Fetal alcohol syndrome

A fetal alcohol syndrome is associated with multiple impairments of cognitive and somatic development of the child and manifests itself as a result of alcohol consumption during pregnancy. With a frequency of about 1 in 500, fetal alcohol syndrome is one of the most common causes of intellectual disability (before Down's syndrome).

What is Fetal Alcohol Syndrome?

As fetal alcohol syndrome (or Alcohol embryopathy) are multiple impairments of the physical and psychological development in children as a result of alcohol consumption during pregnancy.

In most cases, a fetal alcohol syndrome manifests itself in the form of short stature, microcephaly and typical facial anomalies such as blepharophimosis (narrowing of the eyelids), sunken nasal roots, epicanthus (skin folds in the area of ​​the eyelids), narrow red lips, deep-set ears, high palate and other dysmorphisms (malformations) on the skeleton, heart, genitals, blood vessels or kidneys.

In addition, behavioral abnormalities (hyperactivity, attention and concentration disorders) and general mental or psychomotor developmental retardation are characteristic symptoms of fetal alcohol syndrome.

causes

The fetal alcohol syndrome can be traced back to the mother's alcohol consumption during pregnancy, although no direct correlation between the amount and the extent of the impairment has yet been demonstrated.

As a potentially toxic substance, alcohol can cross the placental barrier. Since children only have their own fully functional metabolism (metabolism), in particular for the breakdown of alcohol and its metabolites (including acetaldehyde), only after birth, the organism of the affected child cannot break down these toxins.

As a result of the poisoning, the developmental disorders and organic malformations characteristic of a fetal alcohol syndrome appear. It is also assumed that the mother's consumption of alcohol not only has an inhibitory effect on mitosis (cell division) in the child, but also has a damaging effect on the Purkinje cells of the embryonic cerebellum, which are responsible for the development of balance and muscle coordination.

The causes of alcohol-related intrauterine damage such as fetal alcohol syndrome have not yet been precisely clarified, despite intensive research.

Symptoms, ailments & signs

Fetal alcohol syndrome (FAS) is characterized by malformations and deficiencies in children. The following abnormalities can occur in the head area, such as microcephalus, ptosis or epicanthus. A philtrum is also possible, which means that the furrow between the nose and mouth is only weakly pronounced or completely absent. Sometimes the upper lip is thin and the lower jaw is underdeveloped. Short stature can already be seen in the womb.

Furthermore, skeletal malformations such as a funnel chest or a general reduction in the basic tension of the skeletal muscles (muscular hypotonia) are conceivable. The internal organs can also be affected by malformations such as heart defects or malformations of the kidneys. In addition to mental retardation, psychomotor restlessness is a well-known symptom of the disease. Many patients suffer from ADHD (attention deficit / hyperactivity disorder) in addition to FAS.

Information processing and perception are impaired. This leads to social withdrawal, activity, fear of new situations, exploitation and easy influence. Impulse control disorders that lead to aggressive behavior can also affect social life. Furthermore, hearing and visual disturbances can occur. Adult patients are also prone to depression, addictions and abnormalities in sexual behavior

Diagnosis & course

Fetal alcohol syndrome is diagnosed based on its characteristic symptoms. If necessary, the mother's alcohol abuse can be detected in the context of the anamnesis or by a blood analysis (liver enzymes, ferritin). Imaging methods such as sonography and magnetic resonance tomography can detect impairment of cerebral structures such as dysplasias (undesirable developments) of the cerebellum or the ventricular system as well as damage to the kidneys.

Cardiological diagnostic procedures (EKG, cardiac catheter) allow statements to be made about possible malformations of the heart. In addition, development tests and neuropsychological test methods enable an assessment of the cognitive, motor, social and linguistic abilities of the child concerned.

The fetal alcohol syndrome must be differentiated from Edwards syndrome (trisomy 18), Dubowitz syndrome or triplody by means of cytogenetic examinations. The prognosis and course of a fetal alcohol syndrome depend largely on the extent of the specific impairment present. Only a fifth of children affected by fetal alcohol syndrome can attend a normal school, while over 30 percent are severely disabled.

Complications

Due to the fetal alcohol syndrome, there are various complications in newborns. As a rule, the children suffer from malformations and mental retardation and are therefore relatively severely restricted in their everyday life and in their entire life. In fetal alcohol syndrome, growth disorders are the primary cause.

This means that the children can suffer from short stature or from malformations of the extremities. Concentration is also weakened, and many patients suffer from ADHD. In some cases, unfounded aggressiveness appears in the child. The consumption of alcohol damages the heart muscle of the child, so that in the course of life it can lead to disorders of the cardiovascular system and a heart attack.

Fetal alcohol syndrome cannot be treated directly because it manifests in the womb. However, it is possible to treat the heart defects and other malformations and disorders. If treatment begins early, there are usually no noticeable negative side effects.

The physical and mental disabilities can be alleviated with various therapies. However, a complete cure is not possible. The fetal alcohol syndrome is often a great burden for the parents and leads to psychological complaints for them too.

When should you go to the doctor?

This syndrome definitely needs treatment. The earlier the alcohol addiction of those affected is restricted, the higher the chances of a positive course of the disease. All symptoms of this disease can then possibly be restricted. A doctor should be consulted if the patient consumes alcohol during pregnancy.

