Fetal alcohol syndrome
What is a fetal alcohol syndrome?Fetal Alcohol Syndrome (FAS) is characterized by childhood malformations and deficiencies. In the area of the head, the following anomalies can occur, such as a microcephalus, a ptosis or an epicanthus.
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Fetal alcohol syndrome (or alcohol embryopathy) refers to multiple impairments of physical and psychological development in children due to alcohol use during pregnancy.
A fetal alcohol syndrome manifests itself in most cases on the basis of stunted growth, microcephaly and typical facial anomalies such as blepharophimosis (narrowing of the eyelids), sunken nose root, epicanthus (skin fold in the eyelids), narrow lip red, deep-seated ears, high palate and other dysmorphisms (malformations) on skeleton, heart, genitals, blood vessels or kidneys.
In addition, abnormalities in behavior (hyperactivity, attention and concentration disorders) and general mental or psychomotor developmental retardation are characteristic symptoms of a fetal alcohol syndrome.
The fetal alcohol syndrome is due to the mother's alcohol consumption during pregnancy, although no direct correlation between the amount and the extent of the impairment could be demonstrated.
Alcohol can overcome the placental barrier as a potentially toxic substance. Since children only have their own fully functional metabolism (metabolism) postnatally, especially for the breakdown of alcohol and its metabolites (eg acetaldehyde), the organism of the affected child can not break down these toxins.
As a result of the poisoning, the developmental disorders and organic malformations characteristic of a fetal alcohol syndrome become apparent. It is also suggested that the mother's alcohol use is not only inhibitory to the mitosis (cell division) of the child, but also deleterious to the Purkinje cells of the embryonic cerebellum, which are responsible for the development of balance and muscle coordination.
The causes of alcohol-related intrauterine injuries such as fetal alcohol syndrome have so far not been clarified despite intensive research.
Symptoms, complaints & signs
Fetal Alcohol Syndrome (FAS) is characterized by childhood malformations and deficiencies. In the area of the head, the following anomalies can occur, such as a microcephalus, a ptosis or an epicanthus. A Philtrum is also possible, which means that the furrow between the nose and mouth is weak or absent. Sometimes the upper lip is thin, the lower jaw underdeveloped. Dwarfism can already be seen in the womb.
Furthermore, skeletal malformations such as a funnel chest are conceivable or a general reduction of the skeletal musculature (muscular hypotension). The internal organs can also be affected by malformations such as heart defects or malformations of the kidneys. In addition to mental retardation, psychomotor agitation is a well-known symptom of the disease. Many patients have ADHD (attention deficit / hyperactivity disorder) in addition to FAS.
Information processing and perception are impaired. This leads to social withdrawal, compulsion, fear of new situations, exploitability and easy influenceability. Also impulse control disorders, which lead to aggressive behavior, can affect the social life. Furthermore, hearing and vision disorders can occur. Adult patients are also prone to depression, addictions, and abnormal sexual behavior
Diagnosis & History
A fetal alcohol syndrome is diagnosed on the basis of the characteristic symptoms. If necessary, an alcohol abuse of the mother can be demonstrated in the context of the anamnesis or by a blood analysis (liver enzymes, ferritin). Imaging techniques such as sonography and magnetic resonance imaging can be used to detect impairments of cerebral structures such as dysplasias (defective development) of the cerebellum or the ventricular system, as well as damage to the kidneys.
Cardiological diagnostic procedures (ECG, cardiac catheterization) allow statements about possible malformations of the heart. In addition, developmental tests as well as neuropsychological test methods allow an assessment of the cognitive, motor, social and linguistic abilities of the affected child.
Differential diagnoses include fetal alcohol syndrome from Edwards syndrome (trisomy 18), Dubowitz syndrome or triplodie from cytogenetic studies. The prognosis and course of a fetal alcohol syndrome depend significantly on the extent of specific impairments. Only a fifth of children affected by fetal alcohol syndrome can attend normal school, while more than 30 percent are seriously disabled.
Due to the fetal alcohol syndrome, there are different complications in newborns. As a rule, the children suffer from malformations and mental retardation and are thus relatively severely limited in their daily lives and in their entire lives. The fetal alcohol syndrome is primarily due to growth disorders.
Thus, the children can suffer from a short stature or malformations of the extremities. Also the concentration is weakened, many patients suffer from ADHD. In some cases, the child has unfounded aggressiveness. Alcohol consumption damages the child's heart muscle, causing cardiovascular disease and heart attack during life.
The fetal alcohol syndrome can not be treated directly because it manifests in the womb. However, it is possible to treat the heart defects and other malformations and disorders. If the treatment starts early, there are usually no conspicuous negative side effects.
The physical and mental disabilities can be mitigated with various therapies. However, a complete cure is not possible. Often the fetal alcohol syndrome is also a great burden for the parents and also leads to mental discomfort.
When should you go to the doctor?
This syndrome requires treatment in any case. The earlier the alcohol addiction of those affected is restricted, the higher the chances of a positive course of the disease. Maybe then all complaints of this disease can be limited. A doctor should be consulted if the patient drinks alcohol during pregnancy.
