The drunken baby: fetal alcohol syndrome is the nation's leading cause of preventable mental retardation.

He was drunk. A blood alcohol level of 0.237 percent. More than twice the legal limit for driving in many states. But he wasn't old enough to drive; in fact, he was just born--born with fetal alcohol syndrome (FAS).

Besides spending his first four days "drying out," he was blind, stunted, and malformed. Now 6 years old, he has developed some sight in one eye, but it is highly unlikely he will ever speak. His mental development is that of a 2-year-old, and he still wears diapers. He also suffers from cerebral palsy.

This is not a made-up story. It is the story of a real little boy and too many others like him born suffering from the effects of exposure to alcohol in utero.

It has been more than 20 years since Kenneth Jones and David Smith of the University of Washington familiarized the world with FAS. But that was not the first time the condition had been described. Classical Greek and Roman mythology suggested that maternal alcoholism at the time of conception could result in serious problems for the baby. Indeed, in ancient Carthage there was a prohibition against the bride and groom drinking on their wedding night so they would not conceive a defective child.

But an even earlier recommendation exists. The thirteenth chapter of the book of Judges tells the story of an angel's visit to a woman and later to her husband. The angel told her she was to "conceive and bear a son." The angel went on, "Now, drink no wine or strong drink."

No longer a controversy. Problems associated with alcohol consumption during pregnancy have been recognized by some for many years. A report to the British House of Commons in 1834 said infants born to alcoholic mothers sometimes had a "starved, shriveled, and imperfect look." In 1899 an investigation in the Liverpool jail found the rate of stillbirths and infant deaths in female drunkards was more than double that of their nonalcoholic female relatives. Further, they found that the outcomes of successive pregnancies became increasingly worse as the woman's alcoholism progressed.

Yet others gave little credence to the possibility of damage from alcohol consumed during pregnancy, and 50 years passed with little research on this problem. In fact, in the mid-1940s a report to the United States Congress said that the idea should be dismissed that maternal alcohol consumption during pregnancy caused problems for the infant. As recently as the early 1960s a major pediatric textbook said that alcohol crossed the placenta to the fetus, but that it did no harm.

Fortunately, such attitudes have changed. In 1968 a French physician, described 127 offspring of alcoholics. He said he could diagnose maternal alcoholism just by examining the child. His report was in a rather obscure French medical journal and was given little attention. Then came the reports by Jones and Smith, and since then literally thousands of cases of FAS have been described.

Medical textbooks no longer consider alcohol consumption during pregnancy benign, and results similar to the 1899 study are reported today. There is now a national organization on fetal alcohol syndrome, based in Washington, D.C., and the first fetal alcohol syndrome clinic recently opened at the University of Washington's Child Development and Mental Retardation Center (CDMRC). However, medical schools are just beginning to teach students how to diagnose FAS and how to care for and counsel patients and their families, and most important, how to prevent this incurable disorder.

Suffering children. The surgeon general reported in 1989 that at least 5,000 infants are born in the United States each year with FAS, and for every child with FAS, 10 more suffer from alcohol-related problems. The incidence of FAS is estimated at one to three per 1,000 live births. However, among Native Americans the rate is as high as 10 per 1,000; a similar incidence is found in northern France.

Children with FAS have multiple problems, including diminished head capacity and impaired mental and physical development. Although every fetus is affected differently, common facial abnormalities seen in FAS include a thin upper lip, small eye openings, wide nasal bridge, and small chin. They may also have misshapen ears and a variety of other problems, including seizures. FAS is the nation's leading cause of preventable mental retardation. Children with FAS can be mildly to severely affected.

As FAS children grow older, the abnormal physical features become less apparent, although a smooth philtrum (the groove in the middle of the upper lip), thick or wide lips, and malformed and/or misaligned teeth continue to be common. In addition, their size remains well below normal. Although common FAS physical features diminish with age, behavioral abnormalities, psychiatric disorders, and subnormal intellectual functioning persist.

The FAS infant may be irritable and the FAS child hyperactive, with disruptive behavior more evident among boys than girls. FAS children have difficulty concentrating, and problems with learning, attention, memory, and problem solving are common and persist into adolescence and adulthood.

They may experience eating and sleep disorders. They have emotional and relationship problems and seem unable to understand social expectations. They lack judgment. For instance, Donna Burgess, research assistant professor of special education and a faculty member of CDMRC Experimental Education Unit, says they may ride for hours on a bus before figuring out what to do. According to Dr. Sterling Clarren, director of the FAS clinic at CDMRC, "You can tell these children what a rule is, tell them what happens when they break the rule, and then they'll break the rule. They don't organize experiences and memories to guide future actions." They may commit crimes with no sense of remorse or responsibility.

Fetal alcohol effects (FAE). The unique characteristics of FAS are found in infants of chronic alcoholics, but it is now well recognized that moderate or social drinking may result in more subtle problems, now called fetal alcohol effects, or FAE. In some cases the child with FAE may lack the physical characteristics but manifest the same behavioral and cognitive problems. In some cases there may be no outward indication of FAE until the teen years when problems arise.

There is hope. FAS cannot be cured. But special educational attention and structured environments can help the affected child to function better. It is important that an accurate diagnosis be made as early as possible so that such efforts can be undertaken. Yet a recent report indicated that the physicians studied failed to diagnose FAS even though the physical features consistent with FAS were described in medical charts.

A pregnant woman never drinks alone. Dr. David Smith says, "When the mother drinks, the baby drinks," but "the baby may never get over the hangover." Goals set by Congress call for reducing the incidence of FAS by 90 percent by the year 2000. This is recognized as an optimistic goal, yet it was set quite deliberately because FAS is entirely preventable.

Recent evidence indicates that the number of women who drink alcohol during pregnancy is decreasing. However, the rate of alcohol consumption among high-risk populations remains virtually unchanged. These include pregnant smokers, unmarried women, women under age 25, and women with the least amount of education. Education efforts need to target these high-risk populations.

The more a mother drinks, the greater the potential effect on her child. If a pregnant mother stops drinking during her pregnancy, the baby will have a better outcome than if she continues.

However, each individual is affected differently, and the minimum amount of alcohol below which no harm results has not been identified, meaning there is no known threshold of safe consumption.

According to Dr. Enoch Gordis, director of the National Institute for Alcohol and Alcoholism, "Because we do not know at what point alcohol damage begins, it is prudent to recommend, as I do, that pregnant women abstain from alcohol use." Such advice echoes that given by the angel centuries ago.

CHILDREN OF ALCOHOLICS: BEHAVIOR PROBLEMS

Children of alcoholics are at high risk for developing two behavioral disorders that may lead to alcoholism in later life. Researchers at Washington University School of Medicine in St. Louis found that children with at least one alcoholic parent were at increased risk for oppositional and conduct disorders. Those with oppositional disorder tend to be uncooperative, negative, and stubborn. Conduct disorder children have more serious problems, which include truancy, shoplifting, and drug and alcohol abuse.