Fetal Alcohol Syndrome the Problems

Fetal Alcohol Syndrome

The problems related to fetal alcohol syndrome would seem on the surface to be ones that could be mostly be solved with ample medical research backed by good public information for women. But both of those potential solutions have been tried again and again and have failed to curb the number of babies being born with fetal alcohol syndrome (FAS). In this paper the National Institutes of Health provide good information about how to help person with FAS, and ten scholarly peer-reviewed articles delve into a number of important aspects of this syndrome. Those aspects include: a) exactly / technically happens to a baby born with FAS, what the baby looks like that makes it different from healthy babies; b) why university curricula do not emphasize information germane to this problem; c) the need to have better technologies applied to determining if children actually have FAS and to what degree they are afflicted; d) large numbers of women who seemingly are aware of the need to stop drinking when they are pregnant nonetheless continue consuming alcohol, and there is nothing that apparently has been done to make the danger any clearer; e) animals are being used (rather then humans) now to study the effects that alcohol has on the woman and the baby; and f) in France, if a baby is born with FAS the hospital has the option of taking the baby from the mother and putting the baby into a home where it will receive proper care.

Annotated Bibliography

Medline Plus. (2011). Fetal Alcohol Syndrome. U.S. National Library of Medicine / NIH

National Institutes of Health. Retrieved June 4, 2012, from http://www.nim.nih.gov/medlineplus/fetalalcoholsyndrome.html.

The National Institutes of Health (NIH) explains to a reader that if a woman is pregnant and she is consuming alcohol, her baby is also consuming alcohol. This problem can and does hurt the babies of pregnant women who are drinking alcohol during pregnancy. In fact the most "severe" effects of drinking alcohol during pregnancy is "fetal alcohol syndrome" (FAS), the NIH fact sheet asserts. And according to the NIH the problems that can result for the baby include: mental retardation; birth defects; abnormal facial features; growth problems; problems with the child's central nervous system; difficulty remembering and learning; hearing and vision problems; and behavior problems (NIH). This paper delves into the scholarly literature regarding fetal alcohol syndrome, including how to avoid FAS, what help is available for children suffering from FAS, where the current research is focused, and more. The Medline Plus / National Institutes of Health information also emphasizes that students who are living with fetal alcohol syndrome can be helped. There are eight bullet points of advice NIH offers to teachers: a) talk in "concrete terms" and avoid words that have double meanings; b) be consistent with the vocabulary used; changes are scary to FAS students; c) re-teach the material because FAS students have "chronic short-term memory problems"; d) stay in a day-to-day routine; e) keep it simple; f) "say exactly what you mean"; FAS students have difficult with abstractions; g) the structure is the "glue" that keeps the world for them making sense; and h) constant supervision is a necessity.

Blackburn, Carolyn, Carpenter, Barry, and Egerton, Jo. (2010). Shaping the future for children with foetal alcohol spectrum disorders. British Journal of Learning Support, 25(3), 139-145.

This peer-reviewed article reviews the facts of fetal alcohol syndrome (called "spectrum" disorders in the UK). Fetal alcohol syndrome is the "most common, non-genetic cause of learning disability in the UK" hence it is an important area of research. The FAS hits a child prior to its birth when the mother consumes a given amount of alcohol (as to the exact amount of the consumption, and the timing of the consumption, that go into corrupting the child, is not known, the authors explain). There are several common physical result of FAS that can often be found in the child's face: a) "short palpebral fissures" (a palpebral fissure is the separation between the upper and the lower eyelids), a thin upper lip and "philtrum elongation" (the philtrum is the groove that extends from the upper lip to the nose); b) "a flattened mid-face"; c) "epicanthal folds" (these are folds from the skin just above the upper eyelid that covers the corner of the eye when a child has FAS); d) a short and upturned nose; e) a receding forehead and chin; and f) "asymmetrical ears" (140). Beyond the physical impairments, children suffering with FAS have learning issues as well. They tend to have "cognitive confusion," they have learning and memory impairment, and they struggle to understand "the consequences of their actions" (140). It should be noted that there is no absolutely typical FAS child in terms of learning issues, but it is common for FAS children to have "verbal recall" allowing them to "parrot back" information -- but that doesn't mean they are actually learning.

Brems, Christiane, Boschma-Wynn, Rachel V., Dewane, Sarah L., Edwards, Alexandra, and Robinson, Rebecca Volino. (2011). Prevention of Fetal Alcohol Spectrum Disorders:

Educational Needs in Academia. Journal of Alcohol & Drug Education, 55(1), 15-37.

