Foetal Alcohol Spectrum Disorder
Foetal Alcohol Spectrum Disorder (FASD) is the term used to describe the lifelong physical and/or neurodevelopmental impairments that can result from foetal alcohol exposure. FASD is a condition that is an outcome of parents either not being aware of the dangers of alcohol use when pregnant or planning a pregnancy, or not being supported to stay healthy and strong during pregnancy.
Diagnostic categories and criteria for FASD
Diagnostic assessment for Foetal Alcohol Spectrum Disorder (FASD) can be conducted with people of all ages. However diagnostic assessment is most commonly conducted with children under the age of 18 years. Ideally a child should have a diagnostic assessment as early as possible.
A diagnosis of FASD requires evidence of prenatal alcohol exposure and severe impairment in three or more domains of central nervous system structure or function.
Key components of the FASD diagnostic assessment include documentation of:
- History – presenting concerns, obstetric, developmental, medical, mental health, behavioural, social;
- Birth defects – dysmorphic facial features, other major and minor birth defects;
- Adverse prenatal and postnatal exposures, including alcohol;
- Known medical conditions –including genetic syndromes and other disorders;
Diagnostic assessment; to assess an individual with prenatal alcohol exposure and/or suspected FASD, the following essential criteria must be considered:
- Maternal alcohol use and other exposures
- Neurodevelopmental impairment
- Facial and other physical features
Where does the diagnostic assessment happen and how long will it take?
The doctor will complete a medical assessment which will take about one hour. This will include testing hearing and vision, measuring height and weight and reviewing the documents you have brought to the appointment. During your appointment tell the doctor about the child’s strengths and weaknesses, behaviour, any memory problems and how they relate to other people. Depending on the age of the child, let them talk about their own experiences. The doctor may take a photo of the child’s face or look at the face and take measurements.
Your child may be referred to other health professionals who are skilled in doing different assessments. Make sure you have clear instructions on where each appointment is, the time of each appointment, how long each appointment may take and what to do after all the assessments have been completed.
Depending on your personal circumstances the cost will vary. In a public system the cost of each assessment may be covered but you will need to ask if there are any extra expenses. If you have a diagnostic assessment in the private system you will need to ask the clinic or doctor’s practice about the cost of all the assessments and how much is covered by Medicare. If you have private health insurance contact them to find out how much you will be able to claim.
Why is diagnosis important?
To get to know the child better; A diagnostic assessment looks at all the things a child is good at and where they need help. It gives health professionals, parents, carers, family members, teachers and the child a better understanding of how to manage and or care for the child.
To access services that can help the child; a diagnosis may help you access services in the community that best meet the child’s needs.
To answer your questions; A diagnostic assessment helps you understand more about the child. If you are wondering why the child has challenges in some areas of their life (for example, school, behaviour, memory) the diagnosis will help answer your questions.
To improve the quality of life; a diagnosis and management plan can contribute to positive long-term outcomes for the child and their family.
For more information about Foetal Alcohol Spectrum Disorder from Australian websites
Can alcohol cross the placenta to the foetus?
The placenta links the blood supply of the foetus to the blood supply of the mother and is essential to the growth of a healthy foetus. The placenta cannot keep harmful substances such as alcohol away from the foetus which is why we recommend no alcohol in pregnancy is the safest option. Because the foetus lacks the ability to process the alcohol as the liver is not fully formed, they absorb the alcohol and can have the same blood alcohol content or higher than the mother and it remains at that level for a longer period of time.
Is there a safe amount of alcohol to drink while pregnant?
As researchers we don’t know how much alcohol, if any, is safe to drink during pregnancy. Evidence shows that the level of harm is highest when there are high risk patterns of maternal alcohol use and that binge drinking is especially harmful. The reality is that many women may find it difficult to stay alcohol free during pregnancy and may need support to avoid alcohol during this time. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
Is there a safe time to drink during pregnancy?
No. Alcohol can harm a developing baby at any time during pregnancy. It can cause problems in the early weeks of pregnancy, before a woman even knows she is pregnant and right up to the end of pregnancy.
