What Is Fetal Alcohol Syndrome? Symptoms & Causes Explained

Fetal alcohol syndrome (FAS) is a collection of symptoms that occur if the mother consumes alcohol during her pregnancy. These symptoms may present as altered physical development, intellectual disabilities, language delays, behavioral difficulties, and learning disabilities.   

When a pregnant female consumes alcohol, it passes into her bloodstream and travels through the placenta directly to her baby. Babies’ organs are unable to process alcohol effectively, and exposure to this chemical results in detrimental effects on development. In some cases, maternal alcohol use results in pregnancy loss. Continue reading to learn more about fetal alcohol syndrome, common symptoms, treatments, and prevention strategies.  

What Is Fetal Alcohol Syndrome in a Baby?

Babies who are born after being exposed to alcohol during pregnancy are at risk of fetal alcohol syndrome, which can leave them with lifelong physical and developmental disabilities. These disabilities may include slow growth, developmental abnormalities in organs such as the heart and kidneys, difficulty with communication and judgment, learning and behavior challenges, poor impulse control, and hyperactivity.

Fetal Alcohol Spectrum Disorders

Fetal alcohol spectrum disorders (FASDs) refers to a group of physical and mental conditions that are a direct result of prenatal alcohol exposure. Fetal alcohol syndrome (FAS) is included in this spectrum; it has the most severe effects (physical and cognitive) of the disorders included in FASD.  

Below, the disorders are listed in order from mild to severe:

• Partial fetal alcohol syndrome (PFAS) or fetal alcohol effects.  Occurs when exposure to alcohol has resulted in mild symptoms (i.e. altered facial structure), but the individual does not meet the criteria for the diagnosis of FAS.  

• Alcohol-related neurodevelopmental disorder (ARND) indicates intellectual or cognitive difficulties resulting in behavioral and learning challenges but no physical deficits. 

• Alcohol-related birth defects (ARBD) refer to abnormalities in physical development that are present from birth. These include hearing or vision difficulties as well as abnormal development of organs such as the heart or kidneys. ARBD does not include neurologic involvement, meaning there are no  behavioral, thinking, or learning difficulties.

• A neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) refers to a condition in which an individual suffers some level of neurologic damage from alcohol exposure, leading to impaired ability to complete the following: self regulate, executive functioning, and general cognition, potentially leading to decreased independence and social isolation.   

• Fetal alcohol syndrome (FAS), the severest form of fetal alcohol spectrum disorder, which is associated with physical abnormalities as well as neurologic effects. 

How Prenatal Alcohol Exposure Affects Fetal Development

When a pregnant person drinks alcohol, it crosses the placenta and reaches the fetus. Since their vital organs are still developing, alcohol exposure can be very harmful to a developing baby. Let’s take a deeper look into how alcohol can affect the healthy development of a baby during pregnancy. 

To start, let's discuss organogenesis, which refers to the process of organ development that begins in the early stages of pregnancy. The liver plays a crucial role in breaking down alcohol, but it takes about two years for the liver to fully develop and function effectively. Consequently, when an expecting mother consumes alcohol, it is not properly cleared from the unborn child, which can significantly affect organogenesis and hinder the overall development of the developing baby.

Additionally, alcohol use during pregnancy results in premature birth and low birth weight; it also results in more frequent miscarriages. 

Prevention Strategies During Pregnancy

Avoidance of alcohol throughout pregnancy will eliminate the risk for FAS or FASD. Moderate alcohol consumption during pregnancy is not recommended. In fact, there is no safe amount of alcohol that can be consumed during pregnancy without the risk of developing FASD or FAS. 

Even minimal fetal alcohol exposure can place the developing baby at risk for FAS. This risk for FAS/FASD increases with the amount of alcohol consumed. Drinking large amounts of alcohol, sometimes called binge drinking, places the fetus at very high risk for the development of FAS.    

Preventive strategies for FAS include:

• Consider decreasing or completely ceasing alcohol consumption when you’re trying to conceive.

• Completely avoid alcohol consumption while pregnant.

• If you are pregnant and having difficulty abstaining from alcohol, seek medical care. Support is available.   

• There are many community resources available, including Alcoholics Anonymous and Al-Anon.

What Are The Symptoms of Fetal Alcohol Syndrome?

Cognitive Symptoms 

Difficulty with cognitive functioning, including learning disabilities, can affect the daily life of a child with FAS, including:

• Intellectual disability and problems with learning new things, memory, and concentration.

• Poor judgment, poor reasoning, and inability to think things through.

• Inability to understand the consequences of actions and choices.

• Issues with reasoning, problem-solving, and decision-making.

• Poor attention span, difficulty focusing, and trouble finishing tasks. 

• Inability to understand time concepts resulting in difficulty managing schedules, getting to places on time, or judging how long certain tasks will take. 

• Problems with organization, goal-oriented activities, and following directions.

• Attention Deficit Hyperactivity Disorder (ADHD)

Social and Behavioral Symptoms

Difficulty with self-regulation and behavioral abnormalities leading to social consequences can affect how a child functions in daily life. Children with FAS may experience:

• Rapid mood changes.

