Foetal Alcohol Syndrome Features

South Africa is among the top three heaviest-drinking nations in the world, with the highest number of heavy drinkers and binge drinkers found in the Western Cape Province. The government estimates that alcohol abuse and its associated social and health consequences, including employee absenteeism, costs the South African exchequer over R1 billion annually. It is therefore, no wonder that so many pregnant women are drinking so much.

Foetal alcohol syndrome is growth, mental, and physical problems that may occur in a baby when a mother drinks alcohol during pregnancy. Foetal Alcohol Syndrome is a clinical diagnosis, which means that there is no blood, x ray or psychological test that can be performed to confirm the suspected diagnosis. The diagnosis is made based on the history of maternal alcohol use, and detailed physical examination for the characteristic major and minor birth defects and characteristic facial features.

Let’s not forget what the mother drinks the foetus drinks. The alcohol that the pregnant woman drinks goes directly to the developing baby at the same level of concentration. If mom's blood alcohol level is 0.2, so is the baby's. However, mom is much, much larger. Her mature liver acts to detoxify the alcohol. On the other hand, the fetus is incredibly smaller and the liver is not yet mature. Therefore, while mom might stay drunk for several hours, the developing fetus can stay drunk for three to four days.

Classic features of Foetal Alcohol Syndrome (FASD) include short stature, small head size, low birthweight and poor weight gain, microcephaly, and a characteristic pattern of facial features. These facial features in infants and children may include small eye openings measured from inner corner to outer corner, epicanthal folds small or short nose, low or flat nasal bridge, smooth or poorly developed philtrum the area of the upper lip above the colored part of the lip and below the nose), thin upper lip, and small chin. Some of these features are nonspecific, meaning they can occur in other conditions, or be appropriate for age, racial, or family background. Take a look at these pictures and we can be sure they will make you think about the effect of alcohol on our communities.

Other major and minor birth defects that have been reported include cleft palate, congenital heart defects, strabismus, hearing loss, defects of the spine and joints, alteration of the hand creases, small fingernails, and toenails. Since FASD was first described in infants and children, the diagnosis is sometimes more difficult to recognize in older adolescents and adults. Short stature and microcephaly remain common features, but weight may normalize, and the individual may actually become overweight for his/her height. The chin and nose grow proportionately more than the middle part of the face and dental crowding may become a problem. The small eye openings and the appearance of the upper lip and philtrum may continue to be characteristic. Pubertal changes typically occur at the normal time. These pictures below shows a typical cleft palate and strabismus in children, which can be connerected by surgery. Strabismus surgery is on the extraocular muscles to correct the misalignment of the eyes.

Because of the physical problems such as cleft palate and others, newborns with FASD may have difficulties with feeding due to a poor suck, have irregular sleep-wake cycles, decreased or increased muscle tone, seizures or tremors. They also experience delays in achieving developmental milestones such as:

• Rolling over
• Crawling
• Walking and talking may become apparent in infancy.
• Growing and learning normally for his/her age

Behavior and learning difficulties typical in the preschool or early school years include poor attention span, hyperactivity, poor motor skills, and slow language development. Attention deficit-hyperactivity disorder is a common associated diagnosis. Learning disabilities or mental retardation may be diagnosed during this time. Arithmetic is often the most difficult subject for a child with FAS. During middle school and high school years the behavioral difficulties and learning difficulties can be significant. Memory problems, poor judgment, difficulties with daily living skills, difficulties with abstract reasoning skills, and poor social skills are often apparent by this time. It is important to note that animal and human studies have shown that neurologic and behavioral abnormalities can be present without characteristic facial features.

There is no treatment for FASD that will reverse or change the physical features or brain damage associated with maternal alcohol use during the pregnancy. Most of the birth defects associated with prenatal alcohol exposure are correctable with surgery. Children should have psychoeducational evaluation to help plan appropriate educational interventions. Common associated diagnoses such as attention deficit-hyperactivity disorder, depression, or anxiety should be recognized and treated appropriately.

Home remedies or treatment for FASD includes proper guidance, understanding, care, patience, and support to the child. The best Fetal Alcohol Syndrome treatment is our love. No one understands the FASD patient world than his or her family. The role of the  midwife is to build trust and confidence and to encourage the women they care for, to take control of their addictions, their futures and the health and well-being of themselves and  that of their unborn baby. Our roles are to tailor education for the women and their families setting goals and plans for the future through a coordinated, comprehensive and individual service. 

Although FASD occur in every population in which women drink during pregnancy, they are more widespread in schools where alcohol abuse is prevalent. Midwives and school nurses must communicate with each other. Educational programs must consider the origin of the problem and prepare children to function in the environments in which they will live as adults.

A major focus of education should be effective communication. Just as there is a wide range of IQ and achievement among those with FAS and FAE, so is there also great variability in communication skills. Students may have apparently normal language but other who are severely affected, there will be no verbal communication at all. The majority has some verbal ability, but their language skills often appear much greater than their actual ability to communicate effectively. A child with poor verbal skills may let a teacher know that she needs help by something as subtle as moving her paper aside or something as dramatic as tearing it. Recognizing such behaviours as communication and shaping them into appropriate language is an important part of a comprehensive program. That is where the role of nurse, midwife and teacher overlap; we are all in this together to help our future generation.

Midwives should aim to inspire women to take control of their lives, give up alcohol, eat healthily, and stabilise the pregnancy to improve outcomes. This is not easy; even the most motivated of women will struggle. However, by encouraging early and continuing antenatal care and by being readily available to talk to things might change and improve as times goes on. We should focus our attention on early identification, early intervention and support services and help these people to have a stable home environment.

Sources:
Encyclopedia of Medicine, 3rd ed. | 2006
South African Medical Journal
Britannica: http://www.britannica.com/EBchecked/topic/205469/fetal-alcohol-syndrome-FAS
Youtube: http://www.youtube.com/watch?v=6o3JLlNGZe0
AAPOS: http://www.aapos.org/terms/conditions/102
CDC: http://www.cdc.gov/Features/fasd/