The addiction can be combated in the context of withdrawal. Psychologists and various clinics can also offer support here. Furthermore, the help of friends and acquaintances is very helpful. A doctor should then be consulted if the child is suffering from the symptoms of the syndrome.

The symptoms can be very diverse, mostly they are malformations or disorders in development. The earlier these complaints are diagnosed, the higher the likelihood of a cure. Disturbances of growth and concentration should always be examined by a doctor.

Unfounded aggressiveness or mental and psychological disabilities can also be symptoms. In most cases, the diagnosis of the disease is made by a pediatrician or a general practitioner. The treatment depends on the severity of the individual symptoms and is carried out by different specialists.

Doctors & therapists in your area

Treatment & Therapy

Fetal alcohol syndrome cannot be treated causally. Somatic impairments such as facial anomalies (e.g. cleft palate or lip) or organic malformations (heart defects) as well as visual and hearing disorders can in some cases be corrected surgically.

If the context and environmental conditions are favorable, the development deficits can be partially compensated or existing potentials activated. To compensate for cognitive, linguistic, psychomotor and / or social undesirable developments, early childhood support measures are required, which usually consist of physiotherapy (sensorimotor skills), occupational therapy (action skills through occupational therapy), speech (tongue motor skills, saliva control) and dysphagia therapy (swallowing therapy), music therapy , Hippotherapy (therapeutic riding), motopedia (movement therapy) and sensory integration in the case of insufficient processing of external stimuli or disorders of the sensory organs.

Excessive “therapy” of the affected child should be avoided. In addition, integration aids such as school support for children with fetal alcohol syndrome are recommended. In the case of pronounced hyperactivity or ADHD as a result of the fetal alcohol syndrome, psychotropic drugs such as methylphenidate (including Ritalin, Medikinet.) Are also used in some cases.

In addition, the family or social environment of the affected children, around two thirds of whom grow up in homes or in foster families, should be comprehensively informed and advised on the specifics of the fetal alcohol syndrome and, if necessary, psychologically supported.

Outlook & forecast

Fetal alcohol syndrome is an incurable condition. The mother's alcohol consumption during pregnancy causes permanent and irreparable damage to the unborn child. In most cases, the specific mental and physical impairments remain lifelong. The behavioral and developmental disorders are long-term irregularities that require individual assessment. The prognosis therefore depends on the extent of the disorders present and is different for each patient.

With early treatment and support of the child immediately after birth, optimizations can be achieved that contribute to an improved lifestyle. In severe cases, however, even in adulthood, the patient is unable to cope with life independently without the help of nursing staff or relatives. Children with fetal alcohol syndrome often have to be hospitalized for a longer period of time.

In the first two years of life in particular, they increasingly suffer from infectious diseases or developmental disorders that require medical attention. In the case of malformations, surgical interventions are carried out to alleviate the symptoms. Since the mother's alcohol consumption in a large number of cases indicates a social problem for the parents, it must also be clarified where the child is best looked after. If the parents cannot take care of themselves adequately, a stay in foster families or homes is required.

prevention

Fetal alcohol syndrome can be avoided by completely abstaining from alcohol during pregnancy. An individual and societal education about the risks of alcohol consumption during pregnancy as well as early prevention or treatment of alcohol abuse represent more far-reaching preventive measures for fetal alcohol syndrome.

Aftercare

The options for follow-up care are severely limited in most cases of alcohol syndrome. The alcohol syndrome should be treated even before the child is born so that there are no defects and malformations on the child's body. The other defects after the birth can only be treated symptomatically, but not causally, so that a complete healing usually cannot occur.

The follow-up care itself is based on the exact symptoms and their severity that occur in the child. In most cases, the children are dependent on physiotherapy or physiotherapy. Many of the exercises from such therapies can also be performed on your own in your own home, which accelerates healing.

Furthermore, it is not uncommon for drugs to be taken to alleviate the symptoms. It is important to ensure the correct dosage and regular intake in order to permanently alleviate the symptoms. Most patients with alcohol syndrome are also dependent on psychological treatment and need help and support from friends and family in their everyday lives. The life expectancy of the child is also reduced in many cases.

You can do that yourself

In fetal alcohol syndrome, the alcohol consumption of the pregnant woman leads to physical and mental impairment of the child. What the patients or those responsible for caring for the affected children can do themselves depends on the specific symptoms and the severity of the disability.

If the child's cognitive abilities are impaired, adequate early intervention is important. Targeted educational and psychological support measures can have a positive effect on the child's mental development. If the child has difficulty speaking, speech therapy should be started in good time under the guidance of a speech therapist. This can also help the child to improve the often impaired tongue motor skills and saliva control.

Physical deficits, especially underdevelopment of various muscle groups or motor disorders, can at least partially compensate for development deficits through physiotherapy. Occupational therapy approaches, which are aimed at improving the ability to act in everyday life, promote age-appropriate development.

Very often the children cannot attend a normal primary school. Even many kindergartens are unable to provide adequate care for those affected. The people who are responsible for caring for a child with fetal alcohol syndrome must therefore take care of (pre) school integration in good time.

If the children suffer mentally from their disability, especially from their often conspicuous external appearance and the reaction of the environment to it, a child psychologist should be consulted in good time.