Fetal Alcohol Syndrome: How you can help
“The baby has Fetal Alcohol Syndrome,” the
voice on the phone said.
“The baby has what?” Ms. Sanders asked, not sure her cell phone was
getting a clear signal.
“Fetal Alcohol Syndrome,” the nurse repeated. “It’s a
set of birth defects caused by drinking alcohol during pregnancy.”
As the nurse described the condition, Ms. Sanders began to understand. She had
been concerned about baby Jonathan from the minute his mother had enrolled him
in her child care program. Jonathan was smaller than other 6-month-olds and had
not developed enough to push up or roll over. His feedings were a struggle, and
his naps were short and fitful.
At Ms. Sanders’ urging, the mother had taken Jonathan to a doctor several
weeks ago. Now the tests were completed, and the doctor had made the diagnosis.
The nurse, at the mother’s request, was calling Ms. Sanders to explain.
“Now that we know what the problem is, we can get Jonathan some help,” the
“Yes,” Ms. Sanders said. “Let’s suggest that his family
get in touch with our local ECI program.”
What is Fetal Alcohol Syndrome?
Fetal Alcohol Syndrome (FAS) is a set of mental, physical, and behavioral birth
defects that are a direct result of alcohol use during pregnancy. If a woman
drinks wine, beer, or liquor during pregnancy, her baby could be born with FAS.
During pregnancy, a mother’s diet is her baby’s diet. When a woman
drinks, the alcohol travels from her stomach to her bloodstream. It crosses the
placenta and enters the fetus’ bloodstream. Alcohol can interfere with
normal fetal development and cause life-long defects in major organs and the
central nervous system.
Any amount of alcohol is a danger during all stages of pregnancy. During the
first three months, cells divide to form a baby’s heart, brain, and other
organs. Alcohol can interfere with cellular division and the development of these
vital organs. During the second trimester, alcohol interferes with a baby’s
physical growth. During the final trimester, a baby’s brain and nervous
system mature. Drinking alcohol at this stage can harm a baby’s brain and
result in neurological and behavioral difficulties.
After the child is born, the effects of alcohol are apparent in three areas:
growth. Babies born with FAS are typically underweight at birth. They
usually stay thinner and shorter than others their age throughout life.
features. Babies born with FAS may have characteristic facial features
including short eye openings, no grooves between the nose and upper lip, a thin
upper lip, impaired hearing and vision, limited flexibility in joints, and defects
in some organs.
nervous system damage. Results of this damage can include mental retardation,
learning difficulties, and problems with memory, perception, reasoning, organization,
coordination, and abstract thinking. Social interactions are also often affected.
Behaviors in the classroom
The behaviors of infants and toddlers may signal FAS. Babies are often tired
and irritable because of poor sleep/wake cycles. Some are medically fragile,
have poor weight gains, and difficulty nursing and sucking. Chronic ear infections
and speech delays are common. There can be delays in motor development like rolling
over, crawling, and walking.
Preschool children with FAS continue to be affected by motor delays (including
toilet learning) and medical challenges. Additionally, FAS impacts social interactions
and behavior. Children tend to be easily distracted, fidgety, and unfocused.
They sometimes have trouble identifying friends and engaging in cooperative play.
They often have difficulty with reasoning, memory, and judgment.
Difficulties continue to compound in school-age children. Often children with
FAS have trouble making and keeping friends, become isolated and lonely, and
give up on positive social interactions. Attention deficits magnify academic
problems. Boundaries are challenged and behaviors tend to be impulsive and unpredictable.
Children are easily frustrated and may resort to tantrums, manipulation, and
other destructive behaviors.
What you can do
If you suspect a child is affected by FAS, get help. Don’t rely on a child’s
physical characteristics. Many children with FAS and other alcohol-related birth
defects don’t have physical symptoms.
Instead, document your day-to-day behavioral observations in writing. Remember,
you job is to teach, not to diagnose. Your observations will help you provide
the best care, in the best learning environment.
Share your observations, gently, with the child’s parents. Again, don’t
diagnose, just share what you see. When parents understand that you aren’t
being judgmental—or feel that you are accusing them of being unfit or negligent
parents—they are more likely to share their own observations and concerns
with you. This is the beginning of cooperative problem solving.
