Fetal alcohol syndrome is a disorder that affects a child’s ability to learn, to pay attention, and to control his or her behavior as well as to grow normally. It is the leading known cause of mental retardation in North America. Children with FAS are undersize and underweight for their age, and they have smaller than average heads as well as certain facial features associated with the disorder. The physical features of FAS are usually evident at birth, but problems with learning and other abnormalities in brain development may not be detected until the child starts school. The child’s learning and behavioral problems persist over his or her lifetime, while the child’s facial features usually become less noticeable as he or she grows into adolescence and adulthood.
Researchers estimate that about 1 percent of the general U.S. population is affected by fetal alcohol spectrum disorders and that 40,000 babies are born every year with some kind of birth defect caused by the mother’s drinking. However, fetal alcohol syndrome itself is the only disorder in this group that has been formally defined by the Centers for Disease Control and Prevention (CDC) and by the International Classification of Diseases (ICD). Fetal alcohol syndrome is estimated to occur in one or two out of every 1,000 live births in the United States. The rate may be higher in some countries where binge drinking is common. The cost of treating one child with FAS is estimated to be $2 million over his or her lifetime. The cost of FAS to the American public runs to more than $321 million each year.
As far as is known, FAS affects boys and girls equally and affects children of all races equally. The primary risk factor is the amount and frequency of the mother’s drinking. Other risk factors in mothers include being over age thirty, a history of heavy drinking, and low social or economic status. Smoking and the use of other drugs can worsen the effects of alcohol on the fetus.
Nursing Care Plan Signs and Symptoms
Fetal alcohol syndrome occurs as the result of a woman drinking alcohol during her pregnancy. Alcohol is a teratogen, which means that it is a substance that causes birth defects. Although heavy or binge drinking increases the risk of having a child with FAS, even moderate or occasional drinking can affect the unborn baby. In addition, it does not matter what type of alcoholic beverage is consumed. Beer or wine can harm the baby as much as whiskey or other forms of distilled alcohol. It also does not matter whether the mother drinks throughout her pregnancy or only during a brief period. Alcohol can affect the baby’s development at any point during pregnancy.The ways in which alcohol affects the development of the baby before birth are not fully understood. What is known is that the fetus depends on the mother’s liver to clear alcohol from its bloodstream as well as her own. It is thought that alcohol and a chemical called acetaldehyde, which is formed during the body’s digestion of alcohol, disrupt the process of cell reproduction and tissue formation in the baby’s body. In addition, these chemicals interfere with the transfer of vitamins, minerals, and other nutrients from the mother’s body to the baby, thus starving the baby of nutrients that are vital to healthy growth. Last, alcohol and acetaldehyde interfere with the oxygen supply to the baby.
Some pregnancies end in miscarriage if the mother is a heavy drinker. A child with FAS may also be born prematurely or die of sudden infant death syndrome (SIDS). The symptoms of FAS at birth may include withdrawal syndrome if the mother had been drinking heavily shortly before delivery. Newborns suffering from alcohol withdrawal may be hyperactive, restless, or suffer from seizures. The physical and developmental symptoms are described in the next section because they are used to diagnose the disorder.
Nursing Care Plan Diagnosis
Diagnosis of fetal alcohol syndrome is usually based on a combination of the mother’s drinking history (if known) and a physical examination of the child. The Institute of Medicine (IOM) has established the following guidelines for diagnosing fetal alcohol syndrome:• Facial features that include a smooth upper lip (lacking the normal indentation between the nose and the mouth); a thin red border along the upper lip; and an abnormally short distance between the inner and outer corners of the eye. Other facial features may include flattening of the middle part of the face, drooping of the eyelids, and unusually small eyes. Although these facial features do not look like major deformities to most people, they tell the doctor that the child’s brain has not developed normally.
• Evidence of slow growth either before or after birth. The child is below the tenth percentile in weight or height for his or her age.
• Evidence of abnormalities in the central nervous system. These may include an abnormally small head, developmental delays, learning difficulties, seizures or epilepsy, mental retardation, hyperactivity, irritability in infancy, and poor judgment or impulse control in later childhood. Many children with fetal alcohol syndrome do not learn to communicate normally with others. They may also have problems with memory and with paying attention. Some have difficulties with writing or other skills involving hand-to-eye coordination.
• Confirmed or suspected drinking by the mother.
Children with FAS may have one or more of the following physical features or characteristics even though these are not used to diagnose the syndrome:
• Cleft palate
• Heart defects
• Nearsightedness or other eye disorders
• Hearing loss
• Abnormal curvature of the spine
• Unusual creases on the palms of the hands that resemble hockey sticks
• Joints that are easily dislocated
Nursing Care Plan Treatment
Treatment of children with FAS includes treatment for birth defects at the time of birth and educational or medical treatments for learning problems or behavioral disorders as the child grows older. Behavioral disorders may be treated with medications, psychotherapy, or a combination of both. Adults who care for or teach children with FAS should provide structure and be consistent in their behavior toward them. These children do best with routines that vary as little as possible so that they learn to see the world as a predictable place. Instructions should be brief and repeated frequently because such children have difficulty paying attention.Nursing Care Plan Prognosis
The prognosis of a child diagnosed with fetal alcohol syndromedepends on the type and severity of the child’s symptoms as well as the age at which treatment begins. Some doctors think that early diagnosis is helpful because it gets the child into treatment more rapidly. One study followed a group of people with FAS who were between the ages of twelve and fifty-one. Researchers reported the following longterm consequences of the disorder:
• 95 percent had mental health problems.
• 55 percent had spent time in prison, a drug or alcohol treatment center, or a psychiatric hospital.
• 60 percent had been in trouble with the law.
• 82 percent were unable to live independently.
• 70 percent had problems holding a job.
• 60 percent had problems with drugs or alcohol.
Nursing Care Plan Prevention
FAS can be prevented if a pregnant woman avoids alcoholic beverages. The Institute of Medicine (IOM) recommends a prevention program on three levels: public education aimed at all women of childbearing age; selected screening programs aimed at women who drink heavily and may become pregnant; and prevention and intervention aimed at women who are heavy drinkers and have already had a child with FAS. This third level of prevention would include treatment for alcohol dependence combined with case management.The Future
It is likely that the number of children affected by fetal alcohol syndrome will increase in the United States over the next few decades. Reasons for this include the easy availability of alcohol, the increasing breakdown of families and the growing number of single mothers, and the difficulty of putting preventive measures in place.
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