Fetal alcohol syndrome

Fetal Alcohol Syndrome: Description

As Fetal Alcohol Syndrome (FAS) refer to physicians the prenatal damage of a child through alcohol consumption of the mother. Another term for FAS is alcohol embryopathy.

Fetal alcohol syndrome: frequency

Experts estimate that approximately 10,000 babies with alcohol-related damage (FASD) are born each year in Germany. Probably more than 2,000 of these have the highest severity of injury – a fetal alcohol syndrome. This makes FAS one of the most common congenital disabilities in Germany.

There are no precise figures about frequency because the damage is often not recognized or not correctly diagnosed. This is partly due to the difficult evidence (see below). On the other hand, employees in the health system often have inhibitions to express a suspicion to the parents. Or they themselves do not know enough about Fetal Alcohol Spectrum Disorders and Fetal Alcohol Syndrome.

Fetal Alcohol Syndrome: Symptoms

Childish deficiencies and malformations characterize a fetal alcohol syndrome. Face and head, for example, have various changes and anomalies. These include:

• an unusually small skull (microcephalus) with impaired brain development
• short, narrow and slightly slanted upwards eyelids
• the drooping of one or both eyelids (ptosis)
• an additional fold over the inner eyelid (epicanthus)
• a wide eye relief
• a short, flat nose
• a missing or only slightly pronounced furrow between the nose and mouth (Philtrum)
• a thin upper lip with a narrow lip red
• underdevelopment (hypoplasia) of the lower jaw
• small teeth

Sometimes a cleft palate also appears. Other signs of fetal alcohol syndrome can be:

• Dwarfism in the womb and after birth
• Malformations of joints and skeleton like funnel chest
• reduced skeletal muscle tension (muscular hypotension)
• Malformation of internal organs (such as heart defects, malformations of the kidneys)
• Malformation of the genitals
• psychomotor restlessness (many patients additionally suffer from ADHD = Attention Deficit / Hyperactivity Disorder)
• physical and mental retardation (“retardedness”)

Prenatal alcohol influence also has many implications for a child’s mental abilities: those concerned are hampered by the processing of information and perceptions. The possible consequences are, for example, social withdrawal, fear of new situations, compulsiveness, easy influenceability and exploitation.

Other children who have Fetal Alcohol Syndrome are prone to aggressive behavior and have disturbed social behavior (such as insubordination). Such impulse control disorders also occur in many adult patients (see below).

Fetal alcohol syndrome can also be associated with hearing and vision problems as well as a hernia.

Extent of damage varies

The severity of alcohol embryopathy may vary. In mild cases, those affected have “only” a growth delay, underweight and a too small brain skull (microcephaly) on. In more serious cases, further damage and malformations are added, such as facial anomalies, organ malformation and mental impairment. The latter can range up to severe mental retardation.

FAS syndrome in adults

Fetal adult alcohol syndrome is often associated with other disorders. These include depression, anxiety disorders and impulse control disorders. Some of those affected also show an increased risk of addictions, abnormalities in sexual behavior and dissocial developments. This can massively affect the adaptation to social norms and cause difficulties in everyday life (problems with housing and job search, in social relationships, etc.).

Fetal Alcohol Syndrome: Causes and Risk Factors

In unborn children, the so-called placental barrier prevents various pollutants and pathogens from passing through the maternal bloodstream into the child’s blood. This protection filter does not work 100 percent.

Alcohol from the maternal blood, among other things, can pass almost unfiltered into the blood of the unborn child. According to studies, even 10 grams of alcohol a day can cause a fetal alcohol syndrome in the child. This amount is about a small beer or 100 milliliters of wine.

Alcohol is a poison for the human body in every phase of life. That unborn children are particularly sensitive to it is because their immature liver can not break down the alcohol so well. Thus, it can damage cells more than adults and inhibit cell division – with many consequences, especially for the sensitive brain. The damage and changes lead to Fetal Alcohol Spectrum Disorders (FASD). In the worst case, Fetal Alcohol Syndrome (FAS) develops.

That being said, drinking alcohol during pregnancy increases the risk of miscarriage.

Risk Factors for Fetal Alcohol Syndrome

Not all children whose mothers consume alcohol during pregnancy develop alcoholic embryopathy. According to recent research, the nucleus of some of the unborn children is genetically protected against damage by alcohol.

The risk of a fetal alcohol syndrome in children is mainly due to high and / or chronic alcohol consumption of the mother during pregnancy. But there is also the risk of a FAS if the expectant mother over and over again drinks alcohol over the entire nine months – even if it is only moderate amounts. And even the sporadic or just one-time consumption of alcohol can damage the embryo.

