Infants born with FASD may have a difficult first few months. Some infants show behaviors related to withdrawal symptoms from alcohol. These symptoms can include seizures, sleeping disorders, stomach upsets and extreme fussiness. Some infants are unable to screen out unwanted noise and distractions. This may cause overstimulation, frustration and irritability.

Many infants with FASD are born with low birth weight. Some have difficulty getting adequate nourishment due to poor sucking and swallowing abilities or mouth abnormalities. There may be failure to thrive or height and weight growth deficiencies. Nutritional assessments and monitoring may be needed.

Most infants with FASD show:

• Irritability, jitteriness and nervousness
• Sucking or feeding difficulties
• Poor muscle tone
• Sleep disorders
• Sensitivity to sound and light
• Excessive crying
• Decreased alertness

Older infants with FASD tend to:

• Be easily upset
• Be easily distractible
• Be hyperactive
• Have short attention spans
• Have developmental delays
• Have problems using muscles

Health care team members need to be aware of the infant’s physical, mental, emotional and behavioral development. This will help determine special needs related to FASD. It also helps health providers and professionals understand family strengths and resources. Early intervention is the first step to an improved prognosis. Ongoing follow-up will also be required.

• It is important to learn what your infant is trying to tell you. Understanding cues helps parents meet their child’s needs and lessen stress.
• Because of hypersensitivity to sound and touch, sensory stimulation should be decreased. Try to:

• Keep lights low.
• Keep noise levels to a minimum.
• Gradually introduce stimuli one at a time.
• Use calming techniques when overstimulation occurs. A warm bath or shower, listening to quiet music, swaddling or rocking may help.
• Provide consistent bedtime routines. Darken the bedroom at night and at nap times. Provide soft snug clothing. Try to discover which textures are comforting. Lessen distractions in the bedroom. Avoid mobiles. Use plain bumper pads. Simplify room decorations. Avoid clutter and busyness. Use white noise such as a fan or soft relaxing music.

• Healthy eating should be a daily goal. Try to make mealtime a positive experience. Suggestions for feeding include:

• Learn hunger signs and serve food when signs are first shown.
• Serve small frequent high calorie meals and snacks. Four to six meals per day may be needed for adequate nourishment.
• Reduce distractions while feeding. This helps an infant focus on eating. Feed in a quiet and slightly darkened room. Do not rock or talk while feeding. Do not turn on a radio or television.
• Never prop a bottle or leave a child unattended while eating.
• Allow ample time for eating. Have reasonable expectations on portion size. Serve food warm. Avoid hot or cold foods. It may be helpful to reduce the texture of foods offered.
• Limit choices.
• Seek help from a nutrition professional.

• Continue regular health care. Concerns for this age group include vision, hearing and dental screening, cognitive, motor and language development. Social skills, nutrition and special needs related to FASD also need consideration. The following may be included:
• Height and weight need to be obtained and graphed.
• Infants and toddlers with FASD often have growth problems. Diets need to be monitored. The diet will have many changes during this period. Contact your health provider or dietitian if you have questions.
• Some feeding practices seem to reduce the development of allergies. Breastfeeding is usually best. Avoid alcohol while breastfeeding. Avoid cow’s milk during the first year. Your health care provider or professional can suggest an infant formula if needed. Wait until your infant is 6 months old to slowly introduce solid foods.
• Flu shots may be given to prevent influenza.
• Medication dosages may need to be changed frequently.
• Upper respiratory and ear infections may occur frequently due to an impaired immune system. Antibiotics may be given to treat some infections.
• Parents should be present as much as possible for comfort and support if hospitalization occurs.
• Remember that all children need well-baby checkups and immunizations.

• Children develop faster as infants and toddlers than at any other time in life. Enjoy watching your child grow and develop. Note the dates your infant or toddler reaches milestones. Examples of developmental milestones are crawling, standing and walking. Language milestones include saying the first word, using several words and connecting two words. Remember, infants with FASD may show some delays in reaching these milestones.
• Provide an environment where your child can play safely with the least restriction. Provide toys and activities which are right for your child’s age and development. Children with FASD may need some safety restrictions. Gates on stairways, crib nets and door alerting systems may be necessary.
• Infants with FASD may have eating problems. Some infants and toddlers fail to gain weight even when eating enough. Growth deficiency may continue throughout childhood. Watch your child’s food intake and weight gain. Talk to your health provider or professional if you have concerns.
• Children with FASD are less likely to develop regular sleep cycles than other children. They may also experience more interruptions in their sleep.