• Issues with controlling emotions and behaviors.

• Problems in maintaining school attendance.

• Trouble interacting and getting along with peers.

• Struggles with communication and social skills.

• Being easily duped or taken advantage of.

• Difficulties adapting to new environments or switching between tasks.

• Problems managing everyday tasks such as time management, self-care, finances, and personal safety. 

Secondary Disabilities

Secondary disabilities are problems that arise due to behavioral deficits in children with fetal alcohol syndrome. These can include: 

• Substance abuse (alcohol use disorder or recreational drug abuse).

• Mental health conditions, such as anxiety, depression, or eating disorders.

• Aggression and getting in trouble with the law.

• Social challenges, including improper social behavior and/or difficulty getting along with others.

• Inappropriate sexual behaviors 

• Academic challenges and difficulties with completing education.

• Challenges living independently and holding down a job. 

• Premature death due to accidents, homicide, or suicide.

Physical Development Symptoms

If a mother drank alcohol during pregnancy, fetal alcohol syndrome in the baby can cause changes in the baby’s physical development, including:

• Slowed physical growth, both before and after birth.

• Smaller head and brain size.

• Delays in physical development, including taking longer to sit, talk, walk and reach other developmental milestones.

• Problems in the heart, kidneys, and bones.

• Vision problems.

• Hearing problems.

• Poor coordination and balance issues.

• Hyperactivity and poor impulse control.

What Do People With Fetal Alcohol Syndrome Look Like?

Exposure to alcohol in utero leads to decreased nutrient transport across the placenta resulting in depressed growth, which leads to alteration of physical characteristics.  These may present as: 

• Small eyes

• A flat bridge of the nose 

• A very thin upper lip

• Smooth skin at the philtrum (between the nose and upper lip)

Note: Not every child with FAS has a typical fetal alcohol syndrome face with a thin upper lip, etc. Do not self-diagnose or rule out the condition based on facial features. Consult a developmental pediatrician or mental health professional for an early diagnosis and interventions, if needed.

Diagnosing Fetal Alcohol Spectrum Disorders

There is no single medical test to diagnose fetal alcohol spectrum disorders. Medical providers qualified to make the diagnoses include pediatricians, child psychologists, or developmental pediatricians. If you are unsure which person to go to first, start with your pediatrician. A healthcare professional will make a diagnosis of the condition based on criteria outlined in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5). 

Fetal alcohol spectrum disorders are diagnosed through careful observation of the child’s physical development and brain development during early childhood.  Observation of thinking, learning, behavior, language, and social skills are utilized to form a diagnosis.

Early diagnosis, behavioral interventions, and education therapy for fetal alcohol syndrome can potentially lessen some of the effects of this condition. It is important to consult a healthcare professional if you have a history of alcohol use during pregnancy. Do not wait to see if your child develops fetal alcohol effects before seeking care.

Treatments and Management Options 

Available Therapies and Support Options

Treatment for fetal alcohol syndrome is tailored to each individual child. Interventions may include: 

• Medical care or medications for physical growth deficiencies, kidney or heart conditions, vision or hearing problems. 

• Early intervention with speech therapy, physical therapy, and occupational therapy to help in reaching developmental milestones.

• Special education services to help with learning and behavioral issues. 

• Life skills training to help with independent living, communication, problem-solving, decision-making, social skills, and finances.

• Vocational rehabilitation to help in finding and maintaining employment

• Mental health services to help the child and family cope and maintain a stable home environment.

• Counseling for secondary disabilities, such as substance abuse. 

Long-Term Management Strategies

Prenatal alcohol exposure can cause lifelong disabilities that require ongoing medical care. If alcohol consumption during pregnancy has led to fetal alcohol syndrome in a child, it’s important to seek care as early as possible and to follow up with the child’s healthcare teams at every stage of life. As mentioned before, early interventions can lessen the severity of the condition and prevent secondary problems from developing.

What Is The Life Expectancy of a Fetal Alcoholic Person?

In a study completed in 2012, it was noted that the average life expectancy of individuals with FAS is 34 years. The leading causes of death in people with FAS included suicide, accidental death, and drug and alcohol poisoning.  

Raising Awareness and Educating Communities

Fetal alcohol syndrome (FAS) is a preventable condition. Increased awareness regarding the detrimental effects of in-utero alcohol consumption may reduce risk. Public health education can also improve outcomes for children affected by FAS. 

Healthcare professionals should educate patients about the importance of abstaining from alcohol during pregnancy. Providing support and information to women and their partners may change alcohol use patterns. Through education, healthcare providers can increase understanding regarding the cognitive, physical, and behavioral effects of FAS and FASD.

Resources for Parents, Educators, and Healthcare Providers

• FASD United

• Centers for Disease Control and Prevention’s (CDC) Developmental Milestones, also available as a mobile app for Milestone Tracker

• Early Intervention Services for Growth Deficiency

• SAMHSA Alcohol Treatment Locator Tool