Simone Lawson
Fetal Alcohol Syndrome (FAS) is a preventable birth defect caused by maternal alcohol consumption during pregnancy. It can cause a range of physical and neurodevelopmental issues, including growth problems, facial anomalies, and central nervous system (CNS) abnormalities. While FAS can present with a variety of symptoms, one distinctive feature is railroad track ears, where the top curve of the outer ear is underdeveloped, folded over, and parallel to the curve beneath it. This ear shape is one of several facial anomalies associated with FAS, which also include a thin upper lip and small eyes. Diagnosis of FAS can be challenging, and there is no single definitive test. However, healthcare providers may suspect FAS in newborns based on specific physical characteristics and maternal history of alcohol consumption during pregnancy.
| Characteristics | Values |
|---|---|
| Preventable | Yes, by avoiding alcohol during pregnancy |
| Facial features | Thin upper lip, smooth or absent philtrum, small eyes |
| Ears | "Railroad track" ears, low set pinna or pinnae |
| Size | Small size at birth |
| Brain | Alcohol-related brain damage |
| Eyes | Increased risk of eye defects |
| Heart | Increased risk of heart defects |
| Hearing | Increased risk of hearing defects |
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What You'll Learn
'Railroad track' ears are a symptom of FASD
Fetal Alcohol Spectrum Disorder (FASD) is caused by the effects of maternal alcohol consumption during pregnancy. Fetal Alcohol Syndrome (FAS) is the most clinically recognisable form of FASD and is characterised by a pattern of minor facial anomalies, prenatal and postnatal growth retardation, and functional or structural central nervous system (CNS) abnormalities.
FASD may present in childhood or early adulthood with mild social or intellectual concerns, or it can present with birth defects and growth problems during pregnancy. It can be difficult to diagnose fetal alcohol syndrome, and there is no direct test for FAS. Diagnosis is often based on the size of a child, specific physical signs, and symptoms that develop through childhood.
One of the symptoms of FASD is "railroad track" ears. The top part (curve) of the outer ear is underdeveloped, folded over, and parallel to the curve beneath it, giving the appearance of a railroad track. This is one of the several structural defects associated with FASD. Other structural defects include ptosis of the eyelids, a "hockey stick" palmar crease, and other palmar crease abnormalities.
The presence of "railroad track" ears in children can be a crucial indicator of FASD, and examining the ears during assessment for FASD is essential. Animal studies have suggested that even a single episode of consuming the equivalent of two alcoholic drinks during pregnancy may lead to fetal brain cell loss. Therefore, it is recommended that beverages containing alcohol be avoided when trying to become pregnant.
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FASD can cause hearing loss
Fetal Alcohol Spectrum Disorder (FASD) is caused by the effects of maternal alcohol consumption during pregnancy. Fetal Alcohol Syndrome (FAS) is the most clinically recognisable form of FASD. FASD can cause hearing loss and is associated with four kinds of hearing disorders:
- Developmentally delayed auditory function
- Sensorineural hearing loss
- Intermittent conductive hearing loss due to recurrent serous otitis media
- Central hearing loss
The prevalence of mild sensorineural hearing loss in children diagnosed with FASD (16dB hearing-level or greater) is not higher than expected in this age group. However, because children with FASD are academically and behaviourally challenged, early detection of hearing loss and early intervention is important. Multiple studies have reported that children with FAS show much higher rates of intermittent hearing loss due to recurrent middle ear infections (75-93%).
In addition, children with FAS have been shown to display mild to moderate sensorineural hearing loss. The Fetal Alcohol Research Center at Wayne State University Medical Center found the prevalence rates of bilateral sensorineural hearing loss in FAS children to be 29% and 27% in two studies conducted a decade apart. These rates are more consistent with those reported in children with craniofacial abnormalities like overt cleft palate (47%), submucous cleft palate (26%), and Down syndrome (24%).
FASD is associated with a range of physical birth defects that can affect the ears, among other parts of the body. "Railroad track" ears, where the top curve of the outer ear is underdeveloped, folded over, and parallel to the curve beneath it, is one such example.
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FASD can cause middle ear infections
Fetal Alcohol Spectrum Disorder (FASD) is caused by maternal alcohol consumption during pregnancy, resulting in a range of developmental abnormalities in the child. Fetal Alcohol Syndrome (FAS) is the most severe manifestation of FASD and can affect all parts of the body, including the ears.
Children with FAS have been found to have much higher rates of intermittent hearing loss due to recurrent middle ear infections, with rates ranging from 75-93%. Middle ear infections can also cause long-term problems if left untreated. Fluid can remain in the middle ear even after the initial infection has cleared, leading to a condition called otitis media with effusion. This can affect hearing and may be difficult to treat.
