Fetal alcohol syndrome (FAS) is a condition that can significantly alter the development of a child and affect cognitive and behavioral functions. The cognitive and behavioral problems follow a child throughout his or her life, creating challenges in academic and professional achievement as well as personal relationships. A new study provides new information about the symptoms of FAS that may elude doctors evaluating a child for potential problems. The study, conducted by researchers at the National Institutes of Health, finds that the facial abnormalities believed to be a hallmark of FAS may appear in less than a quarter of patients who have FAS. The majority of children with FAS, say the researchers, do not show facial features that would indicate to a doctor that a child may have FAS. Instead, in some children, the only clue to fetal alcohol exposure is in abnormal behavioral or cognitive development. FAS manifests itself in the nervous system, and children with the syndrome may exhibit a range of intellectual and behavioral development delays, related to language, hyperactivity and cognitive delays. The delays are functions of the neurologic impairments. The researchers found that approximately 44 percent of children who had mothers that consumed at least four drinks each day while pregnant exhibited signs of the cognitive and behavioral symptoms of FAS. Only approximately 17 percent of the children had the facial features associated with and commonly used to diagnose FAS. In some cases, children meet the criteria for some aspects of FAS and are diagnosed with fetal alcohol spectrum disorder. These children do not show the full pattern of FAS. Study author Devon Kuehn, M.D. explains that the study highlights the potential danger for physicians to miss a history of fetal alcohol exposure. If a child does not have the facial features that have been considered a central sign of the disorder, a doctor may pass over the possibility of FAS and the child may not get the services he or she needs. The study's results, published in a recent online edition of the journal Alcoholism: Clinical and Experimental Research, were the product of a study focused on assessing the impact of heavily drinking during pregnancy. The full research is called the NICHD-University of Chile Alcohol in Pregnancy Study. The researchers interviewed more than 9,000 women at a community health clinic in Chile about alcohol consumption during pregnancy. They identified over 100 women who had consumed at least four alcoholic drinks per day during pregnancy. They also enrolled 100 women who were similar in many aspects, but had not consumed alcohol while pregnant. The study found that alcohol consumed during pregnancy resulted in an increased risk of abnormal features in the face (16 percent), language delays (18 percent), and cognitive delays (29 percent), in addition to other symptoms.