First UK estimates of children who could have conditions caused by drinking in pregnancy revealed

Foetal alcohol spectrum disorder (FASD)

According to a study published by the University of Bristol in November 2018

Up to 17 per cent of children could have symptoms consistent with foetal alcohol spectrum disorder (FASD) according to new research published in Preventive Medicine.

The UK has the fourth-highest level of prenatal alcohol use in the world, but no estimates existed from a population-based study on how many people may have FASD. FASD is a group of lifelong conditions caused by exposure to alcohol in pregnancy that affect learning, behaviour and can cause physical abnormalities.

Researchers from the University of Bristol and Cardiff University worked with clinicians to assess a wide range of information on mothers drinking in pregnancy and studied the development of 13,495 children from Bristol’s Children of the 90s study.

They applied a screening tool and found that up to 79 per cent of children in the sample were exposed to alcohol in pregnancy and that up to 17 per cent screened positive for symptoms of FASD

Dr Cheryl McQuire, a researcher in epidemiology and alcohol-related outcomes at the University of Bristol, led the research and said:

“Our results showed that a significant number of children screened positive for features consistent with FASD. The results are based on a screening tool, which is not the same as a formal diagnosis. Nevertheless, the high rates of prenatal alcohol use and FASD-relevant symptoms that we found in our study suggest that FASD is likely to be a significant public health concern in the UK.

“These results are important because without UK estimates of FASD prevalence, awareness will remain low and children, teenagers and adults will continue to find it difficult to seek diagnosis and to access the support they may need.

Dr Raja Mukherjee runs a diagnostic clinic for FASD at Surrey and Borders Partnership NHS Foundation Trust and contributed towards the research. He said:

“It shows that it is a disorder that is seemingly hidden in plain sight that we need to pay attention to. Unless we start looking for it we will continue to miss it. If we fail to diagnose it then those affected individuals will continue to be affected by a lack of support and have a subsequent impact on them and wider service.  These results can be the first step in helping us in the UK to realise it is no longer a condition we can ignore.”

However, there is some dispute about the conclusions drawn from the study, for example, Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:

“To summarise my views: yes, this study does provide some useful information, but I don’t think we can rely on it to estimate how common FASD is in the UK. There are good reasons why the researchers’ estimates of up to 17% of children having FASD symptoms are very likely to be an overestimate of the percentage of children who actually have FASD in the UK, and quite possibly it overestimates a lot. Does that mean that FASD is not really a problem in the UK? That’s absolutely not the case – the relatively high rates of drinking alcohol during pregnancy mean that FASD could well be more of a problem here than elsewhere. I agree with the researchers that research using more reliable methods of finding out the extent of FASD should be done. Is the Chief Medical Officer’s advice to avoid alcohol in pregnancy changed by any of this? Absolutely not.”

IRCT would welcome further research into this problematic area. A child with FAS may have the same presentational difficulties as children who have experienced postnatal developmental trauma (abuse and/or neglect) and two points arise:

  1. There is a need for all agencies working with children to understand both complex trauma and behaviours emanating from FAS.
  2. There is an urgent need to campaign for compensation to be paid to victims of FAS.

In December 2014 the BBC reported:

A child born with foetal alcohol syndrome is not legally entitled to compensation after her mother drank excessively while pregnant, the Court of Appeal has ruled. 

The seven-year-old girl was born with severe brain damage and is now in care.

Lawyers argued her mother had poisoned her foetus but appeal judges ruled she had not committed a criminal offence.

The case was brought by a council in the North West of England, which cannot be named for legal reasons.

It had been argued the woman ignored warnings and drank a “grossly excessive” amount of alcohol while pregnant.

She consumed eight cans of strong lager and half a bottle of vodka a day, the court heard.

Three appeal judges at the Court of Appeal had to rule on whether or not the girl was entitled to a payout from the government-funded Criminal Injuries Compensation Scheme as a victim of crime.

But Lord Justice Treacy said an “essential ingredient” for a crime to be committed “is the infliction of grievous bodily harm on a person – grievous bodily harm on a foetus will not suffice”.

