Alcohol Effects on a Fetus

Topic Overview

What effect does alcohol have on a fetus?

A woman who drinks alcohol while she is pregnant may harm her developing baby (fetus). Alcohol can pass from the mother’s blood into the baby’s blood. It can damage and affect the growth of the baby’s cells. Brain and spinal cord cells are most likely to have damage.

The term “fetal alcohol spectrum disorder” (FASD) describes the range of alcohol effects on a child. The problems range from mild to severe. Alcohol can cause a child to have physical or mental problems that may last all of his or her life.

The effects of alcohol can include:

• Odd facial features. A child may have a small head, flat face, and narrow eye openings. It may be hard to pick out one trait. But in general, a child's head and face just don't look right. This gets more obvious by age 2 or 3.
• Growth problems. Children who were exposed to alcohol before they were born may be smaller than other children of the same age.
• Learning and behavior problems.
• Birth defects. Problems can occur that involve parts of the body such as the eyes, ears, heart, bones, or urinary tract.

Heavy alcohol use during pregnancy can also lead to miscarriage , stillbirth, or a baby being born early .

How much alcohol is safe?

When a pregnant woman drinks alcohol, so does her baby. Heavy drinking (5 or more drinks on at least one occasion) during pregnancy can severely affect a developing baby. Studies do not yet show if it is safe for a pregnant woman to drink a small amount of alcohol. People react to alcohol in different ways, so no one can really say for sure how much alcohol (if any) is safe.

Although the risk is higher with heavy alcohol use, any amount of alcohol may affect your developing baby. You can prevent FASD by not drinking at all while you are pregnant. Many doctors suggest just that.

The effects that alcohol has on a developing baby depend on:

• How much, how often, and at what stage of pregnancy the mother drinks alcohol. The worst effects often are related to heavy alcohol use (5 or more drinks on at least one occasion).
• Whether the mother used other drugs, smoked, or had poor health for any reason while she was pregnant. In these cases, the child is more likely to have problems.
• Traits passed down through families. Some babies are more likely to be harmed by alcohol than others. It’s not clear why, but there may be a genetic link.

What can you do if you're pregnant and have had alcohol?

Try to talk openly with your doctor if you have had alcohol while you're pregnant. The earlier you tell your doctor, the better the chances for your child.

If your doctor knows to look for FASD-related problems while you're pregnant, he or she can watch your baby’s health both before and after birth. And the doctor will know to do more tests, if needed, as your child grows.

If you think you might have a drinking problem, talk with your doctor, counselor, or other support person. Doing this can help you to see and address how alcohol may affect many parts of your life, including your pregnancy. For more information, see the Interactive Tool: Do You Have a Drinking Problem?

The child’s father as well as friends and family members all can help the pregnant woman avoid alcohol and seek help if needed.

When are alcohol effects on a fetus diagnosed?

Signs of FASD don't always appear at birth. A doctor may be able to spot severe alcohol effects ( fetal alcohol syndrome, or FAS ) in the child at birth. But less severe effects, such as behavior or learning problems, may not be noticed until the child is in school.

Sometimes the doctor can find severe problems before the baby is born. If your doctor knows about your alcohol use, he or she can order a test ( ultrasound ) to look for signs of FAS in your baby, such as heart defects or growth delays. The cause of problems that are found during the test may not be clear. But the findings alert the doctor to any special care a baby may need after he or she is born.

What is the treatment for a child born with alcohol effects?

Caring for a child born with alcohol effects takes patience. Help for the child may include extra support in school, social skills training, job training, and counseling . Community services may be able to help your family with the costs of and emotions from raising your child.

Finding the problem early, even if the alcohol effects are mild, gives a child the best chance to reach his or her full potential in life. It may help prevent problems in school and mental health problems, such as substance abuse , depression , or anxiety .

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Frequently Asked Questions

Symptoms

Signs and symptoms of fetal alcohol spectrum disorder (FASD) include:

• Characteristic facial features. The child's head may seem small with narrow eye openings (slits), a short upturned nose, a flattened groove between the nose and the upper lip (philtrum), and a thin upper lip. These features usually become more obvious by the time a child is 2 or 3 years of age. During the teen and adult years, the characteristic facial features become less noticeable. But a larger-than-average nose may become apparent.
• Low birth weight and growth retardation. Newborns with fetal alcohol syndrome (FAS) weigh less than 2500 g (5.5 lb). Babies with less severe alcohol effects will likely weigh more but still be smaller and lighter than average.
• Central nervous system problems. Developmental delays , especially in skills that require muscle strength and coordination, may be the first sign of central nervous system problems. The child who is exposed to alcohol before birth may have tremors , poor hand grip strength, and impaired eye-hand coordination.
• Behavior and cognitive difficulties. Newborns with severe effects may be irritable, have problems sucking, and have difficulty bonding with their caregivers. During the school years, problems with attention, behavior, and learning may become apparent.
• Birth defects. Structural problems that involve the eyes, ears, heart, bones, or urinary tract can occur.
• Mental health problems. Many children and teens who have FASD have mental health problems, such as depression , panic attacks , or anxiety . ¹

