Fetal Alcohol Syndrome (FAS)

In this lesson I will help you understand fetal alcohol syndrome and your role in this patient’s care.

So during pregnancy the mother should not drink. There is no safe amount that protects her fetus. Drinking will put her baby at risk for Fetal Alcohol Syndrome. Drinking alcohol in pregnancy can cause problems with fetal development. So the big things are craniofacial and central nervous system. There are noticeable changes in facial characteristics. Growth is altered so they are typically small and either are short, low weight or both. There can be other concerns with cardiac and different systems but these are really comorbidities of having fetal alcohol syndrome and the big diagnosis pieces are craniofacial and central nervous system. Facial will be our biggest assessment piece because we can easily see this and they are specific facial characteristics. So let’s look at our assessment.

For the assessment we will really see craniofacial abnormalities. The biggest things are the eyes have small openings and can be wideset. The upper lip will be thin and the skin above the lip will be smooth between nose and mouth. The little divot between the nose and mouth is called a philtrum but a newborn with FAS might have a smooth philtrum. You can see in this image there are smaller eyes openings, smooth philtrum and thin upper lip. There will also be central nervous system findings but these are typically going to be seen later. These are things like ADHD, impulsiveness, memory, processing and behavioral problems. Growth deficiencies might occur. They might be born with a smaller head, short height, low weight or a combination.

This patient will have very little management. The newborn might require a low stimulation environment so we can help support that. We will need to pace feedings and make sure they are getting adequate calories for growth since they are already starting out smart. If there is a big concern like cardiac then we would be monitoring and referring to a specialist. If there are any comorbidities we can consult a specialist and we also want to involve case management to help with any referrals to developmental specialist because it is likely that the child will have learning delay.Education should really be given prior to pregnancy that there is no safe amount ever in pregnancy and they need to know the risks. There are cognitive deficits that can not be fixed and the child might have judgment, impulse control issues, and learning disabilities.

Human Development is a concept because the alcohol is affecting the development and health promotion because we want to ensure the health of this newborn going forward.

The key points are that fetal alcohol syndrome can occur when a mother drinks excessive alcohol during her pregnancy and here is no safe amount! There is a cluster of characteristics and these mostly all facial. So things like thin upper lip, small eye openings, smooth philtrum. Later some neurological concerns will show. So learning difficulty, maybe they are impulsive or have anger problems. Things that we won’t know at delivery. There is no treatment or lab test for this diagnosis. It is clearly just assessment findings at delivery with mom’s history being considered.

Make sure you check out the resources attached to this lesson and the key points. Now, go out and be your best selves today. And, as always, happy nursing.