CHILDREN'S HEALTH Birth Defects • Down syndrome • Fetal alcohol syndrome • Phenylketonuria • Ambiguous genitalia • Rett syndrome • Cleft lip and cleft palate • Familial Mediterranean fever • Clubfoot

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If you drink alcohol while you're pregnant, your fetus has a drink as well. This puts your baby at risk of a serious condition called fetal alcohol syndrome (FAS), which is a group of birth defects. These defects are irreversible and can include physical, mental and behavioral problems.

FAS affects about three out of every 1,000 births, causing an estimated 12,000 children to be born with the condition each year in the United States. Although doctors aren't sure how much alcohol you'd have to drink to place your baby at risk, the more you drink, the greater the chance of problems developing — possibly even before you realize you're pregnant. Don't drink alcohol if you're pregnant or at risk of becoming pregnant.

If you suspect that your child has FAS, talk to your doctor as soon as possible. Early diagnosis reduces the risk of problems in life associated with FAS, including troubles at school, with substance abuse and with the law. If your child has FAS, your doctor can help you locate special school and community services designed to help your child succeed.

Fetal alcohol syndrome isn't a single birth defect. It's a cluster or pattern of related problems. The severity of signs and symptoms varies, with some children experiencing them to a far greater degree than others. Moreover, the facial features seen with fetal alcohol syndrome may also occur in normal, healthy children. Facial features of fetal alcohol syndrome are especially difficult to identify in preschool-age children. Distinguishing normal facial features from signs of fetal alcohol syndrome in children of varying ethnic backgrounds requires the expertise of a doctor. Signs of fetal alcohol syndrome may include:

• Distinctive facial features, including small eyelid openings, a sunken nasal bridge, an exceptionally thin upper lip, a short, upturned nose and a smooth skin surface between the nose and upper lip
• Small teeth with faulty enamel
• Heart defects
• Deformities of joints, limbs and fingers
• Slow physical growth before and after birth
• Vision difficulties including nearsightedness (myopia)
• Small head circumference and brain size (microcephaly)
• Mental retardation and delayed development
• Abnormal behavior such as a short attention span, hyperactivity, poor impulse control, extreme nervousness and anxiety

Doctors may use other terms to describe some of the signs of fetal alcohol syndrome. Alcohol-related neurodevelopmental disorder (ARND) refers to the mental and behavioral impairments that occur as a result of fetal exposure to alcohol. Alcohol-related birth defects (ARBDs) refer to the physical defects that occur from fetal alcohol exposure.

When you drink alcohol, it enters your bloodstream and reaches your developing fetus by crossing the placenta. Because a fetus metabolizes alcohol more slowly than an adult does, your developing baby's blood alcohol concentrations are higher than those in your body. The presence of alcohol can impair optimal nutrition for your baby's developing tissues and organs and can damage brain cells.

The more you drink while pregnant, the greater the risk to your unborn baby. The risk is present at any time during pregnancy. However, impairment of facial features, the heart and other organs, bones, and the central nervous system may occur as a result of drinking alcohol in the first trimester, when these parts of the body are in key stages of development. In the early weeks of the first trimester, many women may not be aware that they're pregnant. Alcohol may affect the brain of the fetus at any time during pregnancy.

If you drank alcohol before you realized you were pregnant, or if you're drinking while pregnant, ask your obstetrician or other health care provider about the risks in this pregnancy. He or she can also assist you in abstaining from alcohol during pregnancy and evaluate your risk of alcoholism.

Early diagnosis significantly reduces the risk of long-term problems for children with FAS. If you drank during pregnancy, and you're worried that your child exhibits some of the physical signs and symptoms that may accompany fetal alcohol syndrome, don't delay seeking help. Ask your child's doctor whether your child may be affected by FAS.

Many children with FAS are raised by caregivers who aren't their biological parents. If you don't know your child's biological mother, you may not know whether she was drinking alcohol while pregnant — and it may not occur to you that your child may have FAS. If your child demonstrates learning and behavioral problems, talk with your doctor so that the underlying cause might be identified.

Although doctors can't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of mother and baby during pregnancy. If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome.

Knowing that you had been drinking while pregnant, your child's doctor can look for signs and symptoms of this syndrome in your child's initial weeks, months and years of life. Doctors commonly rely on these manifestations — such as growth impairment, facial malformations and the presence of heart defects — to diagnose FAS. At times doctors use a variety of tests, including evaluations of IQ and language development, to help make a diagnosis. Doctors may refer children with possible fetal alcohol syndrome to a medical genetics specialist to determine whether FAS or other problems are present.

It may be difficult for doctors to identify FAS, especially in preschool-age children. In some cases FAS may be very similar to other syndromes that have some of the same physical or behavioral characteristics. One such condition is Turner's syndrome, a chromosomal abnormality affecting girls that can impair intelligence and physical growth. Another condition that can mimic FAS is fragile X syndrome, a chromosomal mutation that causes a form of mild mental retardation in either boys or girls.

If one child in a family is diagnosed with FAS, it's important to evaluate the siblings to determine whether the same syndrome exists.

There's no cure for fetal alcohol syndrome. In general, the physical defects and mental deficiencies persist for a lifetime. Heart abnormalities may require surgery. Learning problems may be helped by special services in school. Parents often benefit from counseling to help the family with a child's behavior problems.

Doctors haven't identified a safe level of alcohol that a pregnant woman can consume. If you're in your childbearing years, be aware of the risks of FAS in your future offspring. These guidelines can help prevent FAS:

• Stop drinking alcohol altogether if you're planning to become pregnant, as soon as you know you're pregnant or if you even think you might be pregnant. Your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy.
• Continue to avoid alcohol throughout your pregnancy. FAS is completely preventable in children whose mothers don't drink during pregnancy.
• Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned. At the least, don't engage in binge drinking, which may expose the fetus to the highest amount of alcohol.
• If you're an alcoholic, don't get pregnant until you get help. Use birth control methods until you're able to control your drinking.

The psychological and emotional problems associated with FAS are difficult to manage. Families and children with FAS may benefit greatly from the support of professionals and other families who have experience with FAS. Ask your doctor or public health nurse for local sources of support for families and children with FAS.

As a parent of a child with FAS, you may find the following suggestions helpful in dealing with behavioral problems associated with the syndrome:

• Implement daily routines to which your child can become accustomed.
• Create and enforce simple rules and limits.
• Point out and use rewards to reinforce acceptable behavior.
• Because many children with FAS are naive, guard against them being taken advantage of by others. Also, encourage them to make decisions in protected environments.
• Teach your child skills for daily living.

A stable, nurturing home is the single most important factor in protecting children with FAS from some of the problems they're at risk of later in life, including drug abuse, dropping out of school and encounters with the juvenile justice system.

If you've given birth to a child with FAS, you may benefit from substance abuse counseling and treatment programs that can help you conquer your misuse of alcohol.