Preschool children with FASD are usually friendly, outgoing, highly social and talkative. Verbal skills are often better than thinking skills. However, cognitive, motor and complex speech development are usually slow.

Signs of hyperactivity are seen in many children with FASD. Sensitivity to sensory stimulation like touch and sound may continue. There may be difficulty making a transition from one activity to another. There may be difficulty adjusting to change in routines. Frustration and temper tantrums often occur, especially as children get older.

Children with FASD often have no real sense of "stranger danger". They may not be able to differ between a friend and someone they just met. They may respond to strangers the same way they respond to their parents. Close supervision is usually required. Parents may need to be alert 24 hours a day to keep their child safe. This can cause stress and frustration which increases as the child gets older.

The entire family may need support from others to help with coping. Family members can benefit from venting frustrations without feeling blamed. Parent support groups may be helpful. See the Resources section of this booklet for more information.

Continue regular health care as discussed in the Periodic Health Care section of this booklet. Concerns for this age group include promoting optimal growth and development and activities of daily living (Addles) skills. A preschool evaluation and determining special needs related to FASD also need consideration. The following may be included:

• Height and weight need to be obtained and graphed. Children with FASD may tend to grow slower than other children. They may be small for their age. They may not catch up later.
• A nutritious and balanced diet is important. A nutritional assessment may be done.
• Poor gross motor coordination can lead to injury. Frequently the child does not recall how he got hurt. Suspicion may fall unjustly upon the caregiver. The child may not be able to identify pain or know how to tell you about it. Children with FASD may also have a high tolerance for pain. They may not complain. Injuries can go untreated. Teach children what to do when their body hurts.
• Extra care may be needed to treat ear infections which can lead to hearing loss.
• An impaired immune system may continue. It places the child with FASD at greater risk for opportunistic infections.
• Flu shots are usually given to prevent influenza. They are given in the fall to provide protection during the flu season.

• Provide your child with simple information about FASD. Help them tell their own story and identify feelings. See the Resources section of this booklet for more information.
• Provide your child with opportunities to:

• Play with other children the same age. However, some children with FASD are more comfortable playing with children one to two years younger
• Learn to start and complete activities during play
• Play outdoors in a safe area
• Succeed and gain self-confidence
• Maintain a balance between structured activities and free time

• Offer assistance or aids to help your child overcome difficulties which may hinder progress. For example, a computer may help a child who has difficulty writing.
• Irregular sleep patterns may continue. Stay with an established evening routine and bedtime. Routines help children who have difficulty predicting and organizing. Music, singing or reading can help to calm or soothe. Naps may be needed, however, many children with FASD will not nap at all.
• Mealtime is an opportunity for socialization. It helps in bonding and developing relationships. A positive mealtime should be a priority. Children with FASD may lose interest in eating before completing a meal. They may need to be reminded to eat. Often, they need to move about while eating.
• Children with FASD may have difficulty making and keeping friends. Plan brief play periods with one or two friends. Teach friendship and sharing. Friends may be the same age or younger. Supervise and structure activities. Lack of friendships may result in increased dependency on caregivers.
• Parents may need a break from caregiving. Try to arrange respite care. Family and friends may be of assistance. Respite care may also be obtained through county services or parent organizations for children with disabilities. Sometimes trained volunteers can provide babysitting for a few hours or days. See the Resources and General Resources sections of this booklet for more information.
• Most children this age love to pretend. They may act out things they have seen or that have happened to them. Usually this type of play, with friends or stuffed animals, can help the child learn. Parents can help children understand experiences through this type of play. Sometimes parents will need to teach the child how to play and how to separate fact from fiction.
• Children with FASD often must be taught some of the most basic skills. This may include recognizing the difference between friends and strangers. Lessons should be related to needs. Provide real life examples. Role play may help teach these skills.

• 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 painting or coloring may help children slow down.
• Have a place where your child 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. Write them down or 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.
• If anger is a problem, discuss and practice acceptable ways of noticing and dealing with feelings. Provide a way and place to express anger in a physical way such as kicking a ball. During tantrums, make sure children are in a safe place where they cannot hurt themselves or others.
• Protect your child from viewing or participating in violence. Remember he or she may not be able to differ fact from fiction.
• Limit choices. Frustration results from difficulty in choosing between a variety of options.
• Learn to recognize signs that a problem is about to begin. Negative events may then be avoided.
• Children with FASD are usually affectionate and kind. Sometimes this leads to inappropriate behaviors. Teach them social boundaries.
• Children with FASD may be very active, easily distracted and volatile. Remove items your child finds distracting. Minimize excess clutter in rooms. Remove breakables. Remember behavior is not deliberate. It is a result of brain injury.
• Behavior may be misunderstood if the child’s IQ appears to be developing normally. Often parents receive a diagnosis of Attention Deficit Hyperactive Disorder (ADHD) at this age. A neuro-psychological examination helps to identify strengths and special needs.
• Toilet training is often a challenge. Children with FASD may not be trained until they are 4 or 5 years of age. Cause and effect relationships may be difficult. This means your child may not connect the urge to urinate with having wet pants. Set a specific schedule for toilet use including after mealtimes and beverages. Praise often during training. Parenting classes or training books may help with ideas about techniques. Ask your health provider or professional for helpful tips.
• Children with FASD may have poor impulse control and problems managing behavior. This may be due to difficulty with connecting events or impaired reasoning and judgement. Caregivers may need to be alert 24 hours a day to keep the 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 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 ages 3 to 5 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.
• At the beginning of each school year, meet with your child’s teacher and school nurse. Inform them of your child’s development and any special needs related to FASD. Keep them informed of changes throughout the year. See the Family Support and Services section of this booklet for a list of topics to discuss with school staff.
• If your child has asthma or allergies, ask about pets and plants in the classroom.
• Make sure the school has instructions from your health provider about use of medication if needed. The school nurse will need a pharmacy label on all medications given at school. Contact your child’s school for policies on medication given at school.
• Encourage your child to be involved in activities appropriate for his or her abilities.
• Medical appointments may conflict with family and school schedules. Decide on priorities and then arrange appointments. This may not be as important during preschool years as it is when the child is older. Try to arrange appointments during slow times at school.
• If your child is absent from school, request that schoolwork be sent home. If schoolwork causes too much conflict at home, work with teachers to develop alternatives.
• If possible, get to know your child’s teachers and let them know you. If you have time, volunteer. Develop relationships with school staff. This helps to promote sharing of information and understanding of your child’s needs.
• Try to take another parent or friend along with you to important school meetings. Their support may be helpful.

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