Fetal Alcohol Syndrome

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What is Fetal Alcohol Syndrome?
  • Fetal alcohol syndrome (FAS) is a birth defect that can occur in a person whose mother consumed alcohol while pregnant. FAS is encompassed in Fetal Alcohol Spectrum Disorders (FASDs), which refer to the variety of effects that can occur to a baby while in utero as a result of alcohol consumption by the mother. The effects vary considerably from mild to severe based on the individual.

  • FAS is the disorder which represents the severe end of the spectrum. This disorder is characterized by a pattern of physical and mental birth defects—including behavioral problems and learning disabilities—that may occur during embryonic and fetal development as a result of alcohol consumption by the mother.


Cause and Prevention
  • FAS is the direct result of alcohol consumption during pregnancy, and is therefore completely preventable. There is no genetic or hereditary cause for the disorder.

  • While ingestion of alcohol during pregnancy does not always result in FAS, there is no known amount of alcohol or type of alcohol considered safe for consumption during pregnancy. There is also no time during the pregnancy that is safe to consume alcohol, though the timing and duration of alcohol consumption during the pregnancy may impact the effects on the developing embryo. (Centers for Disease Control and Prevention, 2009).

  • The more the mother drinks during pregnancy, the greater the risk of birth defects (Mayo Clinic, 2009). The birth defects may vary depending on the timing of alcohol consumption during the development of the unborn baby. During the first trimester of pregnancy many important parts of the fetus are in key stages of development; these parts include the facial features, the heart and other organs, bones, and the central nervous system. Impairments to these parts may occur as a result of drinking alcohol during this time. Alcohol may affect the brain of the fetus at any time during pregnancy (Mayo Clinic, 2009).

  • Statistics show that half of pregnancies in the United States are unplanned, and therefore many women drink alcohol early in the pregnancy before they become aware that they are pregnant. It is not unusual for a woman to not know she is pregnant for several weeks or more, which is why abstaining for alcohol during times when she may become pregnant is so important (Centers for Disease Control and Prevention, 2004).

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Blood Traveling Through Mother's Placenta to Baby
Alcohol travels through this path and affects the baby's development, particularly the heart and brain.
(Wood, 2009.)



Prevelance
  • “It's estimated that each year in the United States, 1 in every 750 infants is born with a pattern of physical, developmental, and functional problems referred to as fetal alcohol syndrome (FAS).” (KidsHealth)


Symptoms of FAS may include:
  • • Poor growth while the baby is in the womb and after birth (markedly smaller than average, relating to height/weight)
  • • Decreased muscle tone and poor coordination (problems with sucking as an infant)
  • • Mental Retardation, diminished intellectual potential, or low IQ
  • • Behavioral problems, hyperactivity, poor memory, learning disabilities and poor attention span (ADD).
  • • Delayed development and significant functional problems in thinking, speech, movement or social skills
  • • Heart defects such as Ventricular Septal Defect (VSD) or Atrial A Septal Defect (ASD)
  • • Vision or hearing problems
  • • Structural abnormalities in facial features, including:
    • o Small eyes, shorter in width, giving the eyes a wide spread appearance on the face
    • o Small head
    • o Small upper jaw
    • o Smooth groove in upper lip
    • o Smooth and thin upper lip
    • (Centers for Disease Control and Prevention, 2009)


Effects of FAS & Systems Review
  • A developing fetus metabolizes alcohol more slowly than the body of an adult, causing higher blood alcohol concentrations in the fetus than those found in the mother’s blood stream. The presence of alcohol in utero also interferes with the delivery of oxygen and optimal nutrition to the baby's developing tissues, organs and brain (Mayo Clinic, 2009).

  • The following sections outline the effects of FAS on several anatomical systems in the body; these systems are involved in speech production and communication capabilities. It is important to note that this birth defect (FAS) does not manifest in all of the systems listed, or to the same degree in each system.


Effects on CNS
  • The effects of FAS on the Central Nervous System (CNS) are more profound than the effects it has on the others systems in the body. The FAS related problems found in the CNS fall into three categories: structural, neurological or functional (Centers for Disease Control and Prevention, 2010).

  • Structural problems refer to abnormalities in structure of the brain (Centers for Disease Control and Prevention, 2010). Damage to the CNS as a result of alcohol exposure during pregnancy may cause the child to have less brain volume and smaller head circumference (known as microcephaly) (Mayo Clinic, 2009). FAS may also lead to brain malformations and fewer numbers of brain cells, or fewer neurons, that are able to function correctly. Consequently, there are many problems with cognitive abilities and over all brain function, which appear as neurological and functional problems in the CNS.

  • The neurological problems in the CNS include poor coordination, poor muscle control, and problems with sucking as an infant. These problems are considered to be the result of FAS, if they cannot be attributed to another cause (Centers for Disease Control and Prevention, 2010).

  • The functional effects of FAS refer to deficits, problems, or abnormalities in functional CNS skills (Centers for Disease Control and Prevention, 2005); the ability to function for people with FAS is far below the normal expectations for their age, schooling and circumstance (Centers for Disease Control and Prevention, 2010). These problems include developmental delays, intellectual impairment (ex. low IQ), developmental disorders, learning disabilities, attention deficit or hyperactivity, motor functioning delays (gross motor skills and fine motor skills), behavioral problems, problems with social skills, and poor judgment and reasoning (Centers for Disease Control and Prevention, 2005).

