Signs and symptoms of fetal alcohol spectrum disorder (FASD) include:

• Characteristic facial features. The child's head may seem small with narrow eye openings (slits), a short upturned nose, a flattened groove between the nose and the upper lip (philtrum), and a thin upper lip. These features usually become more obvious by the time a child is 2 or 3 years of age. During the teen and adult years, the characteristic facial features become less noticeable. But a larger-than-average nose may become apparent.
• Low birth weight and growth retardation. Newborns with fetal alcohol syndrome (FAS) weigh less than 2500g. Babies with less severe alcohol effects will likely weigh more, but still be smaller and lighter than average.
• Central nervous system problems. Developmental delays, especially in skills that require muscle strength and coordination, may be the first sign of central nervous system problems. The child who is exposed to alcohol before birth may have tremors, poor hand grip strength, and impaired eye-hand coordination.
• Behavior and cognitive difficulties. Newborns with severe effects may be irritable, have problems sucking, and have difficulty bonding with their caregivers. During the school years, problems with attention, behavior, and learning may become apparent.
• Birth defects. Structural problems that involve the eyes, ears, heart, bones, or urinary tract can occur.

The effects that alcohol has on a fetus depend on:

• How much, how often, and at what stage of her pregnancy the mother drinks alcohol. The most severe effects often are related to heavy alcohol use (5 or more drinks on at least one occasion).
• Whether the mother used other drugs, smoked, or had poor health for any reason during pregnancy. A child who is born to a mother with this profile is at increased risk for developing problems.
• Genetic traits a fetus inherits. Some fetuses are more likely to be harmed by alcohol exposure than others. The reason for this is not clear, but there may be a genetic link.

Some other conditions have symptoms that are similar to those that occur with fetal alcohol exposure. These conditions may be caused by other exposures during fetal growth, such as to a seizure medication called hydantoin. Children with certain genetic disorders can also develop similar traits.