This raises significant ethical, moral and legal questions which need addressing as a matter of urgency. While victims of developmental trauma can claim compensation when they have suffered physical and/or sexual abuse and but those suffering the effects of FAS aren’t able to. If the law were changed and criminal compensation could be successfully gained, would the mother necessarily be regarded as a criminal and should, instead support be offered to the mother as well as more support to the child?

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Dry January

Dry January

For those of you who don’t know much about who we are, The Institute for Recovery from Childhood Trauma (IRCT) is a charity whose ambition is to increase the awareness and the understanding of the impact of childhood trauma both during childhood and into adulthood. We are trying to do this to ensure that appropriately informed resources are made available to help those who have suffered and to give all of them the best chance possible of recovery.

So why do we feel the need to speak out during ‘Dry January’? CHILDREN ARE SUFFERING AND ARE AT RISK

Typically, ‘Dry January’ is seen as an opportunity for people to stop drinking for a month to help them recover from the excesses of the Christmas and New Year celebrations. This year those celebrations have been muted by the COVID 19 pandemic but less partying does not appear to have been accompanied by less drinking. Many people reacted to the closure of restaurants and pubs by stocking up to drink at home in isolation and alcohol as well as foodstuffs disappeared from our supermarket shelves. In the week to the 21st March (the beginning of the first lockdown), alcohol sales were up by 67% compared to an increase of 43% for food. (BMJ May 2020) It seems alcohol is being used as a means of coping with the uncertainty and anxiety caused by the pandemic and the accompanying stress.

Things are so difficult we deserve a drink, don’t we?

We are directed to stay home to stay safe but home is not always a safe place to be. As people have had to stay indoors at home, domestic violence cases have surged and 55% of domestic violence incidents have been found to involve alcohol (BMJ May 2020). Alcohol does not cause domestic abuse but it increases the risk of someone perpetrating domestic abuse, or of someone becoming a victim of domestic abuse as well as increasing the severity.  There is a complex relationship between stress, alcohol consumption and domestic violence. Stressed, people tend to feel emotionally and physically overwhelmed and many turn to alcohol as a type of self-medication, which research supports. Weerakoon (2020) found that 60% of binge drinkers reported drinking more during COVID-19 lockdowns with the odds of drinking heavily increasing by 19% each added week. This compared with 28% of regular drinkers who also reported an increase.

COVID-19 has caused major economic devastation, disconnected many from community resources and support systems, created widespread uncertainty and panic. Such conditions may stimulate violence in families where it didn’t exist before or worsen situations in homes where mistreatment and violence have been a problem. High stress plus alcohol consumption plus disruption to normal routines make for a perfect storm. Many victims have been unable to get opportunities to make reports to the police but there has been an increase of 12% in third-party referrals from neighbours who have overheard disputes (ONS). There has been a huge increase in calls to helplines of between 60 and 70% but an increase of 700% to one of the online helplines, which was easier to access discretely. (Women’s Aid Survey) Childline received an increase of 36% in calls reporting physical abuse and 31% reporting emotional abuse. In the UK, 14 women and 2 children were murdered in the first three weeks of lockdown, the highest figure in 11 years (WHO).

It is clear that currently children are being exposed to increased levels of domestic abuse leaving them traumatised and with no one to turn to for help as they have been out of school for long periods and the usual community support services and monitoring of their wellbeing have been disrupted. Many are the victims of increased abuse themselves and are specifically vulnerable to abuse during COVID-19. Research shows that increased stress levels among parents are often a major predictor of physical abuse and neglect of children. Stressed parents are more likely to respond to their children’s dependency demands and anxious behaviours in aggressive or abusive ways. There is a clear association between alcohol/drug abuse and child deaths caused by family members. (Reder and Duncan 1999)

We all need to find ways of not turning to alcohol to get us through these hard times not only in January but beyond. For some, this will be relatively easy but for others almost impossible without significant support and help. This is a national crisis and steps need to be taken to address this need or many more children will be left traumatised and at risk.