Alcohol can harm your baby at any stage during a pregnancy. That includes the earliest stages, before you even know you are pregnant. Drinking during pregnancy can cause a group of conditions called fetal alcohol spectrum disorders (FASDs). Children who are born with FASD can have a mix of problems, such as medical, behavioral, educational, and social problems. The kinds of problems they have depend on which type of FASD they have. The problems could include :

• Abnormal facial features, such as a smooth ridge between the nose and upper lip
• Small head size
• Shorter-than-average height
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty with attention and memory
• Learning disabilities and difficulty in school
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidneys, or bones

Fetal alcohol syndrome (FAS) is the most serious type of FASD. People with fetal alcohol syndrome have facial abnormalities, including wide-set and narrow eyes, growth problems and nervous system abnormalities.

Diagnosing FASD can be hard because there is no medical test, like a blood test, for it. The health care provider will make a diagnosis by looking at the child's signs and symptoms and asking whether the mother drank alcohol during pregnancy.

FASDs last a lifetime. There is no cure for FASDs, but treatments can help. These include medicines to help with some symptoms, medical care for health problems, behavior and education therapy, and parent training. A good treatment plan is specific to the child's problems. It should include close monitoring, follow-ups, and changes when needed.

Certain "protective factors" can help reduce the effects of FASDs and help people who have them reach their full potential. They include:

• Diagnosis before 6 years of age
• Loving, nurturing, and stable home environment during the school years
• Absence of violence around them
• Involvement in special education and social services

There is no known safe amount of alcohol during pregnancy. To prevent FASDs, you should not drink alcohol while you are pregnant, or when you might get pregnant.

Fetal alcohol spectrum disorders (FASDs) can occur in an individual who was exposed to alcohol before birth. Alcohol in the mother’s blood passes to the baby through the umbilical cord. There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer. To prevent FASDs, a woman should not drink alcohol while she is pregnant, or if there is a chance she might be pregnant.

Key Facts

• Drinking alcohol during pregnancy can cause lifelong physical, behavioral, and intellectual disabilities.
• Women who are pregnant or who might be pregnant should not drink alcohol, including women who are trying to get pregnant.
• All types of alcohol are equally harmful, including all wines and beer.
• FASDs last a lifetime. There is no cure for FASDs. But early intervention can improve a child’s development.

Prevention Tips

• Women who are pregnant or who might be pregnant should not drink alcohol. This includes women who are trying to get pregnant.
• There is no known safe amount of alcohol use during pregnancy or when trying to get pregnant.
• The best advice is to stop drinking alcohol when you start trying to get pregnant.
• It is never too late to stop drinking. Because brain growth takes place throughout pregnancy, the sooner you stop drinking, the better it will be for you and your baby.

FASDs can occur when a person is exposed to alcohol before birth. Alcohol in the mother’s blood passes to the baby through the umbilical cord.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer.

To prevent FASDs, a woman should avoid alcohol if she is pregnant or might be pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks.

It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use will improve the baby’s health and well-being.

FASDs are preventable if a baby is not exposed to alcohol before birth.

FASDs refer to a collection of diagnoses that represent the range of effects that can happen to a person who was exposed to alcohol before birth. These conditions can affect each person in different ways, and can range from mild to severe.

A person with an FASD might have:

• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty with attention
• Poor memory
• Difficulty in school (especially with math)
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidneys, or bones
• Shorter-than-average height
• Small head size
• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

Different FASD diagnoses are based on particular symptoms and include:

• Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. People with FAS have central nervous system (CNS) problems, minor facial features, and growth problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

• Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.

• Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these

• Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).

The term FASDs is not meant for use as a clinical diagnosis.

Diagnosing FASDs can be hard because there is no medical test, like a blood test, for these conditions. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FASDs, doctors look for:

• Prenatal alcohol exposure; although confirmation is not required to make a diagnosis
• Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
• Lower-than-average height, weight, or both
• Abnormal facial features (e.g., smooth ridge between nose and upper lip)

FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential.

Protective factors include:

• Diagnosis before 6 years of age
• Loving, nurturing, and stable home environment during the school years
• Absence of violence
• Involvement in special education and social services

No two people with FASDs are exactly alike. Children with FASDs can have impairments in learning, memory, behavior, social interactions, or combinations of these impairments. Some children have poor growth, including reduced head size. A minority of children with FASDs have minor facial features that reflect problems in brain growth before birth. These symptoms and features can range from mild to severe. Treatment services for people with FASDs are most effective when they address a person’s specific impairments and build upon his or her own strengths.

Early Intervention Services

There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. Early intervention services help children from birth to 3 years of age (36 months) learn important skills. Services include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an FASD or other developmental problem. In a majority of states, children with a diagnosis of fetal alcohol syndrome (FAS) are immediately eligible for early intervention services.

Even if your child has not received a diagnosis, he or she might qualify for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children younger than 3 years of age who are at risk of having developmental delays may be eligible for services. The early intervention system in your state will help you have your child evaluated and provide services if your child qualifies.

