In treating families who have given birth to a fetal alcohol-exposed child and those caring for these children in foster, adoptive, or extended family situations, it is important to get a sense of their coping abilities. Most families are stressed by the practical and emotional problems associated with rearing a child with developmental disabilities. Also, the coping abilities of alcoholic families may be especially limited. If the biological mother (or in some cases, any caretaker) is still using alcohol, her addiction process will interfere with the child's treatment. Biological mothers who keep their child need to hear that they can make good parents. If the parent or caretaker is a recovering alcoholic, the child's diagnosis may be very stressful and will have to be faced and worked through. In addition, costs and problems involved in treatment may be overwhelming for a family with limited resources.

Many of the frequently asked questions are drawn from publications of the National Institute on Alcohol Abuse and Alcoholism, especially document #99-4369, which may be ordered for free from NIH (http://www.niaaa.nih.gov/publications/FASguides.htm). Others are being generated as part of ongoing development. If you have a question you would like addressed, please send it in.

Because of the high incidence of, or fear of, abuse and neglect, alcohol-affected children often are placed for adoption or foster care. It may take years for the family to realize that the child's impairments will not be outgrown or repaired by their loving care. Families may have to cope with the loss of their hopes for a healthy normal child or with their anger at the biological mother or the guilt of giving birth to an alcohol-affected child. Also, many families spend much time and energy advocating for appropriate services for their child.

Strategies for Clinicians to Help Parents

  • Avoid labeling the child because you see some signs of FAS, ARND, or ARBD. Refer to a clinician specializing in dysmorphology for a diagnosis. When a diagnosis is certain, it can be very helpful to the family for understanding the problem, getting the appropriate treatment, and qualifying for financial assistance.

  • If there is a diagnosis of FAS, ARND, or ARBD, research indicates that clinicians should stress the importance of early intervention to assure better developmental outcomes for the child.

  • If the parents/caretakers need help quitting or cutting down on their own alcohol use:

    • Give them informational materials.

    • Give them a self-help booklet (see Personal Steps to a Healthy Choice: A Woman s Guide, 1999, NIH Publication No. 99-4370).

    • Refer them to appropriate specialized treatment, if needed.

  • Ask the parent(s) about their fears, concerns, or questions.

  • Parenting education can be an effective adjunct to other treatments and educational interventions.

  • Consider recommending a support group. Many families want to share their feelings, as well as information about their children. (See Appendix D of this Guide for resources.) If a support group is not available, refer the parent to a clinic or social worker and suggest that they explore forming a support group.

  • Prepare a system-based approach with predefined protocols, referrals, and followup strategies.

Responses to Parents' Concerns

These are some examples of concerns that may be raised by parents or caretakers when being advised about possible effects of alcohol exposure during pregnancy on their child. Following each question is a list of some of the possible responses.

Concern: What does this all mean? Does being exposed to alcohol during pregnancy mean that my child will have Fetal Alcohol Syndrome?

Responses:

  • Every child is different and reacts somewhat differently. You can find out more about the effects of alcohol by having your child see a specialist.

  • Even if you (or the biological mother) had been drinking during pregnancy, that does not mean that your child will have FAS. However, I am concerned that there are some signs that your child may have been exposed to alcohol during fetal development. I would like your child to be seen by a physician specializing in alcohol exposure, and to have more tests to discover if there might be problems.

Concern: (From an adoptive parent) I am very angry at the biological mother and that I didn't know about this before adopting.

Responses:

  • I can understand why you are angry. It might be useful for you to talk to other parents or a counselor about how you feel.

  • I can refer you to a place to get more information and support.

  • It is very difficult to tell just exactly what the effects of alcohol exposure will be, and it is usually impossible to tell soon after birth if the child has been affected by exposure to alcohol.

  • Even if you knew that the biological mother had been drinking during pregnancy, that would not necessarily mean that your child would have FAS or other effects of exposure to alcohol during fetal development.

  • It is good to be aware now that there might be some problems, so that you will know why, and you can get appropriate information to help your child.

Concern: I am afraid of what this means and how much work it will be to raise my child. I'm afraid I will fail as a parent.

Responses:

  • Every child is different and reacts somewhat differently. You can find out more about the effects of alcohol and what kind of parenting strategies have worked for others.

  • It might be useful for you to talk to other parents or a counselor about how you feel.

  • I can refer you to a place to get more information and support. You need to fulfill your needs as well as the needs of your child. One way is to connect with a healthy support network. It takes both parents or caretakers (if both are available), talking to other parents in similar situations, or some professional help.

  • We will provide you with as much support and continued care as possible.

Concern: I thought my love and attention would overcome my child's poor start in life. But things seem to be getting worse. I just don't know what to do.

Responses:

  • The love and attention you give your child are vital and will help; but now that we know about the alcohol exposure, we know that love can't do it all. Some behaviors may get better. Some things, however, may not improve much. It will be hard despite all of your good intentions.

  • Understanding what is happening and that it might be related to alcohol exposure during pregnancy will help you learn more about the behaviors and more about what interventions or treatment might help.

  • It might be useful for you to read more about alcohol-related problems and even talk to some other parents. I can give you some resources.

Concern: (From a biological mother) I feel terrible and really guilty that I drank during my pregnancy. Is there anything I can do now? Should I or will I be able to keep my child?

Responses:

  • You may not have known about the effects of alcohol or you may have been unable to quit during your pregnancy.

  • Everyone's body handles alcohol differently. We don't completely understand why these differences occur. Some of these differences are apparently related to genetics. If you are still drinking, it is important that you get help to quit or cut down.

  • If you can't quit or cut down, I would be glad to refer you to a specialized alcohol treatment program.

  • Birth mothers can make very good parents. There will be ongoing issues to address. Even with recovery, there will be risks for relapse. But we know of many successes with mothers in similar situations.

Concern: I don't really know if I want to go to an alcohol treatment program.

Responses:

  • State that you would like to obtain a second opinion about her alcohol use.

  • Reassure her that treatment is voluntary.

  • Make the phone call referral while she is with you in the exam room.

  • Reinforce positive aspects of an alcohol treatment program.

  • Refer her to someone with whom you have worked before.

  • (A very real concern for biological mothers in need of treatment is keeping their baby with them. The reality may be that their child will be in foster care for a while. Some States are adopting laws governing this situation, and you need to be aware of what's happening in your State.)

Other Questions Frequently Asked

AEI is gathering frequently asked questions from our pool of researchers, research participants, and many individuals on the web. These questions will be posted and regularly maintained in the next stage of this ongoing project. If you would like to submit a question you may do so by emailing us (info@academicedge.com). You will recieve a direct reply from one of our research team and your question will be considered for the FAQ. Thank you.