Fetal Alcohol Syndrome/Effect and intercountry adoption: Know the risks


Marg Harrington, Jan Radford, Jan Lutke, and Helen Mark
Focus on Adoption magazine

No large Canadian study has been done on the incidence of Fetal Alcohol Syndrome or Fetal Alcohol Effect (also known as partial FAS) in children adopted internationally. However, Sunny Hill Health Centre for Children in Vancouver is collecting data, and it's clear that any child adopted from any country could have been exposed to alcohol prenatally.

Children born to women who drank during pregnancy have an increased risk for attention deficit disorders with hyperactivity, fine-motor impairment, and clumsiness, as well as more subtle delays in motor performance.

On the plus side, children who are adopted into healthy foster or adoptive families have a better prognosis than children who stay in an environment where drugs and alcohol are used by parents or caretakers. Parents need to assess their capacity for dealing with these considerations when reviewing a proposal for a child born outside of Canada.

Intercountry FAS Facts

  • One to two internationally adopted children per month are diagnosed with FAS/E by Vancouver's Sunny Hill Health Centre for Children. On a yearly basis, between 12 and 24 children adopted by BC families are diagnosed with FAS/E.
  • Family history is seldom available from overseas institutions, including reliable information about maternal alcohol use.
  • Binge drinking (four to five drinks on one occasion) is more harmful to the fetus than occasional (two drinks per month) drinking.
  • A child with FAS may have characteristic facial features indicating alcohol use during pregnancy but a child with FAE may have none.
  • 2/1000 American children are affected by FAS, whereas 2/100 Eastern-European children are affected by FAS.
  • FAS/E is not restricted to children coming from Eastern-European countries. Children adopted from such diverse countries as Costa Rica, Chile, US, and Tunisia have been diagnosed with FAS/E over the past year at Sunny Hill.
  • The best time to diagnose FAS/E is before a child is six years old.

Lowering The Risk

  • Be aware of the risks kids abroad face. Prenatal exposure to alcohol is a potential problem for large populations of Eastern-European children. Prenatal exposure to alcohol can result in FAS/E and significant secondary mental, learning, and behavioural disabilities.
  • If, at the time of proposal, you have concerns about the child's medical status, request more information. Take all your information to your family physician. Also, families can mail a video to the FAS Support Network or an adoption medicine specialist for a non-legal opinion regarding the possibility of FAS/E.
  • A prenatal history indicating the birth mother didn't drink during the week but partied on the weekend is not good news.
  • FAS cannot be readily diagnosed by a video or by pictures alone but a good video and photograph may raise suspicion. The most salient features are: small eye openings, a thin upper lip, flat or smooth skin above upper lip, a flat midface, and a small head.

Dr Dana Johnson, adoptive parent and head of the University of Minnisota Adoption Medical Clinic, says to educate yourself and honestly evaluate your own capabilities. Obtain appropriate information from your agency and have it reviewed by a knowledgeable physician before accepting a referral. An important part of this process is being prepared to say no if you recognize that the needs of a certain child exceed your capabilities.

Acquaint yourself with the health issues of women in their child-bearing years in the country from which you wish to adopt. Dr Johnson says the second most common reason children are institutionalized is termination of parental rights because of neglect and/or abuse, often alcohol related.

FAS/E is easiest to detect between the ages of four and six. The challenges will be lifelong. Early diagnosis has been shown to decrease the incidence of associated problems such as dropping out of school, trouble with the law, and drug abuse.

Source: The AFABC thanks the following: Jan Radford, Sunny Hill Health Centre for Children, Jan Lutke, FAS/E Support Network, Marg Harrington, Sunrise Adoption Centre, and Dr Dana Johnson, University of MN Adoption Medical Clinic.