The effects that alcohol has on a fetus depend on:

• How much, how often, and at what stage of her pregnancy the mother drinks alcohol. The most severe effects often are related to heavy alcohol use (5 or more drinks on at least one occasion).
• Whether the mother used other drugs, smoked, or had poor health for any reason during pregnancy. A child who is born to a mother with this profile is at increased risk for developing problems.
• Genetic traits a fetus inherits. Some fetuses are more likely to be harmed by alcohol exposure than others. The reason for this is not clear, but there may be a genetic link.

Some other conditions have symptoms that are similar to those that occur with fetal alcohol exposure. These conditions may be caused by other exposures during fetal growth, such as to seizure medicines. Children with certain genetic disorders can also develop similar traits.

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.

Treatment

Treatment for fetal alcohol spectrum disorder (FASD) depends on the age at which your child is diagnosed and his or her specific needs.

Initial treatment

After your child is diagnosed, seek care from a pediatrician who is experienced with FASD. A doctor who is experienced in treating the condition is more likely to recognize problems early and treat them more effectively. Also, he or she will likely be able to direct you to appropriate community services, such as those that specialize in counseling or educational support related to FASD.

Caring for your baby who has FASD takes patience. Your baby may be very sensitive to sights and sounds. Keeping your baby's surroundings as calm and quiet as possible can help. Feedings may also take extra time, because your baby may have problems sucking. Help develop your child's language, thinking, and reasoning skills by holding, talking to, reading to, and playing with your child often.

If you or other members of your family have an alcohol use problem , you may be directed to seek treatment. If you are the mother, stopping your alcohol use can prevent your future children from being affected. The father, friends, and family members all have roles to play to help the pregnant woman avoid alcohol and seek help if needed.

Ongoing treatment

Treatment for your child who has FASD will change as he or she grows and develops. Regular visits to your child's doctor are needed to keep track of your child's progress and identify problems.

• Toddlers and young children who have FASD need educational support to encourage and watch their development. Your child may receive physical, occupational, and speech therapy as a part of the early intervention program. Your toddler or school-aged child may need educational support, including early intervention, and help with attention, concentration skills, and social behavior.
• Older children, adolescents, and teens may benefit from social skills training, which helps them learn appropriate social behavior.
• Vocational training in the teen years helps prepare your child to hold a job. A young adult who is severely affected may need to live and work in a situation that provides supervision. But many adults with FASD can live independently.
• Counseling or medicine to treat behavior problems or mental disorders may be needed. People with alcohol effects are at increased risk for developing these types of problems, which may include attention deficit hyperactivity disorder (ADHD), depression , anxiety , or drug and alcohol dependence .

If your child has vision problems, he or she may need corrective glasses. If your child has birth defects, surgery or other therapies (such as speech therapy) may be needed.

A child's core belief about himself or herself, called self-esteem, can suffer because of the effects of fetal alcohol exposure. You can help your child develop a healthy self-esteem by encouraging a sense of belonging, confidence in learning, and a feeling of being valued.

Growth and development: Helping your child build self-esteem

Treatment if new problems develop

Seek help from your doctor if you think your child is not improving or if new problems develop. Further evaluation and referral to other community services may be needed.

Prevention of alcohol effects

Any amount of alcohol may affect your developing baby, although the risk is higher with heavy alcohol use.

No treatment can prevent alcohol from affecting your fetus . Also, no treatment can reduce the effects after a fetus has been exposed to alcohol. The damage cannot be reversed.

You can prevent FASD by not drinking during your pregnancy. The U.S. Surgeon General recommends that all pregnant women and women who are planning to become pregnant not drink alcohol. ³

Home Treatment

Talk to your doctor if you are pregnant and are concerned that your child may have effects from fetal alcohol spectrum disorder (FASD) . If you are not able to talk openly with your current doctor, think about 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-related problems. He or she should also make an effort to help you address and manage any alcohol-related problems that you may have. Call your local hospital or a community referral center for suggestions on finding a doctor or other support person.

