Fetal Alcohol Spectrum Disorder

Your baby doesn't have a choice. You do.

Fetal Alcohol Spectrum Disorder

Adapted and expanded from an article I wrote for the house journal of the NZ Charter of Health Practitioners

If you drink alcohol during your pregnancy, you are harming your fetus, starting with the very first drink.

Some fetuses are genetically more resistant to damage than others, but the principle holds:
the more you drink, the more damage you cause.

That's it.

Full stop.

End of Story.


How much damage is socially acceptable?

Health workers recognise that a total ban on alcohol is often ignored. Also, even though damage to a fetus can be measured, that does not always mean that performance is significantly or even visibly worse.

This has led many medical advisers to specify a weekly maximum intake of around seven drinks. But even this can be a problem. Seven drinks on Friday night do a lot more damage than one drink each night with food.

Interesting Fact: Research shows that the wealthier you are, the more likely you are to drink during pregnancy, and the more you are likely to drink. It's your choice.

What's the damages, then?

Earlier terms, FAS, FAE, and ARND have been overtaken by FASD, or Fetal Alcohol Spectrum Disorder

Fetal Alcohol Syndrome (FAS) was a diagnosis used to distinguish a child who displayed characteristic physical symptoms in addition to other neurological damage. (See illustration in side bar) For FAS to occur, alcohol must be consumed by a child's mother within a relatively small window of about ten hours over the 19th-20th day of pregnancy.

Fetal Alcohol Effects (FAE) was a diagnosis used to describe a child without the characteristic physical effects but displaying characteristic neurological and behavioural symptoms.

Later, Alcohol Related Neurological Disorder (ARND) was used, and most recently Fetal Alcohol Spectrum Disorder (FASD). The new name is intended to make people more aware that this is a disorder with symptoms that range from subtle to quite severe. Formerly, many less severe cases remained undiagnosed and unrecognised.

Physical Features Associated with FASD:

  1. Small head circumference (an indicator of retarded growth)
  2. Unusually small eye openings (causing the eyes to look widely-spaced)
  3. Drooping eyelids
  4. Short, upturned nose
  5. Ear abnormalities
  6. Absent ridges between the nose and mouth
  7. Thin upper lip
  8. Small chin
  9. Underdeveloped, flat midface region

In addition to these traits, heart defects occur in approximately 30% of FASD babies. Complications with the kidneys, joints and genitals are not uncommon.

As children get older these physical symptoms become less obvious. Sometimes they can be masked by racial characteristics.

The brain damage does not disappear.

Check these behaviours...

FASD sufferers exhibit a common set of behavioural and learning problems:

The more damage, the more severe the problems.

    • much lunging and darting about
    • stares into space for long periods of time
    • hurts others by biting and kicking
    • severe temper tantrums/frequent minor tantrums
    • wants things now, impatient
    • does not use toys appropriately
    • does not respond to other people's facial expressions
    • slow to respond to social/environmental cues
    • confused by instructions that contain
      prepositions - with, by, to, in, etc
    • takes risks - often unaware of present
      or approaching danger
    • looks right through people
    • frequently anxious/tense
    • does not easily imitate fellows
    • few friendships or none
    • reacts strongly to changes in routine
    • destructive
    • special abilities which give lie to general retardation
    • learns simple task but forgets easily
    • difficulty with toilet training

Not "bad" but damaged...

Early diagnosis of FASD is vital.

These children are not "bad", but if major antisocial problems are to be avoided, intervention must begin as soon as possible.

Typically, FASD has been under-diagnosed, and the previous terms (FAS, FAE, ARND, etc) generally applied only to conditions where major damage was apparent; but these are simply the top end of a range of damage.

If you suspect alcohol-related damage in a child in your care, seek help and advice.

We're speaking management, not cure

FASD results from permanent damage to the brain.

The best we can do is to make sure that those involved with the child's daily care are aware of the circumstances and make appropriate allowances. We are not dealing with wilful misbehaviour.

For professional and experienced guidance and support in raising a child with FAS or FAE, refer to Fetal Alcohol Support Trust (FAST).
(See contact address at the top of the FAS homepage.)

You may be fit to drive, but your fetus isn't.

Alcohol that crosses the placenta takes much longer to metabolise. Your baby's liver is not yet fully developed. In addition, alcohol excreted from the baby is dumped into the amniotic fluid and recycled.

For these reasons, the alcohol level in a fetal bloodstream can be much higher than the mother's, especially so if more than five drinks have been consumed.

Breast Feeding

Alcohol is present in the breast milk within 30 minutes of taking a drink. While the concentration is much less than the baby receives through the placenta it is still sufficient to damage the rapidly developing brain and nervous system of a new born baby, and the baby will continue to be vulnerable for at least the first year of its life.

Alcohol in the breast milk dissipates at approximately the same rate as alcohol in the blood stream - one drink per hour.

For those concerned to avoid any damage to their breast fed baby, it is still possible to enjoy an occasional drink, provided certain precautions are taken.

The simplest is to feed baby immediately before drinking alcohol, and restricting your alcohol intake to a quantity that will have disappeared from your system before the next feed is due.

Allow an hour for each standard drink, plus a half hour.

It is also possible, before drinking alcohol, to express and store milk to provide a standby supply.

Men have babies, too

Heavy alcohol use during adolescence can permanently alter the DNA in a man's sperm. Alcohol use by the father immediately before the time of conception decreases the mobility of healthy sperm, making it more likely that birth defects will follow.

Women are more likely to drink during pregnancy if their partner continues to do so.

(Heavy alcohol use is defined by the Alcohol Advisory Council as more than five drinks in one sitting, or more than 14 drinks per week.)

Research has also shown (some surprised researchers) that, independent of a mother's use of alcohol or drugs, men who consumed an average of 2 drinks per day fathered babies weighing, on average, 90-100g less

(See also Alcohol and Fertility in Males )




FASD Home Page


Fetal Alcohol Support Trust
c/o Shirley Winikerei
2 Simon Place

ph 07 847 6752

(Mon-Fri, Office Hours)

email: fast@xtra.co.nz

(Shirley welcomes inquiries from overseas.)

Social Costs for Severe FASD Sufferers

Ages 12-51 yrs

  • 95% will have mental health problems
  • 55% will be imprisoned or otherwise confined in an institution
  • 60% suspended or expelled from school
  • 60% will have trouble with the law
  • 52% will exhibit inappropriate sexual behaviour

Ages 21-51 yrs

  • 82% will be unable to live independently
  • 70% will have employment problems
  • 50% of males will have alcohol and drug problems
  • 70% of females will have alcohol and drug problems







An 18 year old badly affected with FASD will present initially as "normal".

He speaks well. Spoken language is least affected.

But, typically

  • Comprehension in reading scores at 6 years
  • Time and Money Concepts score at 8 years
  • Emotional Maturity scores at 6 years
  • Social Skills score at 7 years
  • Living Skills score at 11 years
  • Learning needs constant repetition before it sticks