Night after night, mom gets a bit tipsy and baby gets wasted. After nine months of this, the baby is born, a beautiful girl named Anne. Mother's alcohol problems have become so bad that she is not capable of raising a child and Anne is soon adopted. The baby has finally escaped the clutches of alcohol. Or so it seems.

But wait, why is Anne so small? Her birth weight is in the lowest 5 percentile and her head is extremely small. Not only that, but some of her facial features seem a bit abnormal, from her flat facial profile to her small eye openings. Oh well, all babies are different and at least Anne is healthy. What the family doesn't know is that beneath that seemingly healthy smile, Anne is suffering from a condition called Fetal Alcohol Syndrome (FAS).

As Anne starts to grow up, she turns out to be quite a handful. She is always irritable and never wants to play with the other kids. Her parents are worried, but hope that once she starts school, some of these problems will go away. Unfortunately, they only get worse. At school, Anne is still antisocial and starts getting picked on by other kids. She hasn't been growing at the same rate as most of the other children so she is very small for her age. Plus she seems to have a hard time building friendships. She starts throwing temper tantrums on a regular basis. Her teachers don't know what to do with her. Why is she always so hyperactive? Why doesn't she ever pay attention in class?

As the problems get worse, Anne's parents decide to take her to a doctor. After an extensive evaluation, the little girl is diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). Should she start taking Ritalin or Adderall? Anne's parents agonize over the issue. Their friends warn them about overmedicating kids for behavioral problems, saying that it's just a quick fix and may not be necessary or completely safe. But Anne needs help and her parents decide medication is the best alternative. They are hopeful that Anne's problems at school will be solved.

Although things get a little bit better, the struggle continues. "Anne just doesn't seem to be grasping the material," her teachers say year after year. She has a poor memory and can't seem to keep up with the other kids her age. Finally it is decided that a special education class might be her best option.

Anne is put in a classroom with other children with special needs, receiving extra attention which helps bring some stability to her life. Unfortunately, the feeling is temporary and Anne's problems soon start extending beyond home and school. She is at the store one day and steals a candy bar because she is hungry. Although her family is not poor, she has a hard time grasping the concept of money and just doesn't seem to understand that stealing is bad. In fact, stealing soon becomes a regular habit of hers. When her parents find out, they are not simply outraged; they are also extremely frustrated. No matter what they tell her, they can't seem to get Anne to understand the consequences of her action. They take her to a psychologist, hoping that it might help. Luckily for Anne and her parents, the psychologist has seen cases like this before. She refers them to another doctor for diagnosis and finally the family learns of Anne's condition. The clean break from her birth mother's alcohol problem was not so clean after all. The alcohol has caused irreparable brain damage.

Every year over 5000 children in the United States are born with FAS. This is more than are born with Down Syndrome, Muscular Dystrophy and HIV combined. But even that is only a fraction of the problem. A clinical diagnosis of FAS requires the appearance of a whole array of symptoms, but there are plenty of other children who suffer from prenatal alcohol exposure. In fact, one out of every 100 children is born with enough brain damage from alcohol to cause problems that will interfere with the child's ability to function successfully in life. Many experts believe that a significant percentage of children with learning disabilities suffer from alcohol related birth defects.

What about the effect of other drugs? In the late 1980s, there was a great scare over the development problems suffered by "crack babies" born to cocaine-addicted mothers. Unlike alcohol, however, cocaine use is not associated with a pattern of birth defects. This is not to suggest that cocaine is harmless to a baby, as it does often cause lower birth weight and may contribute to other problems. Yet, according to the Institute of Medicine, alcohol causes more neurological damage to a developing baby than any other substance, including heroin, cocaine and marijuana.

Karen Riley from the Denver Children's Hospital has started a support group for parents of children who have been exposed as fetuses to alcohol and other harmful substances. She also started up the Colorado Coalition on Fetal Alcohol Syndrome, a group of professionals and parents who work on different projects, conferences and speaking events to educate people and raise awareness. She believes that even though most people have a general knowledge that drinking during pregnancy is a bad thing, they don't realize the extent to which alcohol damages the brain. There are medications and behavior interventions that can help, yet Karen warns, "There is no cure."

She also warns that FAS affects all types of people. Although there has been a high prevalence among certain Native American groups, it is a myth to think that it only is a problem for certain ethnic groups. As Karen explains, "Fetal Alcohol Syndrome crosses all socioeconomic and racial lines because alcoholism does as well. FAS does not discriminate."

And what about Anne? What will happen to her? Will she be able to hold a job? Will she be able to live independently? Will she stay out of trouble? Sadly, the outlook is not good. Fewer than 10 percent of FAS children are successful in living and working independently. There is a 60 percent risk of being charged or convicted of a crime. Anne is not a real person that I've met, but she represents the stories of so many children, poisoned by alcohol. The physical deformities, the mental deficiencies, the halted development-- a lifetime of problems from a short time of alcohol exposure.

So how much is too much alcohol while pregnant? Individual differences in processing alcohol, along with the age of the mother and the timing and regularity of the drinking can all have an impact. Since it is unknown how much alcohol causes damage, there is a simple answer: no amount is safe. And since much of the brain damage can occur during the first trimester when a woman may not even know she is pregnant, it is important that women who are thinking of having a baby adopt healthy behaviors. (By the way, even though it is only the mother's drinking that causes FAS, a father's drinking can lower testosterone levels, decrease healthy sperm and increase the risk of disorders in his children. So this warning goes out to you guys out there as well!)

Fetal alcohol syndrome is the leading known cause of mental retardation. The good news is that FAS is 100% preventable. It is up to you and me. If you are pregnant or know someone who is, don't let them drink. Stop the problem at the beginning, so that the children do not have to spend their lifetime paying the price.

Neda

Please email me at: neda@ustrek.org