eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Fetal Alcohol Syndrome: Follow-up

Author: Keith K Vaux, MD, Associate Professor of Pediatrics, University of California San Diego School of Medicine; Attending Physician, Rady Children's Hospital and Health Center; Assistant Clinical Professor of Pediatrics, Uniformed Services School of the Health Sciences
Coauthor(s): Christina Chambers, MPH, PhD, Associate Professor of Pediatrics and Family and Preventive Medicine, University of California at San Diego; Assistant Professor, Graduate School of Public Health, San Diego State University
Contributor Information and Disclosures

Updated: Sep 16, 2009

Follow-up

Deterrence/Prevention

The US Institute of Medicine has outlined a public health model of prevention for fetal alcohol syndrome (FAS). This model includes 3 levels: universal, selective, and indicated.

  • Universal prevention attempts to promote the health and well-being of all individuals in a society or particular community by educating women about the risks of alcohol for the developing fetus and about the importance of avoiding alcohol consumption during pregnancy. This type of prevention can be accomplished with public education and primary care.
  • Selective prevention and intervention is targeted to individuals in the population who are at increased risk (ie, women of reproductive age who drink alcohol and who have the potential to become pregnant). This step can be accomplished with effective screening for alcohol use and with brief interventions.
  • Indicated prevention and intervention is intended for the highest-risk women who are drinking risky amounts of alcohol and who are likely to become pregnant (eg, women who have previously delivered an affected child and who continue to drink). This level of prevention and intervention might be accomplished with treating such women for alcohol dependence and with case management.

Prognosis

  • The prognosis for individuals with fetal alcohol syndrome or fetal alcohol syndrome disorder (FASD) is wide ranging. Some data suggest that having a confirmed diagnosis of fetal alcohol syndrome improves the prognosis, perhaps because this improves access to services. Other fetal alcohol syndrome suggest that early diagnosis improves the prognosis presumably because of the early intervention that results.
  • In one study, researchers followed up the natural history of a group of individuals with fetal alcohol syndrome or fetal alcohol syndrome disorder aged 12-51 years. Although no comparison group was included, rates of various mental, social, and legal problems were documented as follows:
    • Mental health problems (95%)
    • Confinement in prison, a drug or alcohol treatment center, or a mental institution (55%)
    • Trouble with the law (60%)
    • Inappropriate sexual behavior (52%)
    • Inability to live independently (82%)
    • Problems with employment (70%)
    • Alcohol and drug problems (>50% of male subjects, 70% of female subjects)

Patient Education

  • Keys to working successfully with children who have fetal alcohol syndrome or fetal alcohol syndrome disorder are structure, consistency, variety, brevity, and persistence.
  • Because children with fetal alcohol syndrome or fetal alcohol syndrome disorder lack internal structure, caretakers need to provide external structure for them.
  • Be consistent in response and routine so that the child believes the world is predictable.
  • Because of serious problems maintaining attention, be brief in explanations and directions but also use various ways to get and keep the child's attention.

Miscellaneous

Medicolegal Pitfalls

  • Failure to appropriately diagnose fetal alcohol syndrome (FAS) can pose medicolegal issues.

Special Concerns

  • Prompt and accurate diagnosis of fetal alcohol syndrome or fetal alcohol syndrome disorder (FASD) is important.
    • The best time to diagnose fetal alcohol syndrome or fetal alcohol syndrome disorder is at birth, but most cases are not diagnosed until school age. This delay is mostly because clinicians do not routinely and thoroughly gather information about maternal alcohol use in pregnancy and partly because the diagnosis may be difficult to make in the newborn period.
    • Furthermore, the characteristic facial features tend to become decreasingly recognizable as the child reaches adolescence, making diagnosis difficult after this age.
    • Children whose diagnosis is missed in infancy may be most likely recognized at age 4-6 years, when behavioral and cognitive problems become apparent. With natural maturation of the facial structures, some craniofacial features of fetal alcohol syndrome may not be as striking in adolescents or adults as in children; however, the effects of alcohol on brain structure and function remain.
  • For the reasons listed above, obtaining a careful history is of primary concern, followed by an appropriate examination of the child for characteristic features, consultation with a specialist if warranted, and referral for intervention and treatment for both the mother and child if a diagnosis is made.
 
Acknowledgments

The authors gratefully acknowledge the contributions of Christine D Dittmer, MD, and Sarah L Lentz-Kapua, MD, to the writing and development of this article.



More on Fetal Alcohol Syndrome

Overview: Fetal Alcohol Syndrome
Differential Diagnoses & Workup: Fetal Alcohol Syndrome
Treatment & Medication: Fetal Alcohol Syndrome
Follow-up: Fetal Alcohol Syndrome
Multimedia: Fetal Alcohol Syndrome
References
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Further Reading

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Keywords

fetal alcohol syndrome, FAS, FAE, fetal alcohol effects, alcohol-related neurodevelopmental disorders, ARND, alcohol-related birth defects, ARBD, partial fetal alcohol syndrome, fetal alcohol spectrum disorders, FASD, dysmorphology, midfacial anomalies, growth retardation, intrauterine growth restriction, cognitive impairment, learning disabilities, impulsiveness, alcohol consumption during pregnancy, spontaneous abortion, stillbirth, sudden infant death syndrome, ethanol, acetaldehyde, maternal alcohol consumption, fetal alcohol withdrawal, neonatal alcohol withdrawal, treatment, diagnosis

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Contributor Information and Disclosures

Author

Keith K Vaux, MD, Associate Professor of Pediatrics, University of California San Diego School of Medicine; Attending Physician, Rady Children's Hospital and Health Center; Assistant Clinical Professor of Pediatrics, Uniformed Services School of the Health Sciences
Keith K Vaux, MD is a member of the following medical societies: American College of Medical Genetics and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

Coauthor(s)

Christina Chambers, MPH, PhD, Associate Professor of Pediatrics and Family and Preventive Medicine, University of California at San Diego; Assistant Professor, Graduate School of Public Health, San Diego State University
Christina Chambers, MPH, PhD is a member of the following medical societies: International Society for Pharmacoepidemiology, Research Society on Alcoholism, Society for Epidemiologic Research, and Teratology Society
Disclosure: Nothing to disclose.

Medical Editor

Oussama Itani, MD, FAAP, FACN, Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center
Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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