The Neurodevelopmental Consequences of Prenatal Alcohol Exposure

Elizabeth Welch-Carre, RN, MSN, NNP

Disclosures

Adv Neonatal Care. 2005;5(4):217-229. 

In This Article

Nursing Implications

An important responsibility of the intensive care nursery nurse is to obtain a thorough prenatal history and document alcohol exposure in the infant's chart.[12] For the infant who will be going home with his or her biological parents, the nurse must assess parental coping skills and identify support services and resources for the family.[63] Table 5 , provides a list of excellent resources that are available for professionals and parents who care for infants with FAS or ARND.

Biological parents may need referrals to substance abuse treatment programs.[63] The biological mother may experience guilt for causing harm to her child. Alcohol abuse is often transgenerational, adding further complexity to the home environment and limiting the availability of effective social support. The mother may also have other comorbid psychiatric disorders, such as bipolar disorder, depression, post-traumatic stress disorder, or psychosis.[72] A referral to mental health services for further evaluation, counseling, or a support group may be necessary.

Children with PAE frequently become foster children.[60,72] Many placement agencies provide minimal education for foster parents about the implications of PAE. Nurses will need to teach foster parents how to care for these infants.[60,72]

Infants with PAE are often easily overstimulated. Teach the parents the infant's cues that signal over- stimulation and help parents to make appropriate environmental modifications.[63] Demonstrate how to assist the infant to self-regulate, i.e., by helping the infant to return to midline by placing their infant's hands near her or his mouth.[63] Prepare parents for the potential episodes of inconsolable crying and provide them with safe coping strategies.[63] Encourage parents to ask for help if they need it. The Family Teaching Toolbox, A Parent's Guide to Prenatal Alcohol Exposure, on pages 230-231, may be a useful teaching adjunct.

Children with PAE have an increased risk of being insecure and developing attachment disorders.[73] Insecurity is linked to the degree of exposure to alcohol.[73] They often have difficult temperaments, making positive parental interaction difficult.[1] Provide the parents with practical Methods to help the infant feel secure, such as swaddling, periods of quiet time, and opportunities for caregiving.[1,73] With positive support, the infant will be more likely to form secure attachments and coping skills.[73]

Early intervention services should begin as soon as a diagnosis is made.[60] Become familiar with services available in your region. Part C of the Individuals With Disabilities Act is a federally mandated, usually county-administered, program that provides services to children from 0 to 3 years of age. The diagnosis of FAS is a presumptive eligibility diagnosis based on future risk. This means that the infant is eligible for services even if he or she does not meet the usual eligibility criteria at the present time.[60] Physical therapy, occupational therapy, speech and language therapy, parent/infant interaction groups, and respite care may all be available.

Home visits may be indicated for medically challenging infants or when parents need additional support.[63] Home visits provide additional information about the safety and resources of home environment and how both the parents and infant are transitioning and coping with their new situation.[63]

Educate all women of childbearing age about the risks of PAE. Women who are having unprotected sex, are trying to become pregnant, or those who are already pregnant should be encouraged to abstain from alcohol use. Although it has not been determined if an occasional drink during pregnancy will definitely harm a fetus, neither has the safe versus unsafe threshold for any given fetus been determined.

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