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Fetal alcohol syndrome or FAS

There are different characteristics that accompany fetal alcohol syndrome or FAS in the different stages of a child’s life. “At birth, infants with intrauterine exposure to alcohol frequently have low birth rate; pre-term delivery; a small head circumference; and the characteristic facial features of the eyes, nose, and mouth” (Phelps, 1995).

Some of the facial abnormalities that are common of children with FAS are: small head size, small eye openings, broad nasal bridge, flattened mid-faces, thin upper lip, skin folds at the corners of the eyes, indistinct groove on the upper lip, low nasal ridge, and an abnormal smallness of the lower jaw (Wekselman, Spiering, Hetteberg, Kenner, & Flandermeyer, 1995). These infants also display developmental delays, psychomotor retardation, and cognitive deficits. In the central nervous system there is mental retardation, alcohol withdrawal at birth, poor sucking response, sleep disturbances, short attention span, and learning disabilities.

Plus the child will have muscle problems, bone and joint problems, genital defects, heart defects, and kidney defects. As a child with FAS progresses into preschool, physical, cognitive and behavioral abnormalities are more noticeable. These children are not the average weight and height compared to the children at the same age level. Cognitive manifestations are another problem with children who have FAS. “Studies have found that preschoolers with FAS generally score in the mentally handicapped to dull normal range of intelligence” (Phelps, 1995). Children with FAS usually have language delay problems during their preschool years.

Research has also shown that these children exhibit poorly articulated language, delayed use of sentences or more complex grammatical units, and inadequate comprehension (Phelps, 1995). There are many behavioral characteristics that are common among children with FAS. The most common characteristic is hyperactivity (Phelps, 1995). “Hyperactivity is found in 85% of FAS-affected children regardless of IQ”(Wekeselman 1995). School failure, behavior management difficulties, and safety issues are some of the problems associated with hyperactivity and attention deficit disorder.

Another behavioral abnormality of with children with FAS, is social problems. “Specific difficulties included inability to respect personal boundaries, inappropriately affectionate, demanding of attention, bragging, stubborn, poor peer relations, and overly tactile in social interactions” (Phelps, 1995). Children are sometimes not diagnosed with FAS until they reach kindergarten and are in a real school setting. School-aged children with FAS still have most of the same physical and mental problems that were diagnosed when they were younger.

The craniofacial malformations is one of the only physical characteristic that diminishes during late childhood (Phelps, 1995). “Several studies have evaluated specific areas of cognitive dysfunction in school-age children exposed parentally to alcohol. Researchers have substantiated: (a) short term memory deficits in verbal and visual material; (b) inadequate processing of information, reflected sparse integration of information and poor quality of responses; (c) inflexible approaches to problem solving; and (d) difficulties in mathematical computations” (Phelps, 1995).

The behavioral manifestations of a child with FAS during the early years of life are still apparent in children who are in grade school. Hyperactivity is still the most common characteristic portrayed by these children. Some of the descriptions used to explain these school-aged children’s behaviors include: distractible, impulsive, inattentive, uncooperative, poorly organized, and little persistence toward task completion (Phelps, 1995). As a child reaches puberty and develops into an adult, some of the physical, mental and behavioral characteristics change.

These adolescents begin to gain weight, but still remain short and microphalic (Phelps, 1995). Cognitive abilities of children with FAS continue to be low through adolescence and adulthood. Low Academic performance scores of adolescents and adults are persistent throughout their lives. Many cognitive tests have been done on adolescent/adults with FAS, and each of them have found deficiencies in mathematics and reading comprehension (Shelton & Cook, 1993). The behavioral manifestations of adolescents and adults with FAS ontinue to concentrate around the problem of hyperactivity.

Inattentiveness, distractibility, restlessness, and agitation are the main behaviors that stem from hyperactivity. “Vineland Adaptive Behavior Scales results suggest that communication and socialization skills average around the seven year old range”(Phelps, 1995). The prevalence of children with FAS is on the rise. More than ever, children are being diagnosed with FAS. Better techniques and knowledge by physicians are accountable for the increase. Physicians are diagnosing more babies today with FAS, because they have more knowledge and resources to evaluate the children at risk.

FAS has no racial barriers and has been reported by variable ages from neonatal to young adult (Becker, Warr-Leeper, & Leeper, 1990). Estimates in the United States of people with FAS vary from 2 live births per 1,000 to 1 per 750 (Shelton & Cook, 1993). “In a medical review of 5602 women, six instances of FAS were identified among 38 children of alcohol abusing women. Although 22 of the 38 were traced at follow-up, the outcome for the 6 FAS cases per se was not specified.

Nevertheless, 18 of 22 children of the alcohol-abusing women were found to be in state hospitals” (Emhart, Greene, Sokol, Martier, Boyd, & Ager, 1995). For a doctor to identify a child as having FAS, he/she must have the proper education. A test to see if a child has a central nervous system dysfunction or growth deficiency is not enough for a reliable diagnosis. An accurate diagnosis would also involve a facial phenotype study (Astley & Clarren, 1995). The Southwestern Native Americans have the highest incidence of FAS in the United States (Shelton & Cook, 1993).

