Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Although the dangers of alcohol during pregnancy had long been suspected,
fetal alcohol syndrome (FAS) was formally described in 1968 by P. Lemoine and
colleagues from Nantes (France) in 127 children of alcoholicparents. Their
report in a French pediatric journal drew little attention. Focus on FAS only
came after it was independently redescribed in 1973 by K.L. Jones and colleagues
from Seattle (U.S.) in eight children of mothers with chronic alcoholism. Their
report in the British medical journal The Lancet triggered an avalanche of
reports of FAS.
Alcohol is capable of causing birth defects. This capability classifies
it medically as a teratogen. Alcohol is now recognized as the leading
teratogen to which the fetus is likely to be exposed. This applies only to
societies in which alcoholic beverages are consumed. In these populations,
prenatal alcohol exposure is thought to be the most common cause of mental
retardation. In fact, according to research published in Pediatrics, alcohol use among women of childbearing age (18-44 years) "constitutes a leading, preventable cause of birth defects and developmental disabilities in the U.S."
What are fetal alcohol syndrome
symptoms and signs?
Most of the features of FAS are variable. They may or may not be
present in a given child. However, the most common and consistent features
of FAS involve the growth, performance, intelligence, head and face,
skeleton, and heart of the child.
Growth is diminished. Birth weight is lessened. Retardation of
longitudinal growth is evident on the measurements of length in infancy
and of standing height later in childhood. The growth lag is permanent.
Performance is impaired. The FAS infant is irritable. The older FAS
child is hyperactive. Fine motor skills are impaired with weak grasp, poor
hand-eye coordination, and tremors.
Intelligence is diminished. The average IQ is in the 60s. (This level
is considered mild mental retardation and qualifies a child in the U.S. as
educable mentally retarded.)
The head is small (microcephalic). This decrease may not even be
apparent to family and friends. It is evident upon comparison of the
child's head circumference to that of a normal child on a growth chart.
The usual degree of microcephaly in FAS is classified as mild to moderate.
It is primarily due to failure of brain growth. The consequences are
neither mild nor moderate.
The face is characteristic with short eye openings (palpebral fissures),
sunken nasal bridge, short nose, flattening of the cheekbones and midface,
smoothing and elongation of the ridged area (the philtrum) between the
nose and lips, and smooth, thin upper lip.
The skeleton shows characteristic changes; abnormal position and
function of joints, shortening of the metacarpal bones leading to the
fourth and fifth fingers, and shortening of the last bone (the distal phalanx) in
the fingers. There is also a small fifth fingernail and a single transverse
(simian) crease across the palm.
A heart murmur is often heard and then may go away. The basis is usually
a hole between the right and left sides of the heart between the
ventricles (the lower chambers) or less commonly, the atria (the upper
Behavior and education therapy can be an important part of treatment for children with FASDs. Although there are many different types of therapy for children with developmental disabilities, only a few have been scientifically tested specifically for children with FASDs.
Following are behavior and education therapies that have been shown to be effective for some children with FASDs:
Many children with FASDs have a hard time making friends, keeping friends, and socializing with others. Friendship training teaches children with FASDs how to interact with friends, how to enter a group of children already playing, how to arrange and handle in-home play dates, and how to avoid and work out conflicts. A research study found that this type of training could significantly improve children's social skills and reduce problem behaviors.
Specialized math tutoring
A research study found that special teaching methods and tools can help improve math knowledge and skills in children with FASDs.
Executive functioning training
This type of training teaches behavioral awareness and self-control and improves executive functioning skills, such as memory, cause and effect, reasoning, planning, and problem solving.
Parent-child interaction therapy
This type of therapy aims to improve parent-child relationships, create a positive discipline program, and reduce behavior problems in children with FASDs. Parents learn new skills from a coach. A research study found significant decrease in parent distress and child behavior problems.
Parenting and behavior management training
The behavior and learning problems that affect children with FASDs can lead to high levels of stress for the children's parents. This training can improve caregiver comfort, meet family needs, and reduce child problem behaviors.
SOURCE: U.S. Centers for Disease Control and Prevention