If your child has FASD, you can help by:

• Getting treatment for any alcohol dependence or alcohol abuse problems that you or other members of your family may have. Identifying and managing alcohol problems will help you provide the stability and security your child needs to develop to his or her full potential. For more information, see the Interactive Tool: Do You Have a Drinking Problem?
• Learning how to care for your baby who was exposed to alcohol before birth. A baby with a severe form of FASD, fetal alcohol syndrome (FAS) or fetal alcohol abuse syndrome (FAAS), may be very sensitive to stimulation (touch, sounds, and light), have sucking problems, and have trouble accomplishing developmental tasks. If your baby seems irritable and colicky, try to soothe him or her in a quiet, dark room. Avoid as much as possible taking your baby to crowded or noisy places. If feeding is difficult, feed your baby smaller amounts more frequently, maybe as often as every hour. If you bottle-feed your baby, use a nipple made for a premature infant.
• Encouraging your toddler or school-age child to gain independence and to behave well. Providing structure and seeking intervention when needed are important for reaching these goals.
• Scheduling regular visits to the doctor as your child grows. These visits are important for monitoring the effects of alcohol exposure. Treating problems early can help minimize their effect on your child's development.
• Enrolling your child in an early intervention program as soon as possible. Laws in the United States protect the right to education for all children. This includes children who have trouble learning because of FASD. The laws protect a parent's right to be fully informed about educational decisions that concern his or her child. The laws also gives a parent the right to disagree with any decision. Contact your state and local education departments to find out what services your child can be a part of.
• Helping your teen or young adult adapt to greater responsibilities. A teen may benefit from social skills training, which may include professional counseling for emotional problems or a mental disorder, such as depression . Use community services, such as vocational training programs, to help your teen or young adult prepare for and find an appropriate job. A young adult who is severely affected may need to live and work in a situation that provides supervision. But many adults who have effects from alcohol exposure before birth can live independently.

A child who has FASD is at risk for low self-esteem, which is a child's core belief about himself or herself. You can help your child develop a healthy self-esteem by encouraging a sense of belonging, a feeling of being valued, and confidence in learning.

Growth and development: Helping your child build self-esteem

Help for parents

One of the most important ways you can help your child who has FASD is to take care of yourself. Talk with your doctor about resources in your community that may help you and your child. Staying positive and healthy makes it more likely you will have the strength to provide a loving, stable home. These qualities are important for your child to develop to his or her full potential.

You may need help dealing with your feelings about your child's problems. Seek counseling if you need it. For more information, see the topic Grief and Grieving.

If you are pregnant, don't drink. The U.S. Surgeon General recommends that all pregnant women and women who are planning to become pregnant not drink alcohol. ³

Get alcohol treatment if you or other members of your family have an alcohol problem. Use birth control to prevent pregnancy until after you complete treatment. For more information, see the topic Alcohol Abuse and Dependence.

Other Places To Get Help

Organizations

Related Information

• Alcohol Abuse and Dependence
• Alcohol and Drug Problems
• Grief and Grieving
• Pregnancy

References

Citations

1. Goldson E, Reynolds A (2009). Fetal alcohol spectrum disorders section of Child development and behavior. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 98–99. New York: McGraw-Hill.
2. U.S. Department of Health and Human Services (National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect) (2004). Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Washington, DC: United States Department of Health and Human Services.
3. U.S. Department of Health and Human Services (2005). Surgeon General's advisory on alcohol use in pregnancy. Available online: http://www.cdc.gov/ncbddd/fas/documents/Released%20Advisory.pdf.

Other Works Consulted

• Committee on Ethics, American College of Obstetricians and Gynecologists (2004). At-risk drinking and illicit drug use: Ethical issues in obstetric and gynecologic practice. ACOG Committee Opinion No. 294. Obstetrics and Gynecology, 103(5): 1021–1031.
• Bertrand J, et al. (2005). Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR, 54(RR–11): 1–15. [Erratum in MMWR, 55(20): 568. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5520a13.htm.]
• National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effects (2002). Defining the national agenda for fetal alcohol syndrome and other prenatal alcohol-related effects. MMWR, 51(RR-14): 9–12.
• O'Malley KD, Nanson J (2002). Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Canadian Journal of Psychiatry, 47(4): 349–354.
• Simkin DR (2005). Adolescent substance abuse. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 3470–3490. Philadelphia: Lippincott Williams and Wilkins.
• Sokol RJ, et al (2003). Fetal alcohol spectrum disorder. JAMA, 290(22): 2996–2999.
• Stoll BJ (2007). Fetal alcohol syndrome section of Metabolic disturbances. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 780–782. Philadelphia: Saunders Elsevier.

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