• Limit activities which cause overstimulation. Activities such as pillow fighting, wrestling, television, video games or rock music may overstimulate. Alternate activities requiring attention with those requiring physical exercise. Quiet and focused activities such as finger painting or coloring may help children slow down.
• Have a place where your toddler can go when overstimulated or overwhelmed. It should be a comfortable and calm area. It should not be treated as a punishment.
• Teach self-calming techniques. Soft music can be calming and may also help to develop listening skills. If one technique is not working, try something different.

• Set both expectations and limitations. Consistent direction and discipline are important for a child who has trouble learning and remembering rules. Your child may not learn from past mistakes. Mistakes may be repeated over and over again. Consistency helps all children develop self-control.
• Develop a system of rewards and discipline. Try to use the same system for all your children. Children may notice if one child receives special privileges.
• Discipline should be immediate. Do not delay. Your child may have trouble connecting cause and effect. This means there may be difficulty in seeing a connection between the behavior and the punishment. Discipline should be viewed as an opportunity to teach appropriate behavior. A reward system may work best. Sometimes praise and hugs can be just as effective. Change rewards often to keep interest high. To avoid frustration, make sure there are more successes than failures.
• Do not debate rules. Be brief. Avoid lecturing and threats. Review and repeat consequences of negative behavior. Take time to teach and encourage positive behavior.
• Avoid statements which place a value on behavior. For example, do not say "that is a bad word." Say "you may not use that word." Offer a different word which is acceptable.
• Children with FASD may copy behavior they have experienced or observed. For this reason, never use physical punishments. Avoid all forms of violence. Monitor television, movies and radio programs.

• Establish a few simple rules. Use picture cues. Use the same language repetitively. Avoid using words with more than one meaning. Be specific when telling your child what to do. Repeat directions as needed.
• Speak slowly. Pause between sentences to allow time for understanding.
• Daily routine is very important. Daily routine helps your child predict coming events. Before bedtime, prepare for the next day. For example, lay out clothing and shoes.
• Clearly define your child’s space. Children with FASD may benefit from a comfortable area they can call their own. Avoid clutter and distractions.

• All children are better able to manage life if they feel good about themselves. Praise your child often to build self-esteem. Praise accomplishments. Reward rather than punish. Offer support, not criticism. Praise the behavior rather than the child. For example, say "good work" rather than "good boy" or "girl". Separate your child from the behavior. Do not make your child feel as if he or she is a bad person. Encourage positive self-talk.
• Children with FASD may need to be reminded that you like them. Notice good qualities and behaviors. Thank them for their efforts.

• Behavior may be changed by redirecting activities. Try to engage your child into positive play. Learn how to read and respond to emotional cues. This may help avoid behavior problems.
• Infants and toddlers with FASD often have problems with attachment. They may not show a preference for parents over others. They may not be able to differ between a friend and someone they just met. These problems may get worse as the child gets older. This can be very difficult for parents. Caregivers may need to be alert 24 hours a day to keep their child safe.
• Sometimes, children who are not feeling well may regress in behavior. They want parents to help them do things they previously did themselves. Usually this is temporary and will end when they are feeling better.

• If you use child care, choose a provider who is willing to learn about caring for a child with FASD. Be sure you feel confident in your provider’s ability to understand and carry out your instructions. Teach the provider about FASD and how to manage the condition.
• Children with FASD may need extra supervision to keep them safe. Choose child care where this can be provided. Often, children with FASD do better in small groups. Consistency with caregivers and routines is important. Centers which value attachment, predictability, flexibility, nurturing and provide various ways of coping are best.
• Develop an emergency plan for your child care provider. Write a list of the reasons to contact you. Include phone numbers for yourself, your doctor and several family members.
• Be sure your child care provider and helpers do not smoke if your child has allergies, asthma or frequent ear infections.
• Colds and other infections are common in large child care centers. Children with FASD often have more ear infections. Child care with fewer children will reduce exposure to infections. It is not necessary nor are you likely to prevent all illnesses. Having an occasional illness will help develop your child’s immune system.
• The Americans with Disabilities Act (ADA) provides that child care may not refuse a child because of a special health need. This is regardless of child care size or whether they receive public funds.

• Part C of the Individuals with Disabilities Education Act (IDEA) requires schools to provide Early Intervention services. Services are provided to children who have special health needs which affect learning or who have developmental delays. Children from birth to age 3 are entitled to these services. Parents are partners on a multidisciplinary team that develops an Individual Family Service Plan (IFSP) for their child. Contact your local school district to find out how this program works in your area. Ask to speak to the Early Childhood Intervention Coordinator. PACER Center can also provide information about Early Intervention. See the General Resources section of this booklet for more information.

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