  • Excessive fluid in the brain, known as Hydrocephalus is also a possible outcome of FAS, as well as Anencephaly or absence of the brain. “Speech delay and language deficits, such as difficulties in word comprehension, naming ability, articulation, expressive and receptive language skills, and articulation disorders, are also typical.” (Godel, 2002).

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Effects on the Articulatory System
  • As seen in the picture below, FAS can cause altered facial features. Some of these abnormalities may affect the articulatory system, such as a flattened philtrum (midline ridge between nose and lip), a thin upper lip, and abnormalities involving the ears and mouth (palate and teeth).

  • In addition to the structural effects of FAS on the articulatory system, several effects on the CNS may act as secondary effects upon the ability of the person with the disorder to articulate speech (their ability to use their articulatory system adequately).

  • The significant problems with gross and fine motor skills—particularly tongue thrusting—, and cognitive abilities as a result of damage to the CNS, can make articulation of speech particularly difficult for people with the condition (Centers for Disease Control and Prevention, 2010).

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Effects on Auditory System
  • “Hyperacusis (abnormal acuteness of hearing) is common in infants with FAS, and approximately one third of these infants have a conductive hearing loss and another one-third have a sensorineural hearing loss.” (Health Encyclopedia)

  • “Fetal Alcohol Syndrome (FAS) is associated with four kinds of hearing disorders: developmentally delayed auditory fuction, sensorineural hearing loss, intermittent conductive hearing loss owing to recurrent serious otitis media, and central hearing loss. Speech and language pathologies also are common in FAS patients. Although auditory and vestibular systems arise from similar embryological tissue, vestibular dysfunction is variable in FAS.” (Church, M.W., 1998)


Effects on the Respiratory System
  • The respiratory system is not one of the primary systems affected by Fetal Alcohol Syndrome (FAS). Though it is possible for FAS to result in problems with lung function, it is not one of the typical effects seen in people with the disorder. Therefore, problems with respiratory function are not considered to be part of the pattern of characteristics seen in people with FAS.


Effects on Phonatory System
  • The phonatory system is not one of the anatomical systems highly affected by Fetal Alcohol Syndrome. Like the respiratory system, problems with the phonatory system are not considered to be part of the pattern of characterizes seen in people with FAS.


The Overall Effects of Fetal Alcohol Syndrome on Speech Production
  • The combined effect of deficits in the central nervous system, auditory system and articulatory system, as listed in the descriptions above, can cause profound difficulties in speech production for someone with FAS. Damage to the nervous system resulting in fewer neurons in the brain, can impact the ability of the individual to develop auditory pathways and processing sites in the brain during the early years of life when these parts of the nervous system should be forming. This can result in difficulty processing auditory information throughout life. As a result of auditory processing disorders, sounds may not be perceived by the brain, and therefore often lead to significant speech delays and comprehension.

  • Additionally, poor coordination and muscle control can make articulation of sounds particularly difficult. Muscle control contributes to speech production because speech uses the muscles of the face, jaw, neck and tongue to help produce the correct sounds. Behavioral problems, attention deficit disorders, lower IQ and developmental delays (also outcomes of damage to the nervous system) can make participation in therapy sessions and recognition of the need for treatment more challenging.

  • Furthermore, damage to the articulatory system is often a result from damage of the nervous system as well as structural abnormalities. Delayed gross and fine motor skills, (particularly tongue thrusting), can make articulation of speech difficult in those with normal system structures. If these motor problems exist in addition to structural problem commonly seen with FAS, such as flattened philtrum (midline ridge between nose and lip), a thin upper lip, and abnormalities involving the ears and mouth (palate and teeth), the ability to use articulators for the production of speech sounds can be especially difficult.

  • Lastly, damage to the auditory system resulting in hearing loss can be detrimental, because hearing is a big part of speech production. Without proper hearing, the person may not be able to hear how to pronounce and produce the speech sounds correctly, causing delayed speech and speech impediments. Speech language pathologists are often needed to help those suffering from FAS.



References

A.D.A.M. (1997-2010). Fetal Alcohol Syndrome. Retreived June 15, 2010, from


American Family Physician, Fetal Alcohol Spectrum Disorder: An Overview. Retrieved June 16, 2010 from

Centers for Diseases Control and Prevention. (October 28, 2005).

Centers for Disease Control and Prevention. (August 24, 2009). Fetal Alcohol Spectrum Disorders (FASDs):

Church, M.W.; Abel, E.L., (1998, March). Fetal Alcohol Syndrome. Hearing, Speech, Language, and Vestibular
  • Disorders. Obstetrics & Gynecology Clinics of North America, 25 (1), 85-97.

Godel, Dr. John. (2002, March). Fetal Alcohol Syndrome.
  • Paediatric Child Health, 7(3): 161–174.

Health Encyclopedia - Diseases and Conditions, Fetal Alcohol Syndrome, Retrieved June 15, 2010, from

Hope By the Sea, Fetal Alcohol Syndrome Will Be Front And Center In The Supreme Court . Retrieved June 16,

KidsHealth. (1995-2010). Fetal Alcohol Syndrome. Retrieved June 15, 2010, from

Mayo Clinic Staff. (May 22, 2009). Fetal Alcohol Syndrome: Causes.

Mayo Clinic Staff. (May 22, 2009). Fetal Alcohol Syndrome: Symptoms. Retrieved from

Wood, Debra. (2009). Fetal Alcohol Syndrome. Retrieved from