Fetal Alcohol Syndrome From Infancy Through Childhood: A Review of the Literature Kathryn Wekselman, MLn, BSN, RNC Kathy Spiering, MSN, RN, NNP Carol Hetteberg, MSN, RN Carole Kenner, DNS, RNC FAAN Ann Flandermeyer, PhDc, MSN, RNC Because fetal alcohol syndrome (FAS), or fetal alcohol effects (FAE), is being diagnosed in growing numbers of children, there is more interest in their common characteristics and how they change throughout childhood. Few longitudinal studies that describe the common childhood course of FAS address appropriate interventions. Some literature exists that describes follow-up and support services needed by these children and their families. This article examines the common childhood course of FAS/FAE and the interventions and services needed to promote positive child and family health. Copyright 91995 by W.B. Saunders Company DVERSE neonatal/pediatric effects of ma- ternal alcohol consumption are potentially devastating. One estimate of the incidence of fetal alcohol syndrome (FAS) is 1 to 2/1,000 live births (Levy & Koren, 1992). However, if fetal alcohol effects (FAE), a milder form of FAS, is considered, then the true incidence is probably much greater (Morse, Idelson, Sachs, Weiner, & Kaplan, 1992). The diagnosis of FAS is contingent on find- ings in three areas: dysmorphology (particularly midfacial anomalies), growth retarded (intra- uterine growth retardation and failure to experi- ence catch-up growth), and central nervous system involvement (cognitive impairment, learning disabilities, impulsiveness) (Phelps & Grabowski, 1992). The effects of alcohol exhib- ited by exposed children exist on a diagnostic continuum, with FAS on the severely affected end and FAE on the less affected end. Although children with FAS have findings in the three major areas listed above, children with FAE may exhibit little or no dysmorphology but may From the College of Nursing and Health, and Children's Hospital Medical Center, Cincinnati, OH. Address reprint requests to Carole Kenner, DNS, RNC, College of Nursing and Health, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45221-0038. Copyright 9 1995 by W.B. Saunders Company 0082-5963/ 95/1005-000453. 00/0 manifest behavioral aberrations or cognitive deficits associated with in'utero alcohol expo- sure. Characteristics of FAS-affected children are difficult to specify because the accurate diagno- sis of FAS is complicated by lack of a single biological marker, manifestations that are not solely associated with FAS/FAE, and unreli- able maternal drinking histories during preg- nancy (Morse, Idelson, Sachs, Weiner, & Kaplan, 1992). Polysubstance abuse (e.g., alco- hol, cocaine, heroin) also creates difficulty isolat- ing the consequences of particular substances. In addition, interactive effects between sub- stances and life-style (e.g., malnutrition, vene- real disease, hepatitis) exist (Levy & Koren, 1992). As a result, it is difficult, if not impos- sible, to identify the effects associated only with alcohol. Maternal condiations or characteristics also affect the likelihood of producing a child with FAS. The longer a woman drinks, the more likely she is to produce a child with either full-blown FAS or multiple congenital anoma- lies, such as cleft palate and congenital heart defects, associated with alcohol use. Prolonged maternal alcohol consumption adversely affects the woman's general health status and places her at increased risk for having a child with FAS or one with congential anomalies associated 296 Journal of Pediatric Nursing, Vol 10, No 5 (October), 1995