The article points out at the outset what is well-known, and that is that while 4.5 live births per 1000 births are unfortunately affected by FASDs (fetal alcohol spectrum disorders). These babies and their suffering could be prevented, the authors argue, but in order to truly engage in preventative interventions, education about the problem needs to be part of the academic community (15). The research presented in the Brems article indicates that upon investigation of 45 university academic programs, directors of those higher education programs would be pleased to incorporate FASD education, but those 45 institutions say they have "few resources to support it within their own programs" (15). The costs to the United States in medical terms is enormous when it comes to FASD: an estimated cost of $3.6 billion -- and "lifetime costs estimated as high as $1.6 million per affected individual" -- which is staggering, and ironically, avoidable. The ongoing situation where so many children are born with FAS is in spite of the fact that warnings have been given from the Surgeons General and public service announcements have gone out over television and radio for years. Still, Brems asserts that 12% of pregnant women report drinking some alcohol during pregnancy, and up to 2% of pregnant women admit to "binge drinking" (16). The bottom line for this research is that of the 45 institutions that Brems et al. queried, nearly all "strongly endorsed" FASD education belonged as part of the curriculum in their programs. Moreover, almost 87% of programs in allied health disciplines do not have courses with meaningful FASD content (20).

Domellof, E., Fagard, J., Jacquet, a.Y., and Ronnqvist, L. (2011). Goal-directed arm movements in children with fetal alcohol syndrome: a kinematic approach. European Journal

of Neurology. Vol. 18, 312-320.

The authors in this peer-reviewed article claim that while several studies have looked into the "deficits in general motor functioning" in children with FAS, few studies have used strategies that actually explore the "specific nature" of the disability of fetal alcohol syndrome. Hence the authors launched a research project that utilized three-dimensional "kinematic analysis" in the hopes of learning more about motor control issues in the unfortunate children suffering from FAS. Ten children with FAS and ten children that were "typically developing" children (TD) were hooked up to an optoelectronic tracking system. And the results showed that children with FAS showed "evidently poorer task performance" in comparison with TD children. While this was not surprising, indeed it was expected, the results also provided insights into the motor disabilities in the FAS children. To wit, FAS children "exhibited longer arm movement trajectories at both the proximal and distal level" and the FAS children demonstrated "faster velocities" in their proximal level and their head movements were "fast" and "augmented." What does this mean for researchers looking into FAS? Basically all the researchers learned is that using 3D technologies helps to further the understanding of motor control restrictions in those children with FAS (Domellof, 2011). And moreover, this paper attempts to encourage more studies on movements within children suffering from FAS.

Jones, Kenneth Lyons, and Streissguth, Ann P. (2010). Fetal Alcohol Syndrome and Fetal

Alcohol Spectrum Disorders: A brief history. Journal of Psychiatry & Law, 38(4) 373-382.

The authors in this scholarly article provide a short history of FAS, and they explain that in 1973, the syndrome was reported in 11 children born to "chronic alcoholic women" -- and these women had continued to consume alcohol throughout their pregnancies (373). Back in the 19th century, Dr. William Sullivan had investigated females at the Liverpool Prison, females that were known to be alcoholics; from this research he determined that there was -- among alcoholic women -- an increased "frequency of early fetal death" as well as "early infant mortality" in the babies born to these women. Dr. David Smith, professor of Pediatrics at the University of Washington, was asked to carefully investigate eight children born to mothers that were alcoholics. Four of those children had short palpebral fissures, a smooth philtrum (see previous article by Blackburn), and "microcephaly" (a situation where a child's head is far smaller than the heads of children the same age), all manifestations of a child whose mother drank alcohol during pregnancy. Dr. Smith and other doctors that got involved began checking the various maladies these children suffered from with other children whose disabilities hadn't been labeled or fully understood, and hence, this research led to the identification of FAS. That said, there still is no "clear-cut alcohol-specific neurobehavioral phenotype for 'Alcohol Related Neurobehavioral Disorders' (ARND)" (378). Smith, along with professor Jones, in fact coined the phrase, fetal alcohol syndrome.

Kvigne, Valborg L., Leonardson, Gary R., Borzelleca, Joseph, Brock, Ellen, Neff-Smith,

Martha, and Welty, Thomas K. (2008). Alcohol Use, Injuries, and Prenatal Visits During

Three Successive Pregnancies Among American Indian Women on the Northern Plains

Who have Children with Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome.

Maternal and Child Health Journals, Vol. 12, S37-S45.

