Many more children have been affected by alcohol in the womb than experts once thought.
Children born with the worst kind of brain damage from alcohol exposure in the womb have characteristic symptoms: small heads and eyes, and a thin upper lip. They end up intellectually disabled. They suffer from fetal alcohol syndrome.
But children can lack those signs and still suffer as they grow up from the effects of an early alcohol bath. They may be impulsive and distractible, and have a hard time doing tasks in order. They may fall behind in language skills and make bad judgment calls.
That sounds like many children considered to have attention deficit hyperactivity disorder or simply “behavioral problems.” Now, many of them may be diagnosed as having fetal alcohol spectrum disorder, which means that they’ve been affected by alcohol but fall short of the diagnosis of fetal alcohol syndrome.
In 2014, a seminal paper showed that 2 to 5 percent of first-graders in a mainly white, middle-class Midwestern city had fetal alcohol spectrum disorder, falling somewhere along a curve from the worst cases – who actually had fetal alcohol syndrome – to the least. Children with these symptoms are often diagnosed with other psychiatric issues and put in special education classes.
Previous estimates had been lower, and other experts say that the problem may actually be even more common. Doctors are still working out the best ways to diagnose fetal alcohol spectrum disorder, and doctors may disagree about any one child. Sometimes a child is incorrectly labeled as having fetal alcohol syndrome when she has another disorder.
When psychiatrist Carl Bell, MD, conducted a study of 611 of his patients in a low-income African American community on Chicago’s South Side, he concluded that almost 40 percent had some form of fetal alcohol spectrum disorder, including some with fetal alcohol syndrome.
Ira Chasnoff, MD, a pediatrician treating Chicago kids and teens with serious behavioral problems who were adopted or in foster care, concluded that nearly 30 percent suffered from fetal alcohol spectrum disorder. He put the patients through a full day or more of testing. For 80 percent, this was the first time they’d been given this diagnosis, he reported.
The Centers for Disease Control and Prevention (CDC) estimates that about 10 percent of pregnant women in the United States drink alcohol, but those numbers may also be too low.
One reason is that the damage begins as early as three weeks after conception — before a mother will even know she’s pregnant. Consuming four or five drinks around that time can interfere with brain development in the fetus. And lots of young people are binging on alcohol: Nearly 27 percent of young adults under 30 have told pollsters that they had trouble managing their drinking in the past year, in a study from the National Institute on Alcohol Abuse and Alcoholism.
Every major medical organization in the United States, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the U.S. Surgeon General, and the CDC, agree that the best advice is for women not to drink alcohol while pregnant or when there is a possibility of becoming trying to become pregnant.
In the United States, nearly half of pregnancies are unplanned. So if you’re having unprotected sex and are of child-bearing age, you’d better not drink either.
Some women think that their children are safe as long as they stop drinking once they know they’re pregnant. Not so. By one well-respected estimate, drinking in the first trimester (versus no drinking) produces 12 times the odds of giving birth to a child with symptoms somewhere along the spectrum that ends in fetal alcohol syndrome.
Other women think that having a glass of wine or a beer or two occasionally during pregnancy doesn’t count. It’s true that heavy drinking will do more damage. But drinking any alcohol increases the chance of bearing a child with behavioral problems, research indicates. Red wine is no safer than white wine, beer, or mixed drinks, since all contain alcohol.
Some women realize that they drank in the first trimester and assume the damage is done so they keep drinking. Drinking in both the first and second trimester increases the odds of hurting your child 61 times, and drinking in all trimesters increases the odds 65 times.
Mothers: do yourself a huge favor, swallow any shame, and tell pediatricians or psychiatrists about your drinking habits in the months before you knew you were pregnant and after. Fathers: as sticky as this may be, you may need to nudge your child’s mother or speak directly to doctors.
A doctor can help mothers who are currently pregnant and drank early on or after. There’s some evidence that taking vitamin A, choline, folate, and iron prior to conception and during pregnancy may help your future baby’s brain development. Don’t forget to take your pre-natal vitamin!
Another reason to fess up is that targeted coaching can make a big difference. “You have to raise these kids differently than other children,” Bell says. Public programs may help. If your child is younger than three, contact your local early intervention system. The local elementary school or board of education can steer you towards help even before your child enrolls.
Medical care possibly can help a child with the right diagnosis. It may be worth a try, as long as you stick to supplements that cause no harm. Bell gives patients vitamin A, folate, choline, and also omega-3 supplements. Research is underway to demonstrate how helpful choline may be to children with symptoms of fetal alcohol spectrum disorder.
Look for resources and support through the National Organization on Fetal Alcohol Syndrome and the American Academy of Pediatrics. For example, consider this workbook for children that explains the symptoms and how to deal with them.
June 27, 2016
Christopher Nystuen, MD, MBA