for everyone living in Ireland with Foetal Alcohol Spectrum Disorder

How do I know if my child has Foetal Alcohol Spectrum Disorder?

Whilst there are a number of ways to identify if your child has FASD, it can be quite complicated to reach a conclusive decision. For many years medical professionals believed that 'facial dysmorphia' was essential to diagnose FASD, however today it is estimated that this appears in only 10% of cases. Below are some of the indicators to look for, however your child might have a few, or many of them: 


  • Low body weight
  • Poor coordination
  • Hyperactive behavior
  • Difficulty with attention
  • Poor memory
  • Difficulty in school (especially with maths)
  • Learning disabilities
  • Speech and language delays
  • Intellectual disability or low IQ
  • Poor reasoning and judgment skills
  • Sleep and sucking problems as a baby
  • Vision or hearing problems
  • Problems with the heart, kidneys, or bones
  • Shorter-than-average height
  • Small head size
  • Sentinel facial features (Image below)


The image above shows a range of facial dysmorphia that could suggest FASD

Approximately 10% of children with FASD will have sentinel facial features.

Most children will be diagnosed on the basis of their symptoms and evidence of prenatal alcohol exposure.

Disrupted or Limited Sleep

People living with FASD will usually struggle to sleep and/or maintain a regular sleep pattern, often only achieving between 2-3 hours sleep each night. It is not uncommon for a person with FASD to be awake until 2am, and then fall asleep for a couple of hours and then be wide awake again. This is because their pineal gland is not making enough melatonin. The purpose of the pineal gland is to regulate the sleep-wake cycle, known as the circadian rhythm, and it does this by regulating the production of melatonin.


The production and excretion of melatonin are triggered by variances in light levels. Low, or ‘Dim Light’, levels stimulate nerves that cause the release of norepinephrine at the pineal gland cells. When the sun sets, melatonin is triggered to be released. And contrary, blue light (tablets/computers) and bright lights will have a melatonin production lowering effect, keeping the mind and body wide awake!


Several studies support melatonin use in people with FASD, especially those having a co-morbid diagnosis of autism spectrum disorder (ASD) or ADHD.

The key thing to remember is that melatonin does not force sleep. Rather, it signals to the body that it is bedtime. This is why if you’ve had your sleep disrupted (nocturnal toilet visit or jet lag), melatonin can help to reset your confused body and brain.


When to take melatonin


Plasma levels of melatonin peak within one hour of taking it. Therefore, to help re-establish a healthy bedtime (sleep onset insomnia), then taking melatonin 30 minutes to 1 hour before wanted sleep is recommended. However, if a person is wide awake in the middle of the night, owing to sleep interruption, taking an additional dose will not help.


Helpful Tips


Melatonin can only be prescribed by either a Pediatrician or CAMHs Psychologist in Ireland. This is usually prescribed in the form of melatonin capsules, which provide a longer/slower release of the melatonin. If you don't have access to melatonin - perhaps you are waiting for a referral to either service - then there is a natural alternative that can help. Organic milk contains natural melatonin, so gently warming some milk - the old fashioned way in a saucepan on a hob - will help to release the melatonin. Be careful not to boil the milk and do not warm it in the microwave. Unfortunately alternative milk products like oat milk or coconut milk do not contain melatonin. A cup of warm milk should be drunk about 30 minutes before bedtime.


Bedtime routine is a key part of helping with sleep. Whether it's a  school night, weekend or you are on holiday, it is really important that you try to keep to the bedtime/sleep routine as much as possible. This includes the evening routine (washing face, brushing teeth, getting ready for bed) and the nominated time of going to bed. Bright light, including Tablets, Phones and even a TV that emit a white/blue light can disrupt the pattern for sleep. Try to enjoy a quiet time in the hour before bedtime. A bedtime story or reading with reduced or coloured lighting will provide not just a better bedtime atmosphere, but also encourage the brain to process that it is time for sleep. For some people the dark can cause anxiety and fear, and whilst it may seem the right thing to leave a bedside or landing/hallway light on, we would suggest that this is a coloured plug in night light.


We recommend that you 'walk' the journey between the bedroom and the bathroom. Do you see any bright or white lights on the way? If so, remember that when the body is subjected to bright white or blue light, any melatonin is flushed out directly through the skin in an instant. This will cause real difficulty in getting back to sleep. Also, it's probably time to invest in a couple of coloured night lights, maybe for the bedroom and landing/hallway areas. These should be red or green where possible. In addition, if the only light you have in the bathroom is a single bright light, then it may be time to buy an in-toilet light that is PIR activated by movement. Some sample products are below:

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