In addition, treatments such as speech therapy for language delays, or physical therapy for motor issues, often do not need to wait for a formal diagnosis.

Protective Factors

Studies have shown that some positive factors can help reduce secondary effects of FASDs and help people with these conditions reach their full potential. Protective factors include:

• Early diagnosis
  A child who is diagnosed at a young age can be placed in appropriate educational classes and get the social services needed to help the child and his or her family. Early diagnosis also helps families and school staff to understand why the child might act or react differently from other children sometimes.
• Involvement in special education and social services
  Children who receive special education geared towards their specific needs and learning style are more likely to reach their full potential. Children with FASDs have a wide range of of learning needs and behavior challenges that might need to be addressed. Special education programs can better meet each child’s needs. In addition, families of children with FASDs who receive social services, such as counseling or respite care have more positive experiences than families who do not receive such services.
• Loving, nurturing, and stable home environment
  Children with FASDs can be more sensitive than other children to disruptions, changes in lifestyle or routines, and harmful relationships. Therefore, having a loving, stable home life is very important for a child with an FASD. In addition, community and family support can help prevent secondary conditions, such as criminal behavior, unemployment, and incomplete education.
• Absence of violence
  People with FASDs who live in stable, non-abusive households or who do not become involved in youth violence are much less likely to develop secondary conditions than children who have been exposed to violence in their lives. Children with FASDs need to be taught other ways of showing their anger or frustration.

Types of Treatments

Several types of treatments are available for people with FASDs. They can generally be broken down into five categories:

• Medical Care
• Medication
• Behavior and Education Therapy
• Parent Training
• Alternative Approaches

Medical Care

People with FASDs have the same health and medical needs as people without FASDs. Like everyone else, they need well-baby care, vaccinations, good nutrition, exercise, hygiene, and basic medical care. But, for people with FASDs, concerns specific to the disorder must also be monitored and addressed either by a current doctor or through referral to a specialist. The types of treatments needed will be different for each person and depend upon the person’s symptoms.

Types of medical specialists might include:

• Pediatrician
• Primary care provider
• Geneticist/Dysmorphologist
• Otolaryngologist
• Audiologist
• Immunologist
• Neurologist
• Mental health professionals (child psychiatrist and psychologist, school psychologist, behavior management specialist)
• Opthalmologist
• Plastic surgeon
• Endocrinologist
• Gastroenterologist
• Nutritionist
• Speech-language pathologist
• Occupational therapist
• Physical therapist

Medication

No medications have been approved specifically to treat FASDs. But, several medications can help improve some of the symptoms of FASDs. For example, medication might help manage high energy levels, inability to focus, or depression.

Following are some examples of medications used to treat FASD symptoms:

• Stimulants
  This type of medication is used to treat symptoms such as hyperactivity, problems paying attention, and poor impulse control, as well as other behavior issues.
• Antidepressants
  This type of medication is used to treat symptoms such as sad mood, loss of interest, sleep problems, school disruption, negativity, irritability, aggression, and anti-social behaviors.
• Neuroleptics
  This type of medication is used to treat symptoms such as aggression, anxiety, and certain other behavior problems.
• Anti-anxiety drugs
  This type of medication is used to treat symptoms of anxiety.

Medications can affect each child differently. One medication might work well for one child, but not for another. To find the right treatment, the doctor might try different medications and doses. It is important to work with your child’s doctor to find the treatment plan that works best for your child.

Behavior and Education Therapy

Behavior and education therapies can be important parts of treatment for children with FASDs. Although there are many different types of therapy for children with developmental disabilities, only a few have been scientifically tested specifically for children with FASDs.

Following are behavior and education therapies that have been shown to be effective for some children with FASDs:

• Good Buddies – A children’s friendship training to teach individuals with an FASD appropriate social skills
  Children with FASDs often have difficulty learning subtle social skills from their own experiences; those kinds of skills are typically “learned by osmosis” on the playground, such as how to slip into a group, appropriate sharing, or dealing with teasing. This intervention uses a group format to teach age-appropriate social skills over 12 weekly sessions for parent and child. Sessions are organized around and toward each child hosting a play date with a classmate or peer.

• Families Moving Forward (FMF) program to provide support for families who deal with challenging FASD behaviors
  This intervention is most appropriate for children with severe, clinically significant behavior problems based in part on positive behavior support techniques. It is a feasible, low-intensity, sustained model of supportive consultation with a parent or caregiver (rather than directly with the child). The intervention lasts 9 to 11 months, with at least 16 every-other-week sessions, typically lasting 90 minutes each. Services are carried out by mental health providers with specialized training.

• Math Interactive Learning Experience (MILE) program to help with mathematics difficulty
  Deficits in mathematical functioning have been reported consistently among alcohol-affected individuals. The MILE program is designed to improve the child’s mathematical knowledge and skill. Children complete 6 weeks of one-to-one tutoring using specifically adapted materials (eg, vertical number line, timers, etc.) that are appropriate to their academic level. Parents also receive training on behavioral regulation techniques to optimize the child’s readiness to learn.