Particularly dangerous is the consumption of wine & Co. in the 1st and 2nd trimester of pregnancy (trimester). The risk of FAS also exacerbates when the mother also consumes amphetamines or various other drugs.

Other risk factors for a fetal alcohol syndrome include:

• the age of the mother> 30 years
• Maternal malnutrition, or the lack of trace elements or vitamins
• stress
• Siblings with FASD
• genetic background

Fetal Alcohol Syndrome: Examinations and Diagnosis

Ideally, Fetal Alcohol Spectrum Disorder (FASD) or Fetal Alcohol Syndrome (FAS) should be detected as early as possible. The affected children can then quickly receive adequate and individual support and support.

Problems with the diagnosis

Fetal Alcohol Spectrum Disorders and Fetal Alcohol Syndrome are often difficult to diagnose. This is because, for example, the maternal alcohol consumption during pregnancy is difficult to detect – for example, because the mother gives false information. In addition, many children in Germany who have a fetal alcohol syndrome live in adoptive and foster families – the alcohol consumption of the biological mother is then difficult to determine.

Another problem is that many abnormalities of a fetal alcohol syndrome change with age. For example, facial anomalies and impaired growth are clearly recognizable in childhood, but less noticeable in adolescence and adulthood.

In contrast, attention and behavioral disorders are more common with growing up.

Exclusion of other causes

For the reliable diagnosis of alcohol embryopathy other causes have to be excluded (differential diagnosis). For example, stunted growth may also be due to familial dwarfism, prenatal deficiencies, hormonal imbalances, genetic syndromes, chronic diseases or neglect.

FAS diagnosis

For a fetal alcohol syndrome experts have developed diagnostic criteria. Thus, a FAS is when someone meets the following four points:

1. at least one growth abnormality (abnormally low birth or body weight, reduced length of birth or body or lower body mass index = BMI)
2. three abnormalities on the face, namely narrow upper lip, missing or less pronounced furrow between the nose and mouth, and short eyelids
3. at least one abnormality of the central nervous system (such as mental retardation, impaired speech or fine motor skills, attention deficit disorders, microcephaly)
4. Alcohol consumption of the mother in pregnancy

If the first three points are met, but maternal alcohol use during pregnancy can not be confirmed, the diagnosis “Fetal Alcohol Syndrome” should nevertheless be made.

Fetal Alcohol Syndrome: Treatment

The damage that alcohol has caused to a child in the womb can not be reversed. Although you can operate on some of the physical deformities such as a heart defect or cleft palate. In addition, visual and hearing disorders can be corrected with aids (glasses, hearing aids).

However, most of the consequences of a fetal alcohol spectrum disorder or a fetal alcohol syndrome can not be resolved. These include, for example, mental impairments, behavioral problems, stunted growth and facial anomalies.

Instead, the treatment of FASD and FAS is about helping sufferers to deal with alcohol-related disorders and abnormalities as well as possible. For example, children with developmental delays may benefit from physiotherapy, speech therapy and / or occupational therapy. Under favorable conditions, some development arrears can then be partially compensated.

In the case of traumatic experiences in early childhood (such as with an alcoholic mother), psychotherapeutic help may also be useful. In addition, if FAS sufferers have ADHD, behave very aggressively, or show severe social disorder behavior, concomitant treatment with medications may be appropriate.

Which promotion and supporting measures are appropriate in the individual case, is decided individually.

Fetal alcohol syndrome: disease course and prognosis

A fetal alcohol spectrum disorder or a fetal alcohol syndrome is not curable. The occurring mental and physical changes, developmental disorders as well as behavioral problems usually persist permanently. The prognosis depends mainly on the extent of cognitive impairment. Hard-hit children are usually not capable of independent living and depend on outside help for life.

A Fetal Alcohol Syndrome often requires hospital inpatient treatment during the first two years of life due to increased frequency of infection, failure to thrive, and any necessary surgery.

Because of social problems, many affected children can not stay with their biological parents, but must be placed in foster homes or homes.

Fetal Alcohol Syndrome: Prevention

Alcohol use during pregnancy is one of the few completely preventable causes of severe developmental problems in the child. Experts recommend pregnant women to completely abstain from alcohol. After all, even moderate alcohol consumption can cause a fetal alcohol spectrum disorder or even a Fetal alcohol syndrome cause the unborn.