Native Americans are three times as likely as Caucasians to produce FAS children” (Shelton & Cook, 1993). Tribes that have a loose social organization reflect a higher rate of FAS compared to a structured organization because the structured organization views a alcoholic female in the tribe as socially unacceptable (Shelton & Cook, 1993). More cases of FAS are being diagnosed, but there are many children who slip through the cracks and do not receive the support that is needed. There are few interventions and programs to help children that are affected by FAS.

Most states fail to identify FAS program coordinators, it is difficult to ascertain respective program parameters” (Shelton & Cook, 1993). Many children with FAS are living with an alcoholic parent. Children of alcoholics are at greater risk for developing social and emotional problems that need intervention options so they do not follow in their parent’s footsteps and become alcoholics (Wekselman, 1995). “Even though public schools are attempting to work with FAS, the bottom line is that more research needs to be done on treating FAS” (Shelton & Cook, 1993).

Educators and administration personnel working in the school system should be knowledgeable about FAS and the different age characteristics, degrees of incidences, and interventions that are available to their students. All children with FAS are at risk for failure in school and in every day life. With proper diagnosis and treatment that is available, some of these failures will be avoided. After all of this there are still common questions than now have answers, such as the following: What is meant in warnings to pregnant women not to drink alcohol?

Research has shown that even small levels of alcohol consumed during pregnancy may affect the fetus in damaging ways. In pregnant women, alcohol is not only carried to all organs and tissues, but also to the placenta, where it easily crosses through the membrane separating maternal and fetal blood systems. In this way, alcohol is transported directly to the fetus and to all its developing tissues and organs. When a pregnant woman drinks an alcoholic beverage, the concentration of alcohol in her unborn baby’s bloodstream is the same level as her own.

Unlike the mother, however, the liver of a fetus cannot process alcohol at the same adult’s rate of one ounce every two hours. High concentrations of alcohol, therefore, stay in the fetus longer, often for up to 24 hours. In fact, the unborn baby’s blood alcohol concentration is even higher than the mother’s during the second and third hour after a drink is consumed. What kind of damage can occur to the fetus from alcohol consumption by the mother? There are two degrees of damage that can occur. The most severe is Fetal Alcohol Syndrome (FAS).

The Fetal Alcohol Syndrome Study Group of the National Council on Alcoholism outlines minimal criteria for the diagnosis of FAS as being, “evidence of abnormalities in three specific areas: growth, central nervous system functions and facial characteristics. ” Fetal Alcohol Effects (FAE) include less severe birth defects in the same areas. In both FAS and FAE, birth defects are caused when a woman drinks alcohol during pregnancy. FAS and FAE form the single largest class of birth defects that are 100 percent preventable. (The Arc National Headquarters, 2000) Is there a safe amount of alcohol that a pregnant woman can drink?

The best advice is not to drink during pregnancy. It has not yet been determined if there is a safe level, and it may vary considerably with different individuals. The adverse effects of alcohol may vary with the stage of pregnancy and the amount of alcohol consumed on each occasion. There appears to be no difference in the type of alcoholic beverage (beer, wine, hard liquor) and its effects during pregnancy. Early exposure presents the greatest risk for serious physical defects, and later exposure increases the chances of neurological and growth deficiencies or miscarriage. Women should just not drink while pregnant.

The First Trimester — This appears to be the most critical time when abnormal features can be caused. Alcohol may affect the way cells grow and arrange themselves as they multiply, altering tissue growth in the part o f the fetus that is developing at the time of exposure. The brain is particularly sensitive to alcohol which diminishes the number of cells growing in the brain. Consequently, the brain is smaller and often its neurons are found in the wrong places. The early loss of cells in the developing fetus may help explain overall retarded growth and low birth weight in babies with FAS.

Second Trimester — Miscarriage is a major risk during this time. There may be times of fetal distress related to binge drinking (irregular periods of heavy drinking). Third Trimester — During this period the fetus normally undergoes rapid and substantial growth. Alcohol can impair this growth. This is also the time of greatest brain development. Research with animals indicates the brain and central nervous system are at great risk during the third trimester. (The Arc National Headquarters, 2000) Do all children with FAS/FAE have mental retardation?

No. A recent study of 61 adolescents and adults with FAS or FAE revealed IQ scores ranging from 20 to 105, with an average of 68. Fifty-eight percent of these individuals had an IQ score of 70 or below (Streissguth, et al. , 1991). Can FAS be treated? Birth defects related to alcohol use are permanent. Surgery can repair some of the physical problems, and schools and day care centers offer programs to improve mental and physical development. However, children born with FAS remain below average in physical and mental development throughout their lives.

In all, the main element that is causing FAS is addiction. Children with FAS did not have the choice of saying no and have to live with their mothers decision to drink every day of their lives. Something needs to be done with mother who have babies that are addicted at birth. Laws and other regulations will probably not solve the problem, but make it more complex. A mother shouldn’t have a child if she has an addiction problem. Woman should be able to receive free abortions if they are addicts and don’t want to quit drinking during their pregnancy. A child should never be born with fetal alcohol syndrome.

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