Fetal Alcohol Spectrum Disorder (FASD) refers to the very broad spectrum of health issues infants' encounter from their mother's alcohol use during pregnancy. FASD includes several different health diagnosis; fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorders (ARND), alcohol-related birth defects (ARBD), fetal alcohol effects (FAE), and partial fetal alcohol syndrome (PFAS). There is still much debate about a safe level of alcohol use, with many advocates saying any use during pregnancy puts a child at risk for negative physical or behavioral problems.

When a mother drinks alcohol during her pregnancy, it crosses the placental barrier and into the womb. A mother's body may be able to metabolize the alcohol, while the small or underdeveloped infant liver cannot. The alcohol may then stay inside of the infant's system longer. So, even the smallest amount of alcohol can have detrimental effects to a fetus.

The amount, sequence and timing of alcohol to the fetus all directly influence the type of health issues the child may experience once born. This causes a wide range of effects on the spectrum from severe (facial anomalies) to mild (judgment skills compromised.) Even more problematic is that many issues may not arise until the child begins to grow. The child may initially appear typical until there are subtle, and not so subtle, behavioral problems associated with the prenatal injury. Children who display facial anomalies, growth retardation and developmental abnormalities of the center nervous system are associated with the severe end of the spectrum. or simply fetal alcohol syndrome (FAS.)

Diagnosis & Symptoms

Diagnosis of full fetal alcohol syndrome is based on three key features, a pre- and post-natal growth deficiency, facial abnormalities, as well as brain and central nervous system dysfunction. Professor Sterling Clarren's primate and mouse research on alcohol and pregnancy found that the lip and philtrum anomaly of (full) FAS happened during a very small development period; the 19th to 20th day after conception in the human – the period called gastrulation. However, it is well documented that children with facial features are only the tip of the iceberg. For every child diagnosed with full FAS, there will be another three to ten with alcohol-related neurodevelopmental disorders.

The brain injury that results from FASD can lead to developmental delays, an information processing deficit, the inability to reason in the way that others do and a distressing inability to fit in with the rules and behaviors required by society (deficits in self-control, hyperactivity and increased rates of ADHD) due to damage of the sensory processing system, nervous system and the brain. Heavy prenatal alcohol exposure can lead to structural abnormalities in the orbitofrontal cortex, anterior singulate, hippocampus, amygdala and corpus callosum.

The corpus callosum is the part of the brain that links the right hemisphere of the brain to the left hemisphere. The right-brain handles creativity, intuition and impulse and the left-brain handles the rules, logic, order and thoughts. When the two cannot link properly, because of prenatal exposure to alcohol or another brain injury, then the person cannot always predict the outcome of his actions even though he knows and can repeat the "rules."

Primary characteristics in children, adolescents and adults affected by FASD, include memory problems, difficulty storing and retrieving information, impulsivity, distractibility, disorganization, cognitive processing deficits (may think more slowly), slow auditory pace (may only understand every third word of normally paced conversation), developmental lags (may act younger than chronological age) and inability to predict outcomes, or understand consequences and inability to show remorse. However they often have strengths such as being highly verbal, artistic, musical, mechanical, athletic, friendly, outgoing, determined and persistent. In addition to cognitive and functioning difficulties, sleeping is also of great concern for children affected by FASD.

How Massage Can Help

Growth and developmental issues are key to the diagnosis of FAS, and in research studies of pediatric and infant massage therapy, it has been demonstrated to assist in both. For infants born prematurely, the use of massage has demonstrated a measurable increase in weight for the infants who received the therapeutic intervention. Additionally, when followed to an infant's one year birthday, researchers found that the massaged infants had a weight advantage, as well as, placing 12 to 15 points higher on the mental and motor tests of the Bayley Scales of Infant Development than the infants who hadn't been massaged. Even better, these results have been replicated by at least two other groups of researchers.

Another study was done with full-term, healthy 1 to 3-month-old infants who were given 15 minutes of either massage or rocking for 12 days over a 6-week period. What the group found was that the massage group gained more weight, displayed better face-to-face interactions, improved on emotionality, sociability and soothability, displayed less stress hormones and increased serotonin levels.

Sleep issues are a common complaint for many children with FASD, massage may not only help the child fall asleep quicker, but can often improve the quality of deep sleep. Having adequate amounts of sleep can assist in the child's mood, their behavior and may even decrease hyperactivity. Attention issues are also another key issue for children and adolescents with FASD and research demonstrates that massage increases mental focus and concentration.

While research is ongoing with both FASD and massage therapy, it is important to best understand the child who may benefit from massage therapy and what those indications may be. As a practitioner, it is important to provide the time to complete a detailed intake. A safe environment benefits all clients, but in the case of children affected by FASD you should also consider an environment which is not over stimulating to other senses. Take your time and proceed slowly when introducing touch therapy, as children may experience sensory processing difficulties and may be hypo or hyper sensitive to touch.

While it is a clear that massage is beneficial for many children, those affected by FASD may see some wonderful improvements following the intervention of pediatric massage therapy.