My partner and I are trying for a baby, can I continue to drink alcohol until we conceive?
It is great that you are planning your pregnancy. As you don’t know you are pregnant until confirmation which can be some weeks later, and to give your baby the best start in life the Australian Guidelines recommend if you are planning a pregnancy, not drinking is the safest option.
I’m breastfeeding, is it safe for my baby if I drink alcohol?
Alcohol in breast milk can disrupt the hormones needed to successfully breastfeed. Alcohol stays in breastmilk for as long as it remains in your bloodstream – not drinking is the safest option.
Where do the recommendations not to drink when planning a pregnancy, while pregnant or breastfeeding come from?
Recommendations are based on the latest Australian research and are included in the National Health & Medical Research Council (NHMRC) Guidelines to reduce health risks from drinking alcohol.
These updated guidelines published in 2009 aim to communicate evidence concerning these risks to the Australian community to allow individuals to make informed decisions regarding the amount of alcohol they choose to consume.
Guideline 1: Reducing the risk of alcohol-related harm over a lifetime
The lifetime risk of harm from drinking alcohol increases with the amount consumed. For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.
Guideline 2: Reducing the risk of injury on a single occasion of drinking
On a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed. For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.
Guideline 3: Children and young people under 18 years of age
For children and young people under 18 years of age, not drinking alcohol is the safest option.
- Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
- For young people aged 15−17 years, the safest option is to delay the initiation of drinking as long as possible.
Guideline 4: Pregnancy and breastfeeding
Maternal alcohol consumption can harm the developing foetus or breastfeeding baby.
- For women who are pregnant or planning a pregnancy, not drinking is the safest option.
- For women who are breastfeeding, not drinking is the safest option.
The NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol concludes:
- Not drinking alcohol is the safest option.
- The risk of harm to the foetus is highest when there is high, frequent, maternal alcohol intake.
- The risk of harm to the foetus is likely to be low if a woman has consumed only small amounts of alcohol before she knew she was pregnant or during pregnancy.
- The level of risk to the individual foetus is influenced by maternal and foetal characteristics and is hard to predict.
For more information read the NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol or go to the Frequently Asked Questions
What is a standard drink?
It is important to know what a standard drink is so that when you are drinking you can manage how much alcohol you consume. Using standard drinks to measure your alcohol consumption is more accurate than counting the number of drinks you have. In Australia, a standard drink is any drink containing 10 grams of alcohol, regardless of container size or alcohol type (e.g beer, wine, spirit).
Examples of a ‘standard drink’:
- Small glass of wine or champagne (100ml)
- Stubby of mid-strength beer
- 1 nip of spirits (30ml)
A 100ml glass of wine is a standard drink; however, the average restaurant serve is 150ml or 1.4 – 1.6 standard drinks. One can of full strength beer is equivalent to 1.4 standard drinks.
I’m male, will drinking alcohol affect my fertility?
Yes, it can. Binge drinking and regular heavy drinking may damage the function of the testicles.
As an expectant father, what can I do to support my partner to not drink during pregnancy?
Supporting your partner is most effective in helping her not to drink during pregnancy, especially through modifying your own alcohol or not drinking as well throughout your partner’s pregnancy
My friend is pregnant but she doesn’t want to tell anyone just yet. How can I support her in social situations so that she doesn’t feel pressured to drink?
Join her in not drinking and say “we’re on a health kick”. Meet friends for breakfast or morning tea rather than dinner where alcohol is common.
What does alcohol do to my developing baby?
Alcohol can affect the development of the brain and other organs. It can result in lifelong problems with memory, learning, attention, maths, money, time, decision making, behaviour, judgement and impulsivity.
Will the effects of foetal alcohol exposure disappear as the child gets older?
The effects of foetal alcohol exposure are life-long and may not be obvious at birth. A minority of people may be identified by abnormal facial features (with or without other birth defects), poor growth and abnormalities of the brain and its functions. The majority of people with a FASD may not look different to others but will experience significant difficulties with behaviour, learning and development caused by alcohol’s damage to different parts of the brain.