What Is Fetal Alcohol Syndrome?

Fetal alcohol syndrome (FAS) is a permanent condition that causes brain damage and developmental delays in a fetus due to prenatal (before birth) alcohol exposure (PAE). FAS is the most severe fetal alcohol spectrum disorder (FASD), a group of conditions caused by PAE.

About 1 in every 1,000 babies born in the United States is diagnosed with fetal alcohol syndrome. Symptoms can vary in severity but include central nervous system (brain and spinal cord) damage, abnormal facial features, and growth impairment. Children with FAS also experience learning and behavioral challenges.

The effects of FAS will persist throughout life. However, early intervention services, medication, and therapy programs may help improve a child's development and quality of life over time.

Fetal Alcohol Syndrome Symptoms 

People with fetal alcohol syndrome experience growth deficits, abnormal facial features, and central nervous system (CNS) damage.

Facial abnormalities include:

• Small eye openings
• Abnormally thin upper lip
• Smooth skin without a groove (philtrum) between the nose and upper lip
  

Damage to organs and body systems in the womb can lead to physical abnormalities and growth delays like:

• Smaller head size (head circumference less than the 10th percentile)
• Low body weight for age
• Short height for age
• Vision or hearing conditions
• Heart, kidney, or bone conditions
• Difficulty sucking (infants)
  

Central nervous system damage can lead to developmental, social, and behavioral challenges including:

• Poor coordination  
• Poor memory
• Difficulty paying attention and processing information
• Poor reasoning, judgment, and problem-solving
• Hyperactivity
• Rapid mood changes
• Intellectual and learning disabilities
• Speech and language delays
• Sleep difficulty (infants)

People with FAS might also have a smaller brain size.

Causes

Fetal alcohol syndrome is caused by drinking alcohol while pregnant. When a pregnant person drinks alcohol, the alcohol enters the bloodstream and can reach the bloodstream of the developing fetus. Exposure to alcohol can affect the fetus's growth and development.

Alcohol exposure can damage facial features in the first three months of pregnancy and affect growth and brain development at any point during pregnancy.

Binge drinking or heavy drinking throughout pregnancy might increase the risk of fetal alcohol syndrome. However, drinking any amount of alcohol during pregnancy can potentially increase the risk of developmental delays and birth defects. 

Risk Factors

The severity of fetal alcohol syndrome can increase based on factors like:

• How much a pregnant person drinks 
• How often a pregnant person drinks
• If the pregnant person drinks heavily during pregnancy stages that develop specific body systems, structures, and brain regions
• The genetic makeup of the pregnant person and fetus

Fetuses are more likely to be exposed to alcohol if the pregnant person:

• Smokes
• Comes from a family of heavy drinkers
• Lives with people who promote alcohol misuse
• Has high stress levels
• Experiences social isolation
• Lives in a community with limited prenatal care

Diagnosis

No specific test detects fetal alcohol syndrome. If a caretaker or healthcare provider believes a child has fetal alcohol syndrome, they are typically referred to an FASD specialist.

These specialists include:

• Developmental pediatrician: A medical doctor who specializes in developmental and behavioral challenges in infants and children
• Child psychologist: A mental health professional who specializes in assessing and providing therapy to children and adolescents
• Clinical geneticist: A medical doctor who specializes in genetic disorders (disorders caused by altered genes)

Some clinics can also diagnose and treat children with FASDs. You can find a clinic in your area through FASD United's National and State Resource Directory. 

FAS diagnosis requires the following criteria:

• Prenatal exposure to alcohol
• Structural or functional central nervous system abnormalities
• Three facial abnormalities: small eye openings, smooth skin between the upper lip and the nose, and a thin upper lip
• Growth deficiencies during pregnancy and/or after birth

Other FASD Diagnoses

Other fetal alcohol spectrum disorders share some symptoms with fetal alcohol syndrome. Like FAS, symptoms vary from person to person. All FASD diagnoses require evidence of fetal alcohol exposure in the womb.

Other FASDs include:

• Partial fetal alcohol syndrome (PFS): Some FAS symptoms, but not all of the same features—such as growth restrictions and a smaller head size 
• Alcohol-related birth defects (ARBD): This includes medical conditions like heart and bone conditions, vision and hearing difficulty, and lower immunity. No evidence of neurocognitive deficits (reduced cognitive function) or neurodevelopmental deficits (impaired development of the brain or nervous system).
• Alcohol-related neurodevelopment disorder (ARND): This is characterized by neurodevelopmental or neurobehavioral effects (conditions related to communication between the brain and nervous system). No physical deficits or facial abnormalities like those required for FAS diagnosis.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): This is characterized by neurodevelopmental, neurobehavioral, or mental health effects. Impaired cognition, self-regulation (the ability to manage your thoughts, feelings, and behaviors), and adaptive functioning (the ability to cope with daily life demands). Possible physical deficits or facial abnormalities.
  

Fetal Alcohol Syndrome Treatment

There is no cure for fetal alcohol syndrome: the effects remain throughout a person's lifespan. However, treatments can help manage symptoms and increase a person's quality of life. Treatment varies depending on the severity of symptoms.

Early Intervention Services

Early intervention (EI) services are the most effective step in improving outcomes for children born with fetal alcohol syndrome. These state-run services vary by state but include evaluation and services based on your child's developmental needs. EI can help children with developmental disabilities learn essential skills like talking, walking, and social interaction from birth to 3 years old.

