Ask the Adoption Medical Expert: Prenatal Alcohol Exposure
by Deborah Borchers, M.D.
Q:"The child we're adopting may have been exposed to alcohol prenatally. What should we watch for? What does this mean for him?"
A:Although it's known that any prenatal alcohol consumption is not good for a developing baby, it's nearly impossible to predict a child's degree of impairment because of it. One child exposed to alcohol before birth may exhibit virtually no ill effects, while another may suffer from serious physical impairments, behavior challenges, and growth and developmental delays.
For years, the term Fetal Alcohol Syndrome (FAS) was used to label any child who was affected by alcohol prior to birth. Now it's used for children who have certain characteristic facial features. Most specialists currently use the umbrella term, Fetal Alcohol Spectrum Disorder (FASD), to identify children who display impairment in their mental or behavioral development.
The good news is that any supports you provide will make a difference for this child. Current research is showing that FASD is a condition for which "nature helps nurture." Although every child exposed to alcohol before birth is at risk for delays and challenges, the environment into which he's placed can have a positive, lasting impact. In other words, adopting this child and meeting his individual needs will be the first steps to minimizing the effects of any prenatal alcohol exposure, and will give him the best chance for as normal, productive, and happy a life as possible.
Physical and mental indicators
Many changes can take place in a developing fetus exposed to alcohol in the womb. Typical FAS facial features include a small head size, narrow eye openings, a relatively thin upper lip and flat cheekbones, and an elongation of the ridge between the nose and the mouth (which is known as the philtrum). The child may be born at a very low birth weight, and continue to be small (both in height and weight) for his age as he grows.
Fantastic Antone Succeeds: Experiences in Educating Children with Fetal Alcohol Syndrome, edited by Judith Kleinfeld and Siobhan Wescott (University of Alaska Press)
The Broken Cord: A Familyís Ongoing Struggle with Fetal Alcohol Syndrome, by Michael Dorris (HarperCollins)
National Organization on Fetal Alcohol Syndrome, nofas.org.
Children exposed to alcohol in utero are also at increased risk for spina bifida, hearing loss, cerebral palsy, heart defects, and cleft lip and palate.
Prenatal alcohol exposure can also affect the brain, causing developmental delays and behavioral problems. Delays may express themselves as learning disabilities, attention deficit/hyperactivity disorder, problems with language and memory, or mental retardation.
In the behavioral realm, infants may be unusually irritable, present significant sleep or eating problems, or have difficulty tolerating much stimulation. School-age children are more likely to have difficulty controlling anger, to display poor judgment, and to have little understanding of social expectations. In adolescence, mental illness and alcohol and substance abuse are more likely to occur than in the general population.
Diagnosis and treatment
Unfortunately, there is no definitive diagnostic test for either condition. Children with FAS can generally be identified soon after birth. If there are no physical signs, FASD is more difficult to diagnose. Itís quite common for children to go undiagnosed, and so untreated, until nine or 10, when behavioral or neurological problems become more apparent.
Because you know that FASD is a possibility, however, your child won't be at risk for the disadvantages of a late diagnosis. You can work with a specialist and watch for symptoms from the child's birth, and make use of free Early Intervention evaluations and services as he grows. Your child may also need speech, occupational, or physical therapy, as well as special-education services at school.
Deborah Borchers, M.D., is a founding member of the American Academy of Pediatrics Section on Adoption and Foster Care, and the mother of three adopted children.
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