alcohol exposure and the reduction of T-cells (web) Each child is affected differently by Fetal Alcohol Syndrome. There are many factors that affect the risk and severity of FAS. First of all the timing of the exposure is a very influential factor.
Heavy drinking during the first few months of pregnancy will affect the cells of the fetish brain and face. Consuming alcohol during the first trimester is the most damaging to the baby because of the interference it will have on the development of the brain. Binge drinking is extremely harmful and increases the risk of extreme brain damage. Mothers who abuse both alcohol and drugs place their babies at an even greater risk, and severity of brain damage. Most recently researchers have found that heredity can often have an affect on the babies ability to metabolize alcohol which explains why some children have more serious cases of FAS then others. Other factors include socioeconomic status, race, and culture of the mother (web).
A big part of the Fetal Alcohol Syndrome problem is the misdiagnosis and the under diagnosis of children with FAS. The key to treating and helping a child with Fetal Alcohol Syndrome is early diagnosis, which leads to early treatment. A doctor makes a diagnosis of FAS based upon the history of the pregnancy and the physical examination. Certain defects that a doctor may look for to determine if a baby has FAS is small for gestational age, failure to thrive despite good nutrition, low birth weight and height, craniofacial deformities, small brain size, impaired fine motor skills, memory deficits, and many more. Fetal Alcohol Syndrome is also determined by confirmed prenatal exposure to alcohol by the mother (web). Nationwide our communities are not well informed and educated on the dangers of consuming alcohol during pregnancy.
In fact most health care providers are unfamiliar with and untrained in the issues of substance abuse amid pregnant women. Fetal Alcohol syndrome is very often misdiagnosed and under diagnosed which may be due to the fact that less then 10 % of medical schools require students to take a course on the proper diagnosis and referral of individuals with alcoholism or other drug addictions. Specifically training health care professionals in the diagnosis and treatment of FAS will increase the ability to prevent it and helping those already affected by it. The Josiah Macy Jr.
Foundation assembled a national panel to discuss FAS and health care professionals. The panel found that most doctors do not try to identify alcohol or drug problems by simply asking the patients questions and do not know how to respond to a situation if they do find evidence that there may be an addiction. Alarmed by this the panel called for an increase in mandatory training on substance abuse (web) There are two types of disabilities associated with FAS, primary and secondary. Primary disabilities are those that are inherently part of FAS and a direct result of the prenatal exposure to the teratogenic agent alcohol (Hess and Kenner 3). Secondary disabilities are those that result as complications from lack of early intervention and diagnosis of primary disabilities (Hess and Kenner 3). Examples of secondary disabilities include mental health problems, inappropriate sexual behavior, disrupted school experience, trouble with the law, confinement for a crime, and drug and / or alcohol abuse.
Early identification and intervention may be the most effective way to avoid or lessen the secondary disabilities. Interventions in the childs and family's educational, health and psychosocial needs could help children afflicted by FAS reach their highest potential. Early intervention includes strategies and services that are provided to aid the child and family of the child with FAS. The first five years of life are the most important in a childs development, therefore early intervention is most effective during these early years.
The most beneficial interventions are those that take on the holistic approach, which includes not only providing support for the child with FAS but the family of the child also. The family needs to be provided with educational, health, and psychological services in order to fully understand and support their child. (Hess and Kenner 3) Working with children affected by Fetal Alcohol syndrome can be difficult and tiring but with the right knowledge of the disease and how it effects the child, interaction can be much easier. There are five key to working with these children structure, consistency, variety, brevity and persistence. Caregivers should provide external structure for these children because they lack internal structure. It is also important to be consistent because the child needs to know the world is predictable. Brevity in explanations and directions is important because they have serious problems with attentiveness.
Use a variety of different ways to keep the childs attention. Lastly one must repeat over and over again what is being taught. A few effective strategies a parent or caregiver can use are foster independence in self-help and play, encourage decision making, teach daily living skills, encourage use of positive self talk, establish a few simple rules for the child to abide by, establish routines, give advance warning about upcoming activities and break things down into small parts so it is not so overwhelming. (web). Blackman, James A. MD, MPH. Medical Aspects of Developmental Disabilities In Children Birth to Three.
Aspen Publishers, Inc. Gaithersburg, Md. 1997. Chang, Grace; Wilkins-Haug, Louise; Berman, Susan; Goetz, Margaret Ann. Brief Intervention for alcohol use in pregnancy: A randomized trial Addiction. Volume 94, Issue 10. Carfax Publishing Company.
Abingdon; Oct 1999. Gilbert, Elisabeth Step RNC, MS and Harmon, Judith Smith, RN, MS. High Risk Pregnancy and Delivery. Mosby Inc. Boston and London. 1993. Hess, Deborah J. ; Kenner, Carole.
Families caring for children with fetal alcohol Syndrome: The nurses role in early identification and intervention Holistic Nursing Practice. Vol. 12, Issue 3. Aspen Publishers Inc. Fredrick; Apr 1998. Lorente, Christine; Cordier, Sylvaine; Goujard, Janine; Ayme, Segolene. Tobacco and alcohol use during pregnancy and risk of oral clefts, American Journal of Public Health.
Vol. 90, Issue 3. Washington Mar 2000. web Adam. com encyclopedia web Alcohol Related Birth Injury Site. 2000 ARBI. ORG web National Organization on Fetal Alcohol Syndrome
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