• Parents and Children Together (PACT) a neurocognitive habilitation program to improve self-regulation and executive function
  Building upon techniques developed from the brain injury literature, this intervention used 12 weekly sessions with parents and children to address and improve behavior regulation and executive function (that is, planning, organizing, and understanding of others). It uses a particularly engaging metaphor of “how does my engine run” to teach children awareness of their current behavioral state and specific techniques for optimizing that state for the current situation.

Parent Training

Children with FASDs might not respond to the usual parenting practices. Parent training has been successful in educating parents about their child’s disability and about ways to teach their child many skills and help them cope with their FASD-related symptoms. Parent training can be done in groups or with individual families. Such programs are offered by therapists or in special classes.

Although each child is unique, the following parenting tips can be helpful:

• Concentrate on your child’s strengths and talents
• Accept your child’s limitations
• Remember, much of your child’s challenging behavior is because of brain-based challenges rather than willful misbehavior
• Be consistent with everything (discipline, school, behaviors)
• Use concrete language and examples
• Use stable routines that do not change daily
• Keep it simple
• Be specific-say exactly what you mean
• Structure your child’s world to provide a foundation for daily living
• Use visual aides, music, and hands-on activities to help your child learn
• Use positive reinforcement often (praise, incentives)
• Supervise: friends, visits, routines
• Repeat, repeat, repeat

Families might need support from a family counselor or therapist. Parents might also benefit from local support groups, in which parents of children with FASDs can discuss concerns, ask questions, and find encouragement.

Alternative Approaches

With any disability, injury, or medical condition, many untested therapies become known and are promoted by informal networks. These therapies are referred to as alternative treatments. Before starting such a treatment, check it out carefully, and talk to your child’s doctor. Your child’s doctor will help you weigh the risks and benefits of these therapies.

Some of the alternative treatments used for people with FASDs include:

• Biofeedback
• Auditory training
• Relaxation therapy, visual imagery, and meditation (especially for sleep problems and anxiety)
• Creative art therapy
• Yoga and exercise
• Acupuncture and acupressure
• Massage, Reiki, and energy healing
• Vitamins, herbal supplements, and homeopathy
• Animal-assisted therapy

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from FASD United (formerly NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state or territory’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

If your child is younger than 3 years old, Call your state or territory’s early intervention program and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”

If your child is 3 years old or older, contact your local public school system.
Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Prenatal Alcohol Exposure…

...is associated with an increased risk of miscarriage, stillbirth, prematurity, and sudden infant death syndrome (SIDS), as well as fetal alcohol spectrum disorders (FASD).

FASD is a term for a range of lifelong conditions that can occur in individuals who were exposed to alcohol before birth and often lead to disability.

Children with FASD are more likely to:

• Have low birthweight.
• Have problems eating and sleeping.
• Have problems with vision and hearing.
• Have trouble following directions and accomplishing everyday tasks.
• Have difficulty paying attention and learning in school.
• Have cognitive and academic problems and need special educational services.
• Have trouble controlling their behavior and getting along with others.
• Have behavioral and medical issues that can become apparent at different life stages.
• Be prone to develop alcohol and other substance use disorders later in life.
• Often need extra medical and behavioral care, assistance, and social support throughout life.

Here are some questions you may have about alcohol and drinking while you are pregnant.

1. Is it all right to drink alcohol if I am pregnant?

No. A developing baby is exposed to the same concentration as the mother during pregnancy. There is no known safe amount of alcohol consumption for women who are pregnant, including early in pregnancy when a woman may not know that she is pregnant.

2. Are some kinds of alcohol less harmful than others?

No. Exposure to alcohol from all types of beverages–including beer wine, hard seltzer, hard cider, alcopops, distilled spirits (liquor), and mixed drinks–is unsafe for developing babies at every stage of pregnancy. A glass of wine, a can of beer, and a shot of liquor all have about the same amount of alcohol. Cocktails (mixed drinks) may have twice as much alcohol as these other beverages.

3. What if I drank during my last pregnancy and my child was fine?

Every pregnancy is different. Alcohol exposure before birth may harm one child more than another. You could have one child that is born healthy and another child born with problems. Some intellectual and behavioral problems related to FASD may not be apparent initially and can appear at any time during childhood.

4. Does FASD have lifelong effects?

Yes. Although some of the lifelong effects of FASD can be recognized early, other issues become apparent later in life. While early diagnosis and treatment can improve the child's health and behavior, there is no cure for FASD currently.

5. What if I am pregnant and have been drinking?

If you drank alcohol before you knew you were pregnant or before you knew that alcohol could harm your baby, stop drinking now. Every day matters. The sooner you stop drinking, the better for your baby.

6. How can I stop drinking?

If it is hard for you to stop drinking, talk with your healthcare provider about getting help. There are a variety of treatments that can help you. Options for pregnant women include behavioral treatments and mutual-support groups. Your healthcare provider may be able to help you determine the best option for you.

Treatment is an ongoing process. Even if you have been through treatment before, don't give up.