The addiction can be fought in the context of a withdrawal. Here also psychologists and various clinics can offer a support. Furthermore, the help of friends and acquaintances is very helpful. A doctor should be consulted if the child suffers from the symptoms of the syndrome.
The symptoms can be very diverse, mostly malformations or developmental disorders. The sooner these symptoms are diagnosed, the higher the likelihood of recovery. Disorders of growth and concentration should always be examined by a doctor.
Unfounded aggressiveness or mental and psychological disabilities can also be symptoms. The diagnosis of the disease is made in most cases by a pediatrician or by a GP. The treatment depends on the severity of the individual symptoms and is carried out by different specialists.
Treatment & Therapy
A fetal alcohol syndrome can not be treated causally. Somatic impairments such as facial anomalies (including cleft palate or cleft lip) or organic abnormalities (heart failure) as well as visual and hearing disorders can be partially corrected surgically.
If there are favorable contextual and environmental conditions, the development deficits can be partially compensated or existing potentials activated. To compensate for the cognitive, linguistic, psychomotor and / or social aberrations, early childhood support measures are required, which are usually from physiotherapy (sensorimotor), occupational therapy (activity skills through occupational therapy), speech (tongue motor skills, saliva control) and dysphagia therapy (swallowing), music therapy, Hippotherapy (therapeutic riding), Motopädie (movement therapy) and sensory integration in insufficient processing of external stimuli or disorders of the sensory organs put together.
Excessive "therapy" of the affected child should be avoided. In addition, integration aids such as school attendance for children with fetal alcohol syndrome are recommended. In cases of marked hyperactivity or ADHD as a result of the Fetal Alcohol Syndrome psychotropic drugs such as methylphenidate (eg Ritalin, Medikinet.) Are also used in some cases.
In addition, the family or social environment of the affected children, of which about two-thirds grew up in homes or in foster care, should be comprehensively informed and advised on the specifics of the fetal alcohol syndrome and possibly also be supported psychologically.
Outlook & Forecast
The fetal alcohol syndrome is an incurable disease. Alcohol consumption by the mother during pregnancy causes permanent and irreparable damage to the unborn child. The specific mental and physical impairments persist in most cases throughout life. The behavioral and developmental disorders are part of long-term irregularities that require an individual assessment. The prognosis is therefore based on the extent of the existing disorders and are different for each patient.
By early treatment and promotion of the child immediately after birth, optimizations can be achieved, which contribute to an improved lifestyle. In severe cases, however, the patient is unable to manage his or her own life without the help of nursing staff or relatives, even in adulthood. Often children with a fetal alcohol syndrome need to be hospitalized for a longer period of time.
Especially in the first two years of life they suffer more infectious diseases or developmental disorders that need medical care. In case of malformations surgical interventions are carried out, which contribute to a relief of the complaints. Since the mother's alcohol consumption in many cases indicates a social problem of the parents, it must also be clarified where the child is best kept. If the parents are unable to take sufficient care, it is necessary to stay in foster homes or homes.
A fetal alcohol syndrome can be avoided by a complete alcohol abstinence during pregnancy. An individual and social education about the risks of alcohol consumption during pregnancy as well as an early prevention or treatment of an alcohol abuse constitute further preventive measures for the fetal alcohol syndrome.
The possibilities of follow-up are severely limited in the case of alcohol syndrome in most cases. The alcohol syndrome should be treated even before the birth of the child, so it does not lead to defects and malformations on the body of the child. The other defects after birth can be treated only symptomatically, but not causally, so that a complete cure usually can not occur.
The aftercare itself is based on the exact symptoms and their expression, which occur in the child. In most cases, the children are dependent on physiotherapy or physiotherapy. Many of the exercises from such therapies can also be carried out on one's own home, which accelerates healing.
Furthermore, it is not uncommon for medications to be taken to relieve the symptoms. It is important to ensure a correct dosage and also on a regular intake to relieve the symptoms permanently. Most patients are also dependent on psychological treatment for the alcohol syndrome and also need the help and support of friends and family in their daily lives. The life expectancy of the child is also reduced in many cases.
You can do that yourself
Due to the alcohol consumption of pregnant women, fetal alcohol syndrome leads to physical and mental impairment of the child. What the patients or the persons responsible for caring for the affected children can do themselves depends on the specific symptoms and the severity of the disability.
If the child's cognitive abilities are impaired, adequate early intervention is important. Through targeted educational and psychological support measures, the mental development of the child can be positively influenced. If the child has difficulty speaking, a speech therapy should be started in good time under the guidance of a speech therapist. This can also help the child to improve the often disturbed tongue motor skills and the saliva control.
In case of physical development, especially underdevelopment of different muscle groups or motor disorders, developmental deficits can be compensated by physiotherapy at least partly. Ergotherapeutic approaches, which are aimed at improving the ability to act in everyday life, also favor age-appropriate development.
The children are very often unable to attend a normal primary school. Even many kindergartens are unable to provide adequate care for those affected. The persons who are responsible for caring for a child suffering from fetal alcohol syndrome must therefore take care of the (preschool) integration in good time.
If the children suffer emotionally from their disability, in particular under their often conspicuous external appearance and the reaction of the environment to it, a child psychologist should be drawn in time.