What is FAS ?

Fetal Alcohol Syndrome (FAS) includes a spectrum of physical, neurological and behavioural problems in children exposed to alcohol before birth (while their mothers were pregnant with them)

When a pregnant women drinks, her unborn baby is affected by the alcohol. The alcohol she consumed is absorbed through the bloodstream and reaches the unborn baby (fetus) within 20 minutes. The alcohol is poisonous (toxic) for the unborn baby and it may affect any of the unborn baby’s organs, although the brain is most vulnerable. For this reason, all children with FAS have a mild to severe degree of brain damage. The average IQ of a child with FAS ranges between 65 and 75. (The norm for IQ is 100). South Africa is currently following a policy of inclusive education; there fore these children are in mainstream schools. The children with FAS, their educators, and parents fight a daily battle to cope with the daily challenges of growing up.

WHAT ARE FETAL ALCOHOL SPECTRUM DISORDERS?

FAS is the worse degree of Fetal Alcohol Spectrum Disorders, the so called tip of the ice berg. Fetal Alcohol Spectrum Disorders refers to the spectrum of difficulties which may result from exposure to alcohol while the bay is still in utero. These difficulties may include the following:

Alcohol Related Neurodevelopmental Defects / ARBD

Any of the unborn baby’s developing organs may be damaged by the poisonous (toxic) affect of the alcohol; however the brain is especially vulnerable.

Children with Alcohol Related Neurodevelopmental Defects have brain damage, but none of the other obvious signs or symptoms of FAS and no other organs are affected.

Making this diagnosis demands careful neuro-developmental assessment using specific psychometrical tests. Children with this disorder are often wrongly labeled as naughty, hyperactive and / or with attention deficit.

Alcohol Related Birth Defects’ / ARBD

Sometimes children are born without the typical signs and symptoms of FAS, but with damaged organs (e.g. heart, eye, hand and other defects.) The diagnosis of these children is a complex procedure and requires specialized knowledge.

HOW MUCH IS TOO MUCH?

Unfortunately there is no safe amount of alcohol. Every person metabolizes alcohol in a unique way. One person may feel intoxicated from a few sips of champagne while another person may be able to tolerate more alcohol. No-one can predict how your body will respond to alcohol. As soon as a woman falls pregnant, her body’s ability to metabolize also changes. In addition the unborn baby (fetus) has an immature liver and has great difficulty to metabolize the alcohol it is exposed to.

Binge drinking is wide spread in South Africa. It is common practice for many people to abstain from alcohol for periods of time (e.g. during the week) and then consume large quantities of alcohol over weekends or at parties. Binge drinking is defined by 5 or more drinks (15 ml absolute alcohol / drink) in one sitting of 2 – 3 hours. These sudden increased alcohol peaks in the blood stream of the pregnant woman bombards the unborn baby with alcohol and is detrimental for the unborn baby’s development.

IS FAS A BIG PROBLEM?

Yes, worldwide FAS is a big problem, although formal figures of the incidence are only available for America (0,1 – 3%), France (2,1%) and South Africa (8 – 12%). South Africa has the highest reported rate of FAS worldwide. Here is our country FAS is 30 – 50 times more common than Down syndrome.

Only 4 prevalence studies have been done in South Africa. All these studies were conducted by the Foundation for Alcohol Related Research (FARR):

Area	Province	Date	Prevalence expressed as %
Gauteng (Gedeeltes van Johannesburg	Gauteng	2000	2,1%
Wellington	Western-Kaap	2001	8,8%
Upington	Northern-Kaap	2002	6,9%
De Aar	Northern-Kaap	2003	12%

Currently FARR is also busy with a prevalence study in the Witsenberg district. This data should be available during 2010. The FASER-SA group (an American consortium which used to work with FARR and is currently associated with the University of Stellenbosch) is repeating the Wellington study, and doing prevalence studies in the Bonnievale, Robertson, Ashton and Montegue area. This data should be available in 3 years time.

All the above studies are conducted, according to international scientific standards and guidelines, on grade 1 learners (school entrants.) The findings can there fore be generalized for the specific communities, but is not sufficient to provide a prevalence rate for South Africa. Because international standards are used in the studies, we are able to compare our data with the rest of the world.

(Please note that statistical information should be handled with utmost care, not to label certain communities as ‘FAS-towns’. It is important not to name communities in the media)

Can any child get FAS?

Yes, no matter what the colour of your skins is, what your race or religion is, any child is vulnerable. If woman drinks alcohol during pregnancy she is at risk of having a child with FAS.

Often FAS is not diagnosed in a child and the child carries the burden of the debilitating affects of alcohol during pregnancy without a chance of remedial help.

Can FAS be cured?

Unfortunately no. FAS is 100% preventable by simply not drinking during pregnancy, however the damage to the unborn baby (fetus) is irreversible and permanent.

Many women only discover at 3 to 4 months that they are pregnant. Consequently they continue to drink alcohol as usual, without realizing the damage caused to the unborn baby.

Damage includes:

	Growth retardation (The babies are small for their age)
	Any organ can be damaged, especially the brain, eyes and ears
	The forming of the child’s facial features may be affected.
	Brain damage results in lifelong problems with relationships and learning such as delayed development of fine motor control, difficulties with mathematics and abstract reasoning, understanding concepts such as cause and affect.

In conclusion persons with FAS have a lifelong struggle as a result of these difficulties.

HOW IS A DIAGNOSIS OF FAS MADE?

It is vitally important that the correct, scientific diagnostic criteria are used to ensure that a child truly has FAS and to prevent to incorrect labeling of a child and family. It is even more important in a multi cultural society such as South Africa, where many of the ‘so-called” typical features of FAS are present in some of the ethnical groups. The wrong diagnosis is often made on these features and may have devastating results for both the child and the family.

The diagnosis of FAS can only be made by a multi disciplinary team of trained specialists and includes:

	Clinical assessment (IOM model)
	Neuro-developmental assessment (specific psychometrical tests to diagnose FAS)
	Intensive maternal interview (to establish the type, time and quantity of alcohol used during pregnancy)

These results are compared and only if all three tests are conclusive a diagnosis of Fetal Alcohol Spectrum Disorder is made according to specific degrees.

WHAT CAN BE DONE TO PREVENT FAS?

It is of the utmost importance that as many people as possible receive the message, so that we can all support pregnant women not to drink alcohol while pregnant. Friends, family and the father of the unborn child all have an enormous responsibility in this regard.

It is also important to include the higher socio-economic groups, as many people still believe the myth that FAS is only a problem of the lower socio-becoming group.

Professional people such as social workers, health workers and educators should receive training to best equip them in the prevention, diagnosing and management of people with FAS.

Contact Information

Telephone: +27 (0) 21 686 2645 /6/7

Fax: +27 (0) 21 685-7034

Postal address

37 Thornhill Road, Rondebosch, 7700, South Africa

Electronic mail: CEO : Leana Olivier