The impact of FASD on middle ear infections and hearing loss has important implications for speech, language, and auditory learning. Early identification and intervention of hearing loss are crucial to enable age-appropriate acquisition of speech-language and auditory skills. Additionally, FASD can cause structural abnormalities in the ears, such as "railroad track" ears, where the top part of the outer ear is underdeveloped, folded over, and parallel to the curve beneath it.
While there is no cure for FAS, early treatment of some symptoms can improve a child's development. This includes behavioral and education therapy, parental training, and medication to manage attention and behavior issues.
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FASD can be difficult to diagnose
Fetal Alcohol Spectrum Disorders (FASD) are caused by the effects of maternal alcohol consumption during pregnancy. Fetal Alcohol Syndrome (FAS) is the most clinically recognisable form of FASD. FAS presents a pattern of minor facial anomalies, prenatal and postnatal growth retardation, and functional or structural central nervous system (CNS) abnormalities.
Additionally, obtaining a complete history of alcohol intake during pregnancy can be challenging. Some pregnant women may not feel comfortable disclosing their full alcohol consumption history to their healthcare providers. This can be due to stigma, guilt, or fear of judgment. As a result, some cases of FASD may go undiagnosed or misdiagnosed. Furthermore, the variety of symptoms and spectrum of severity in FASD can make diagnosis difficult. While some individuals with FASD may present with mild social or intellectual concerns, others may exhibit more severe birth defects and growth problems during pregnancy.
In some cases, healthcare providers may suspect FASD based on the presence of certain physical anomalies or growth issues. However, a referral to a multidisciplinary team, including a dysmorphologist/clinical geneticist, developmental pediatrician, mental health professional, social worker, and educational specialist, is often necessary for a comprehensive diagnosis. This team can help assess the individual's growth, CNS function, and facial features, as well as identify any overlapping symptoms with other disorders.
While FASD can present challenges in diagnosis, early identification and intervention are crucial for improved outcomes. Treatment and management of FASD typically involve the coordination of multiple community services, including social services, parental education, and educational support.
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FASD is preventable
Fetal Alcohol Spectrum Disorders (FASD) are a group of preventable conditions that can occur when a developing baby is exposed to alcohol in the womb. FASD is preventable if a developing baby is not exposed to alcohol. Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental deficits.
FASD is an umbrella term for a range of physical, cognitive, and behavioral disorders caused by prenatal alcohol exposure. These disorders can affect each individual differently and can range from mild to severe. The effects of FASD can be lifelong and include problems with behavior, learning, and physical development.
Fetal Alcohol Syndrome (FAS) is the most clinically recognizable form of FASD. It is characterized by a pattern of minor facial anomalies, prenatal and postnatal growth retardation, and functional or structural central nervous system (CNS) abnormalities. People with FAS may experience problems with learning, memory, attention span, communication, vision, or hearing. They may also struggle in social settings and have difficulty getting along with others.
To prevent FASD, it is recommended that women avoid consuming alcohol if they are pregnant or trying to become pregnant. This is because a woman may not know she is pregnant for up to 4 to 6 weeks, during which time the fetus undergoes a critical period of development. Any amount of alcohol during pregnancy can cause FASD, and there is no safe time to drink during pregnancy. Even a single episode of consuming the equivalent of two alcoholic drinks during pregnancy may lead to the loss of fetal brain cells.
Early treatment and intervention for FASD can improve outcomes and lessen the severity of symptoms. Treatment approaches may include medication, behavior and education therapy, and parental training to help families cope with the challenges associated with FASD.
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Frequently asked questions
Fetal Alcohol Syndrome (FAS) is a preventable permanent birth defect syndrome caused by maternal alcohol consumption during pregnancy. It is the most clinically recognizable form of Fetal Alcohol Spectrum Disorders (FASD) and is characterized by a pattern of minor facial anomalies, prenatal and postnatal growth retardation, and functional or structural central nervous system (CNS) abnormalities.
There is a long list of features associated with FAS, but there are only three features that are required for a diagnosis of full-blown FAS: a thin upper lip, a smooth or absent philtrum (vertical groove between the nose and lip), and small eyes. Other features that are not necessary for a diagnosis include "railroad track" ears, "clown eyebrows", wide-spaced eyes, epicanthal folds, flat nasal bridge, short upturned nose, flat midface, and small chin.
It is difficult to determine how common FAS is because diagnosis can be difficult. Pregnant women may not give a complete history of alcohol intake during pregnancy, and there is no direct test for FAS. However, a study of women between 18 and 44 years of age showed that 10% used alcohol during pregnancy and 2% engaged in binge drinking.
Having small ears alone does not constitute fetal alcohol syndrome. However, ear abnormalities, including "railroad track" ears, have been observed in children with FASD. A systematic review and meta-analysis found that ear abnormalities were present in 88% of children in two small studies of FASD. Therefore, examining the ears is important during an assessment for FASD.