The authors in this article compared three sequential pregnancies of Northern Plains American Indian children who had FAS and children that had "incomplete FAS" with Indian women who had children free of the FAS malady. Two studies are presented in this paper, one with three successive pregnancies that ended in live births -- using 43 case mothers with children with FAS and 35 case mothers whose children had incomplete FAS -- and the second study using the pregnancies of 86 and 70 "control" mothers whose children did not have FAS. The results of this research showed that when compared with the mothers of children did not have FAS (the "control mothers") "…significantly more case mothers used alcohol before and after all three pregnancies" (S37). One hundred percent of mothers whose children had FAS used alcohol during pregnancy; 60% of mothers whose children had "incomplete FAS" used some alcohol during pregnancy and only about 9% of mothers whose children did not have FAS used alcohol during their pregnancy. The bottom line for this research is very obvious: Women who are of childbearing age should be screened for potential use of alcohol "whenever they present for medical services" (S37). In other words, when a woman of childbearing age goes to the doctor for any reason, she should be screened and advised or counseled as to the need for her to not drink if and when she becomes pregnant. The good news that comes from this article is that women with an FAS child "decreased their alcohol consumption" during the following pregnancy (S37).

Kvigne, Valborg, L., Leonardson, Gary R., Borzelleca, Joseph, and Welty, Thomas K. (2008).

Characteristics of Grandmothers who have Grandchildren with Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome. Maternal and Child Health Journals, 12(6), 760-765.

The authors in this journal article researched the characteristics of Northern Plains American Indian maternal grandmothers that had grandchildren with fetal alcohol syndrome or "incomplete FAS" (760). The point of the research was to determine how to more effectively "prevent fetal FAS and alcohol use during pregnancy" among Native Americans (760). The research took place in four Indian service hospitals or clinics; once the grandchildren were identified with either FAS or incomplete FAS, the medical records of the grandmothers were carefully examined to discover her use of alcohol and any injuries, problems, or trauma she may have gone through. It turned out 92.6% of the grandmothers of the FAS grandchildren had used alcohol and also 45% of the women who drank alcohol during pregnancy "had parents who drank" (762). Hence, it was shown that parents pass along their habits (bad or good) to their children, and in turn the children pass those habits along as well, even in cases where habits negatively affect newborn children. The bottom line is that alcohol use by maternal grandmothers is definitely "a risk factor for FAS"; and so, screening women during their pregnancy "is essential to intervene" so counseling can be offered and hopefully children can be saved from the ravages of FAS (763).

Toutain, Stephanie, and Lejeune, Claude. (2008). Family Management of Infants with Fetal

Alcohol Syndrome or Fetal Alcohol Spectrum Disorders. Journal of Developmental

Physical Disabilities, 20(5), 425-436.

Part of the research of fetal alcohol syndrome leads to a reader encountering pathos and sadness, and this article is an example of that. To wit, 28 infants that were born between 1995 and 2003 in a hospital near Paris, France were born to mothers who abused alcohol. When the authors of this article reviewed the obstetrical files of the 28 mothers, and conducted additional research through questionnaires and interviews with doctors it was revealed that all 28 mothers "…came from underprivileged backgrounds, had chronic health problems, and/or lived with alcohol abusers" (425). In France, the neonatology team must decide at the time the mother and child are discharged from the hospital, whether or not those mothers are capable to providing "a good environment" for their children. If the team determines that the mother cannot provide the care required, the courts take custody of the children. In this instance, 18% of the children were taken from their alcoholic mothers and placed in care centers. This is considered a "tragedy of the poor" in France, and has become a serious health issue. Some 7,000 infants are born to alcoholic mothers every year in France; and the socioeconomic status of most of these women is very low and these women are living in environments with malnutrition, conjugal violence, and poor access to healthcare facilities. This is a problem France has not solved, and the authors hint that France isn't the only nation that has this serious problem with FAS.

Warren, Kenneth R., Hewitt, Brenda G., and Thomas, Jennifer D. (2011). Fetal Alcohol

Spectrum Disorders. Alcohol Research & Health, 34(1), 4-14.

Warren and colleagues touch on two salient problems with reference to FAS. One, there needs to be more work in terms of healthcare professionals being able to correctly identify all individuals that are affected and their "individual patterns of alcohol-induced deficits"; and two, because "large numbers of women" continue to drink during their pregnancies, prevention efforts are obviously not succeeding and hence they need "further refinement to enhance their effectiveness" (4). As to the first problem mentioned, presently healthcare professionals are stuck with the fact that the only obvious condition -- that is "currently widely accepted" by the medical community -- is based on the "full presentation" of FAS. Clearly, there are some children that have FAS but because the full potential of this health issue is not always detectable, the correct diagnosis of their condition remains a mystery. One possible solution for the lack of specificity when it comes to incomplete FAS is the use of imaging technologies like magnetic resonance imaging (MRI). Put to full use with children suspected of suffering from some level of FAS, the MRI could allow investigators to "visually track changes in bundles of nerve fibers…in the brains of humans of any age" (7). The authors represent that the MRI seems to be a hopeful and positive advance in the FAS field.