You can call your state's early intervention program to request a free evaluation if you or your healthcare provider suspects your child has fetal alcohol syndrome.  

Children born with fetal alcohol syndrome are automatically eligible for early intervention services in most states. Children can also qualify for services without a diagnosis if they have signs of a developmental disability. 

Children older than 3 are not eligible for early intervention, but they can qualify for special education services before kindergarten or while enrolled in school. You can contact your local elementary school or board of education to request an evaluation.

Medication

Certain medications can improve and manage behavioral symptoms associated with fetal alcohol syndrome.

These medications include:

• Stimulants: Medications like Ritalin (methylphenidate) and Adderall (amphetamine) help stimulate the brain and treat attention-deficit/hyperactivity disorder (ADHD) symptoms. ADHD is a neurodevelopmental condition characterized by inattention (difficulty focusing), hyperactivity (feeling restless), and impulsivity (making decisions without thinking).
• Alpha-2-adrenergic agonists: Non-stimulant medications like Catapres (clonidine) and Intuniv (guanfacine) help reduce anxiety responses and treat ADHD symptoms. These medications can cause fatigue (tiredness) and are often used to help children sleep. 
• Selective norepinephrine reuptake inhibitors: Non-stimulant medications like Strattera (atomoxetine) can help treat ADHD symptoms if stimulants are ineffective.
• Anxiolytics: Medications like BuSpar (buspirone) help treat symptoms of anxiety.
• Antidepressants: Medications like Zoloft (sertraline) and Prozac (fluoxetine) can help treat depressive symptoms, including mood swings and difficulty sleeping.
• Neuroleptics: Medications in this class of antipsychotics, including Risperdal (risperidone) and Abilify (aripiprazole), typically have a calming effect. They can help treat severe behavioral symptoms like aggression and poor impulse control.

Behavior and Education Therapy Programs

Certain programs can help improve behavioral and learning challenges associated with fetal alcohol syndrome.

Common programs for children with FAS and other FASDs include:

• Good Buddies: Social skills training sessions that teach children and parents age-appropriate social skills like sharing and conflict resolution in a group setting. Includes 12 weekly sessions. 
• Families Moving Forward (FMF): Positive behavior support techniques taught to caregivers by mental health providers. These techniques help caregivers support severe behavior problems. Includes at least sixteen 90-minute sessions for 9-11 months.  
• Math Interactive Learning Experience (MILE): A program that helps children improve their math skills, a common issue with children with FASDs. Parents are also trained on how to help their children learn. Includes 6 weeks of one-on-one tutoring. 
• Parents and Children Together (PACT): Parents and children learn to work on self-regulating behavior and improving executive function skills. Includes 12 weekly sessions. 

Parent training can also help caregivers learn how to teach their child skills and coping mechanisms that can help manage FAS. Parent training includes strategies like concentrating on your child's strengths, using stable routines, and using concrete language. Therapists, family counselors, and special classes can provide parent training. FASD United's Family Navigator program and resource directory can help you find programs in your area.

Prevention

The only way to prevent fetal alcohol syndrome is to avoid drinking alcohol during pregnancy. Additional guidelines to help prevent fetal alcohol syndrome include:

• Use birth control if you're sexually active and enjoy drinking alcohol: Birth control can help reduce your risk of an unplanned pregnancy.
• Avoid alcohol if you're trying to conceive: Avoiding alcohol while trying to get pregnant can help ensure you don't accidentally drink during pregnancy.
• Avoid alcohol while pregnant: There are no guidelines on how much alcohol is safe to drink during pregnancy, so avoid it altogether as soon as you know you're pregnant. Even non-alcoholic beers may contain some alcohol. 
  
• Seek help if you're pregnant or want to get pregnant and are having difficulty giving up alcohol: Contact your healthcare provider, as well as services and programs like FindTreatment.gov, NIAAA alcohol treatment navigator, and Alcoholics Anonymous (A.A.). 

Related Conditions 

People with fetal alcohol syndrome and other FASDs are more likely to develop secondary conditions.

More commonly diagnosed conditions include:

• Attention deficit/hyperactivity disorder (ADHD): A neurodevelopmental condition characterized by inattention (difficulty focusing), hyperactivity (feeling restless), and impulsivity (making decisions without thinking).
• Substance use disorder (SUD): A mental health condition characterized by excessive and uncontrolled drug or alcohol use.
• Depression: A mental health condition that causes feelings of intense sadness, loss of interest, and negative thought patterns.
• Anxiety disorders: Mental health conditions characterized by intense dread, nervousness, or fear that can cause physical symptoms like sweating and a rapid heart rate.
• Conduct disorder: A childhood behavioral disorder that includes aggression toward others and a disregard for rules and socially acceptable behavior.

Living With Fetal Alcohol Syndrome

People with fetal alcohol syndrome have a life expectancy of about 34 years. Many adults with FAS die from accidents, suicide, or drugs and alcohol misuse. Living with fetal alcohol syndrome can be challenging. Research has found young adults with FASDs—including fetal alcohol syndrome—are more likely to drop out of high school, get into legal trouble, and struggle with substance use.

Children with fetal alcohol syndrome may have a lower risk of developing secondary conditions and behavioral challenges as adults if they:

• Are diagnosed early (before 6 years old)
• Live in a nurturing and stable home environment 
• Grow up in an environment without violence
• Have access to developmental disability services
• Are involved in early intervention and special education programs

Reach out to a healthcare provider if you think a child within your care might have fetal alcohol syndrome. Early supportive services can help increase their quality of life.