Fetal Alcohol Spectrum Disorders (FASD) refers to a group of conditions that can affect a child if the birth mother consumed alcohol during pregnancy. Fetal Alcohol Syndrome (FAS) represents the most severe end of the spectrum. FAS is a birth defect caused by heavy consumption of alcohol during pregnancy. Damage to the fetus includes facial deformities, poor growth (weight, length and head), and impairment of the central nervous system. Drinking that occurs in the first 8 weeks of pregnancy poses the most risk, but alcohol consumption at any stage of pregnancy can be harmful.
The global prevalence of FAS/FASD is estimated to be 0.97 cases per 1000 live births. However, the prevalence tends to be higher among vulnerable populations, particularly those of low socioeconomic status. Typically, country-specific data regarding prevalence among orphan populations is widely unavailable. However, some countries, particularly former Soviet countries have a reputation for high alcohol use. Some experts estimate the prevalence of FAS/FASD among Russian orphans to be 8 times higher than the global prevalence.
FAS/FASD can be diagnosed at any age, but typically diagnosed when a child is school-aged. In the case of many adoptions, it is often not diagnosed until the child is home with their adoptive parents. With most adoptions, parents receive little information about the child’s birth mother and are unable to know if the mother used alcohol during her pregnancy.
FAS/FASD has lifelong implications, and so there are many characteristics to watch for at each age that can affect mealtimes and overall nutrition.
All these factors can make feeding and mealtimes a challenge. Under institutional care, feeding challenges may lead to low food intake and contribute to poor growth. Children with FAS/FASD are often at risk for a condition called failure to thrive . Even after a child is adopted, it can be difficult to meet calorie needs in order to stimulate desired growth.
If an infant or toddler with FAS has any nutrition-related difficulties, a visit to a comprehensive feeding team can be helpful. Feeding teams consist of a doctor, nurse, dietitian, and a speech and/or occupational therapist that specialize in feeding therapy. The team can help to address medical and behavioral needs and create a plan to help your child develop and grow to the best of his or her abilities.
For some children, catch-up growth (faster than normal rate of weight gain and length growth) can be achieved through using high calorie infant or toddler formulas as well as by adding calories to baby foods. Before introducing high calorie foods to your child’s diet, please consult your pediatrician.
Sometimes it is necessary for a child to receive tube feedings to stimulate appropriate weight gain and growth. Tube feedings can be given temporarily (weeks or months) through a tube running from the nasal passage, down the throat into the stomach, or can be given long-term (months or years) through a gastrostomy tube (G-tube) that is surgically inserted into the stomach. Tube feedings not only provide much needed nutrition to children, but also lessen the stress a family experiences while trying to feed a child who isn’t able to meet their needs on their own. More time is freed up to work on other areas of behavior and development, or to simply enjoy being together.
Children with FAS may continue to struggle with growth for a lifetime. With good intervention, a normal weight-for-length in infants (or Body Mass Index in children and adults) can be achieved even though children may continue to be small statured and have a small head size into adulthood.