Alcohol Effects on a Fetus

Exams and Tests

Evaluation of the child

A pediatrician often diagnoses fetal alcohol spectrum disorder (FASD) from a combination of:

• Medical histories of both the mother and the child. The mother is asked how much and how often she drank alcohol while she was pregnant. The child's medical history includes a review of growth charts and questions about his or her patterns of learning, behavior, and physical skills, such as eye-hand coordination.
• Physical exams of the child. Height, weight, and head measurements are regularly taken and documented. A doctor also evaluates the child for typical physical features that can result from alcohol exposure, such as distinctive facial features.

The doctor may order an ultrasound to look for problems before the baby is born, such as heart defects or irregular growth patterns. The cause of problems that are detected during the ultrasound may not be clear, but they can alert a doctor to any special care a baby may need after he or she is born. If the child's doctor knows about the mother's alcohol consumption, he or she can screen a newborn for FASD and follow up closely with the child to catch problems as early as possible.

Problems related to FASD range from mild to severe. It may take several years to identify the cause of a child's problems. Mild symptoms may not be noticed until a child reaches school age, when behavior and cognitive problems often become more noticeable.

A child who has a severe type of FASD (fetal alcohol syndrome [FAS] or fetal alcohol abuse syndrome [FAAS]) can be diagnosed in the first 2 to 3 years of life, sometimes soon after birth. A child with FAS has:²

• Certain facial features, which include a small head, flat face, narrow eye openings (slits), a short upturned nose, a flattened groove between the nose and the upper lip (philtrum), and a thin upper lip.
• Slowed growth. Children with FAS are at or below the 10th percentile for height or weight (or both) before or after birth. This means that these children are shorter and weigh less than 90 out of 100 children who are the same age and sex. In general, a birth weight of less than 2500 g (5.5 lb) is considered low. Before a baby is born, his or her height and weight can be estimated by using an ultrasound.
• Central nervous system abnormalities. Signs may include a small head size. Certain behavior and thinking and reasoning (cognitive) problems may also mean there are central nervous system problems.

If behavior problems related to FASD are suspected in an older child, the parents and/or teachers (or day care providers) may be asked to complete a behavior checklist questionnaire. A chromosome analysis, genetic testing, and a complete developmental evaluation may be needed to rule out other causes of the symptoms.

Even if no symptoms are present, any baby whose mother is known to have consumed alcohol heavily (5 or more drinks on at least one occasion) while she was pregnant needs to have a thorough evaluation at about 18 months of age. The child is then checked regularly until about age 3 years for signs of alcohol effects. During these evaluations, the child's language skills, cognitive abilities, and adaptive skills are assessed.

Evaluation of the mother

If you drank alcohol while you were pregnant and you are concerned about whether to have your child evaluated for fetal alcohol spectrum disorder (FASD), talk with your child's doctor. The information you give can help the doctor detect and treat any problems in your child as early as possible.

If you are not able to talk openly with your current doctor, consider finding another doctor with whom you feel more comfortable. Your doctor should treat you with respect and be willing to work with you to find out whether your child is at risk for FASD. He or she should also make an effort to help you address and manage any alcohol-related problems you have. Call your local hospital or community referral centers for suggestions on finding a doctor.

If a doctor suspects that you have a problem with alcohol, you may be asked to complete a questionnaire, such as the T-ACE or CAGE test. If these tests indicate that you do have a problem, you may be referred to an alcohol treatment center for further evaluation and treatment.

Having these tests and getting treatment, if needed, for alcohol dependence or alcohol abuse may help prevent FASD for any children you have in the future.

A proper and timely diagnosis of problems related to FASD is important for your child to receive the best treatment. The diagnosis can also help other people who are involved in your child's care and education to understand his or her problem areas and needs.

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Author:	Debby Golonka, MPH	Last Updated: March 17, 2009
Medical Review:	Michael J. Sexton, MD - Pediatrics William Gilbert, MD - Perinatology
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