Dear Confused Canadian #15,

FAS is the abbreviation for fetal alcohol syndrome, which describes a set of problems that could result if a woman drinks alcohol during her pregnancy. FAS is not just one disease, but is, like other syndromes, a set of symptoms and specific characteristics that may or may not appear in each individual affected. Some of the most common physical symptoms of fetal alcohol syndrome include:

• distinct facial features, such as widely spaced eyes, a low or wide nose bridge, or a flat area between the nose and upper lip
• small teeth and weak enamel
• small head and brain size
• deformed joints, arms, legs, or fingers
• heart problems

Mental disabilities also can result from drinking alcohol while pregnant, including:

• mental retardation and slow intellectual development
• short attention span and hyperactivity
• general anxiety and nervousness

When a pregnant women drinks alcohol, that alcohol reaches her developing fetus directly through the placenta. Because metabolism rates for the fetus are much slower than the woman's, the fetus's blood alcohol levels are far higher than the mother's. The alcohol present in the fetus's blood can impair the development of tissues and organs as well as permanently damage brain cells. The danger exists throughout pregnancy, though alcohol intake is more likely to have negative physical effects earlier in the pregnancy, when most of the organs are forming. This is also the time when many women may not realize that they're pregnant and they inadvertently consume alcohol that could damage their fetus. FAS has no cure, and a child born with FAS, and her/his family, will need to learn how to live with the various symptoms.

Because you live with someone with FAS, you have probably noticed some of the behavioral issues that many children with FAS exhibit, including:

• difficulty focusing or remembering
• impaired learning and slow development
• impulsiveness
• poor social judgment (lack of understanding of social cues)
• fearlessness and trusting towards strangers
• bullying of others

You may have witnessed behavior on the part of the girl you live with that you thought was inappropriate, or you may have thought to yourself that she doesn't act her age. This is normal in children with FAS, as they develop more slowly and may demonstrate impaired reasoning and an inability to pick up on social cues. Taking this into consideration is important if you find yourself frustrated or hurt by this girl's actions. She can't think through some of her actions the way you can, so she may not realize if something she does or says isn't appropriate, or will make you or others annoyed or angry, for example.

Being aware of some of this girl's limitations can help you change the way you interact with her, and keep you calm when faced with "challenges" that her behavior(s) may pose. Knowing more about FAS also can help you to appreciate positive aspects of her personality. To help deal with some of her attention problems, you need to explain things clearly and simply. Maintain eye contact with her, so that she knows that you're focusing on her; that will help her focus on you. Try not to ask her to do too many things at once, and be patient and willing to repeat things if she needs that. If she asks for you to repeat something, she's trying to understand you. If she does something that annoys you, or isn't appropriate, explain in an uncomplicated and calm way what she did and why it didn't make you feel good.

FAS can't stop this girl from being a friend. Many people with FAS are trusting and can be loyal and compassionate friends. In spite of some developmental disabilities, children with FAS tend to be highly verbal and like to talk. Focusing on these good qualities, as well as her general personality, might make dealing with some of the limitations posed by FAS easier. The girl you live with is not limited to her being born with FAS; she is a person similar to any other, and has a range of interests, abilities, difficulties, hopes, and dreams.

A number of good resources for more information about FAS are available online. You can get more information from the following web sites and perhaps share that information with the other members of your household and/or with the girl's teachers, classmates, and/or friends:

National Organization on Fetal Alcohol Syndrome

Alcohol Related Birth Injury Resource Site

You might also consider contacting an organization like the March of Dimes's Pregnancy and Newborn Health Education Center to dialogue with a health information specialist for more information.

Women who are pregnant, or hoping to become pregnant, may be wondering how much alcohol is considered safe. Unfortunately, no one has yet determined at what level of alcohol consumption a woman's chance of damaging her fetus increases. While FAS is most commonly found in children born to alcoholics, women who abuse alcohol can have normal children, and women who only moderately consume alcoholic beverages have had children born with impairments. This is why most medical authorities urge women to give up drinking alcohol altogether during pregnancy, though your own personal and cultural beliefs may affect your own decision. Until more information becomes available, however, it's probably best to err on the side of caution.

Alice

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