Encourage parents to seek the help of a specialist. Early Childhood Intervention
(ECI) programs can help you and the child’s parents with early identification
of disabilities. ECI can also support the child and the family with appropriate
Children with FAS—and other alcohol-related birth defects—need the
guidance of attentive, responsive, consistent, and compassionate adults. Because
they lack internal controls, you need to provide external supports that help
them grow and learn. The following tips are appropriate to all young children.
They are key needs of children with FAS.
Routine and consistency
Establish routines so children can learn to predict coming events. For example,
lunch is always followed by toothbrushing and nap time.
Do not debate rules and routines already established. Consistency is essential
Build calming, sensory activities into the schedule, especially to precede
significant transitions—outdoors, mealtime, or a large group activity,
Give children five- and then one-minute warnings before a transition.
Avoid flickering lights or loud timers to signal transitions. If necessary,
click the classroom light off completely to direct children’s attention
to you. Turn the light back on as the group moves to a new activity.
Encourage children to use transitional objects—a toy, meaningful picture,
or even a blanket—to minimize stress.
Use colored tape to create floor paths that guide children from one activity
Set limits and follow them consistently.
Focus on teaching daily living skills.
Avoid frequent changes in the environment. Children with FAS need guidance
in learning to negotiate through the classroom and the rest of the facility—getting
to the bathroom, the kitchen, or outdoors—without getting lost.
Concrete and specific expectations
Remember to set expectations to the child’s developmental level—not
age. Adapt materials as needed.
Break activities and tasks down into small, specific steps.
Be concrete when teaching a new concept. Show—rather than just tell.
Provide a beanbag chair, rocker, or hammock to use for self-soothing. Some
children find a headset and quiet music calming and relaxing.
Avoid overstimulating activities and events. Create a quiet, peaceful learning
Help children learn to be friends. Encourage pairing with one other child rather
than the large group.
Simplicity and repetition
Get children’s attention before giving directions. Use gestures, voice,
and eye contact.
Make directions short, concise, clear, and one step at a time.
Use rebus charts, pictures, and signs to make directions concrete. Have children
repeat directions back to you.
Let the environment help you teach by making materials accessible and learning
Be attentive to food sensitivities and eating behaviors. Serve small portions
of lukewarm foods that have some texture. Don’t hurry meals and minimize
Consider using songs to reinforce and repeat directions.
Try to limit sensory overload—strong smells, hanging mobiles, and strong
air currents, for example.
Children with FAS require lots of repetition with materials and learning activities
to build a knowledge base. Often things learned one day are gone the next. Avoid
rotating materials too quickly. Instead, offer slow and subtle variations—different
colored paper for an art activity, for example.
Offer simple choices and encourage decision making.
Be realistic in your expectations. Don’t set up situations (field trips,
for example) that are too challenging. It’s unfair and unproductive to
set a child up for failure.
Establish a few simple rules. Use identical language to remind children of
the rules. “Throwing toys is not acceptable. Please go and get the puzzle
piece. I’ll sit with you while you finish the puzzle.”
Redirect inappropriate behavior. Intervene immediately—before behaviors
get out of control.
Develop and share consequences for misbehavior. Impose consequences immediately
Reinforce positive behaviors with private words of encouragement and congratulations.
Watch for signs of frustration and stress—clenched fists, reddened face,
restlessness, and inability to attend to tasks. Evaluate the situation and respond
Provide areas that help children relax and “turn off” stimulation.
Include pictures of relaxation techniques and earphones and soothing music that
can block out other classroom sounds.
Help children learn to think by making thinking as concrete as possible. Use
facial expressions, body language, charts, and self-talk to reinforce the need
to think before acting. Encourage and reinforce thinking behaviors.
Use rebus figures or photographs to chart the sequence “Stop-Calm-Think.” For
example, you can use a picture of a stop sign, a quiet forest scene, and a child’s
picture with a hand on the head.
Centers for Disease Control and Prevention. www.cdc.gov/ncbddd/fas/fasask.htm.
Duckworth, Susanna and Terry Norton. 2000. Fetal alcohol syndrome and fetal alcohol
effects—Support for teachers and families. 28 (3): 19-23.
Mitchell, Kathleen T. 2002. Washington, D.C.: National Organization
on Fetal Alcohol Syndrome. www.nofas.org.
National Institute on Alcohol Abuse and Alcoholism. www.niaaa.nih.gov.
Rattray, Jennifer. 2002. Canadian Broadcasting System. www.cbc.ca/national/news/fas/index.html.
Special thanks to Carolyn A. Smith, executive director, Texas Office for Prevention
of Developmental Disabilities, for assistance with this article.