Fetal Alcohol Spectrum Disorder (FASD)

What is fetal alcohol spectrum disorder (FASD)?

Fetal alcohol spectrum disorder (FASD) is a general or "umbrella" term used to describe disabilities caused when a woman drinks alcohol during pregnancy. FASD includes any of the following diagnoses:

  • fetal alcohol syndrome
  • partial fetal alcohol syndrome
  • alcohol-related neurodevelopmental disorder
  • alcohol-related birth defects

FASD is caused by drinking alcohol during pregnancy

FASD can happen when a pregnant woman drinks any type of alcohol, including beer, wine, hard liquor, or coolers. Alcohol crosses the placental barrier from mother to baby. Any amount of drinking during pregnancy can cause FASD.

  • High risk begins when a woman has 2 drinks a day, or 14 drinks on average per week, or 4 or more drinks on any one occasion.
  • Recent evidence suggests that even 1 drink per day may cause behavioural problems.

The kinds of problems the baby may have depends on when the mother drinks during the pregnancy:

  • Since the brain is developing during the entire pregnancy, the brain is always being affected if the mother drinks regularly.
  • Drinking during the first trimester increases the chance that the baby will have a small brain, physical problems, and/or severe intellectual disability.
  • Drinking during the second trimester increases the chances of spontaneous abortion (miscarriage).
  • Drinking during the third trimester, and during nursing, can affect intelligence.

Not all babies who are exposed to alcohol during pregnancy will have FASD. We do not yet understand why some babies are born with problems and others are not, even when their mothers drank about the same amount of alcohol during their pregnancies. In some cases, one baby will have FASD but his fraternal twin will not.

Signs and symptoms of FASD

The effects of FASD are not always obvious at birth. Often, behavioural and learning problems are not noticed until the child is old enough to go to school. Differences from other children become more apparent at about Grade 3 or 4.

Some people with FASD have a mixture of physical and mental problems. Many children with FASD do not have physical problems.

Problems with intelligence and learning

Children with FASD may have one or more of the following problems:

  • intellectual disability (IQ below 70); however, most children with FASD have IQs in the normal range
  • slow learning, short attention span, hyperactivity, or memory problems
  • learning disabilities, especially with reading, comprehension, and abstract math
  • delays or lack of abilities in speech and language: for example, the child may have receptive language disorder, interrupt, talk out of context, or chat with no content
  • lack of executive function skills, including difficulties with organization, planning, and reasoning
  • inability to manage money, for example by saving and budgeting
  • inability to understand cause and effect

Sensory integration problems

Children with FASD may need more or less stimulation than the average person. This is called a problem with sensory integration. These problems may involve one or more senses, such as:

  • sensitivity to touch; the child may not be able to tolerate tags in shirts or seams in clothing
  • seeming to need more touch than other children; for example, the child may need tight hugs or may not seem to feel pain
  • hating bright lights or noise
  • noticing smells more than others
  • being bothered by "every little thing"

These problems may occur in combination. A child with FASD could be hypersensitive to bright lights, but crave deep pressure or touch.

Behaviour and mood problems

Babies with FASD may have one or more of the following problems:

  • irritable, nervous, or sensitive to sound and light
  • cry often
  • very quiet and not very responsive

Children with FASD may have one or more of the following problems:

  • behavioural problems, such as oppositional defiant disorder and aggressive or defiant behaviours
  • mental illness, such as depression or psychosis
  • drug and alcohol problems
  • anger control problems or violence

Poor judgment and the inability to connect an action with its consequences are the hallmarks of FASD. As a result, people with FASD are at high risk for getting in trouble with the law.

Physical problems

At birth, babies may have one or more of the following:

  • low birth weight (less than 2.5 kg or 5 lb 8 oz)
  • small head size
  • face and mouth deformities
  • flat shape of the face
  • specific facial features may include thin upper lip, flatness under nose, and smaller eyes

Other physical problems may include:

  • delayed growth
  • small height and/or weight
  • short height as an adult
  • bone, joint, or muscle problems
  • hearing problems
  • repeated ear infections
  • visual and eye problems
  • genital defects
  • heart defects
  • kidney problems

How FASD is diagnosed

If you think that your baby could have been exposed to alcohol before birth, speak to your doctor. A health care provider can diagnose FASD by:

  • asking about the mother's pregnancy and the child's birth
  • doing a physical exam
  • testing the child's abilities to understand, communicate, move, and adapt
  • measuring facial features

There is no cure for FASD

It is not easy to "treat" FASD. However, it is important to diagnose FASD early because there are some things that can help.

  • Physical and occupational therapy can often help somewhat.
  • A child with FASD should have psycho-educational testing to find specific difficulties. This will help the child get services in school that will help with the difficulties.

  • Social workers can help the family cope and deal with family issues.

FASD lasts throughout a child's life

The effects of FASD last throughout life. The problems change as the child grows up. Behaviour and mood problems such as alcohol and drug abuse, depression, psychosis, and aggressive behaviour often begin in the teenage years.

People with FASD are commonly not able to manage their own lives, or to be totally independent as adults. They will need some kind of help their whole lives to be successful.

FASD is common

FASD affects approximately 1% of people living in Canada. This means that there may be about 300,000 people with FASD living in Canada today.

Preventing FASD

The only way to prevent FASD is by not drinking when pregnant.

For more information, please see the AboutKidsHealth Pregnancy resource centre.

If you are pregnant or think you might be pregnant, do not drink alcohol. If you have a problem with drinking, talk to your doctor or another health professional. They may be able to help you stop drinking, or to cut back on your drinking as much as possible.

Key points

  • Drinking alcohol during pregnancy can cause many different problems for the baby, including physical problems and problems with learning, attention, memory, and behaviour.
  • Problems caused by drinking during pregnancy are called fetal alcohol spectrum disorder (FASD).
  • There is no cure for FASD, but it may be possible to get help for specific problems. It is important to diagnose FASD early.
  • If you are pregnant, do not drink alcohol.

Margaret Lintott, RN

Peggy Kirkpatrick, MD, FRCPC