FAS - What To Expect During Infancy

John was only 2 and a half pounds at birth. He was 4 weeks early but should have weighed abour 5 pounds. In spite of being premature and very small, he did not require ICU and did not even need supplemental oxygen. It amazed me how healthy he was in spite of the alcohol damage.

* Irritability
* Tremors
* Sensitivity to external stimuli
* Poor sleep patterns
* Feeding difficulties
* Strong startle reflex
These symptoms are common in babies exposed prenatally to alcohol, and are similar to those seen in babies exposed to cocaine and other drugs. Together they are called Neonatal Withdrawal Syndrome. With heroin use, the symptoms are most severe. With alcohol, the symptoms persist. With all other drugs (if there was no alcohol damage), the symptoms disappear after a few weeks, a few months at the most. Women who use ilicit drugs are at high risk of abusing alcohol as well. When symptoms usually attributed to "crack babies" or "coke babies" are still present after 6 weeks, they are most likely due to alcohol exposure. Babies exposed to drugs but not alcohol are usually more passive and have fewer problems than those who are alcohol exposed.

Fo the baby with FAS, this makes the first year extremely difficult. Because the baby is so sensitive to stimulation, he or she cannot tolerate being touched, and tends to be colicky and doesn't enjoy taking a bottle because it usually results in gas pains which are more intense for the baby with FAS than for healthy babies. Because they have trouble sucking, and because they are so tiny and gain weight so slowly anyway, they are often diagnosed as "failure to thrive" and are a challenge for even the most experienced foster mother. In the care of a drinking birth mother, the child is at great risk of malnutrition, neglect and/or abuse.

For the first year of Johnny's life, he did not sleep through the night. His unconsolable screaming night after night was very frustrating, as there was nothing I could do to comfort him. A typical baby who wakes up at night can be changed and fed and put back to bed within 15 minutes, being happily cuddled by mother. A baby with FAS cries and cries, does not want to take a bottle (it causes more pain), does not want to be touched, much less cuddled. There is nothing to be done, except to cry along with the baby. Sometimes the only way I could get Johnny to take a bottle was to let him rest on his back in a room alone, with the bottle propped and no one around. The slightest noise might set him off, and a crying jag after feeding might burn up more calories than he took in. It would take 20 minutes just to get him to take 2 ounces of formula, if everytihng was calm and quiet, and if I didn't touch him. As a nurturing foster parent, this was very frustrating, but I did what I had to do to help him thrive and grow.

Because the babies' systems are so underdeveloped, they are more likely to get frequent ear infections and allergies, and the immune system might be compromised, so there are frequent trips to the doctor. The baby with FAS has a sensitive gag reflex and is likely to vomit easily. This, along with excessive crying and lack of sleep, contribute to difficulty stabilizing weight. The baby might need higher caloric formula given in small, fequent feedings. There may be little eye contact, and they don't "mold" well to being held. The baby with FAS is likely to be tense and stiff, sometimes arching his or her back, not bending gently to the curve of mother's arms like a typical baby. I would have to literally bend Johnny into my arms to cradle him.

The baby that is full FAS is likely to have some degree of developmental delays. John was typical FAS in that he didn't talk baby talk and needed speech therapy at age two, when he learned about 24 signs before beginning to talk on his own. (Now he never stops talking!) He sat up alone at age one, and didn't walk until he was two. Once he started going, he never stopped. By then he turned into a happy, affectionate, loveable little sweetie. But the first year was very trying. I can't imagine a birth mother attempting to care for a screaming, irritable baby while struggling with an alcohol addiction and all the dysfunction that goes along with that lifestyle. There is a need for treatment programs for pregnant women that meet their special needs.

What helps some babies is: quiet dark rooms, minimal social contacts (avoid churches, malls, stores - too stimulating, even the chaos of a household with many siblings is detrimental), closely wrapped swaddling or no clothes at all, no bouncing or rocking, held away from caregiver, don't force eye contact (too overwhelming during feeding).

Once you get past the first year or two, then it is smooth sailing (or should I say bumpy bouncing) through the next few years, until the school system tries to assimilate a very immature 5-year-old into the social mainstream, which is most likely met with failure, and the frustration begins all over again. But that's another story. Luckily there are very good Early Intervention programs that can help the child with FAS transition into the school environment.

by Teresa Kellerman, mom to John (FAS), president of Fasstar Enterprises and coordinator of the FAS Community Resource Center