Fetal alcohol syndrome vs. Down syndrome

At first glance, fetal alcohol syndrome (FAS) and Down syndrome can look like they’re in the same “bucket” because both can involve developmental delays,
learning differences, and some shared health concerns. But medically? They’re not cousins, not siblings, not even “Facebook friends.” They’re two very
different conditions with different causes, different diagnostic pathways, and different support needs.

The 30-second answer

• Down syndrome is a genetic condition caused by an extra full or partial copy of chromosome 21 (trisomy 21).
• Fetal alcohol syndrome (FAS) is part of fetal alcohol spectrum disorders (FASDs) caused by prenatal alcohol exposure.
• Both can affect learning, development, and healthbut the “why,” “how,” and “what helps most” are different.

Why people compare them in the first place

People tend to compare conditions when they share “headline” features: developmental delay, speech or learning challenges, and the need for early
supports. In real life, a child’s early symptoms can be nonspecificmaybe slower milestones, a little low muscle tone, or struggles with attention.
That overlap is real. The mistake is assuming overlap means “same condition.”

Think of it like this: two phones can both have a cracked screen, but one got dropped (environmental) and the other left the factory with a defect
(genetic). The fixand the preventionwon’t be the same.

Root cause: genetics vs. prenatal exposure

Down syndrome (trisomy 21): a chromosome difference

Down syndrome happens when a person has extra genetic material from chromosome 21. The most common form is full trisomy 21 (an extra
whole chromosome in each cell), but there are other types such as mosaic Down syndrome (extra chromosome 21 in some cells) and translocation Down
syndrome (chromosome 21 material attached to another chromosome).

This extra genetic material changes how the body and brain developaffecting muscle tone, physical features, learning profile, and risk for certain
medical conditions. It isn’t caused by parenting choices, stress, personality, or “something the parent did wrong.”

Fetal alcohol syndrome: a preventable brain-and-body injury from alcohol exposure

Fetal alcohol syndrome (FAS) sits on the more “classic” end of fetal alcohol spectrum disorders (FASDs). FASDs occur when alcohol
exposure during pregnancy disrupts fetal development. Alcohol can interfere with growth and brain development, and the effects can be lifelong.

Important nuance: many people with FASD do not have the full facial pattern seen in FAS, which is one reason FASD can be under-recognized.
Also important: if alcohol exposure happened, it’s never helpful to pile on shame. The goal is accurate identification and effective support.

How they can look similar

Here’s where confusion is understandableboth conditions can involve:

• Developmental delay (speech, motor skills, learning pace)
• Learning challenges (especially when school demands get more complex)
• Behavioral or attention difficulties (more common in FASD, but attention challenges can occur in Down syndrome too)
• Hearing/vision issues (possible in both)
• Heart differences (more strongly associated with Down syndrome, but can occur in FASD as well)

Similar “symptoms” don’t equal the same diagnosis. That’s why diagnosis focuses on cause, specific physical patterns, and a full developmental/medical
evaluationnot a quick guess based on one trait.

Signature physical features: what tends to be different

Fetal alcohol syndrome: the “classic triad” plus growth/CNS findings

In FAS (not every FASD diagnosis), clinicians look for a recognizable pattern that often includes:

• Facial features such as a smooth philtrum (the groove between nose and upper lip), a thin upper lip,
  and short palpebral fissures (shorter eye openings)
• Growth problems (before and/or after birth)
• Central nervous system (CNS) involvement (structural, neurological, or functional differences)

Some children also have other physical or health findingslike issues with the heart, kidneys, bones, hearing, or vision. Not everyone has the same
combination, which is why it’s called a “spectrum.”

Down syndrome: a consistent “gestalt” plus muscle tone and body traits

Down syndrome often comes with a recognizable set of features and body traits, such as:

• Low muscle tone (hypotonia), especially noticeable in infancy
• Characteristic facial features (for example, a flatter nasal bridge/midface and upward slanting eye openings)
• Hand/foot traits that can include a single transverse palmar crease or a “sandal gap” between toes
• Shorter stature on average (but growth patterns differ from the growth restriction pattern often emphasized in FAS)

None of these features alone diagnose Down syndromediagnosis is confirmed with chromosome testing (karyotype or related tests).

Brain and learning profile: different “shapes” of support needs

FASD: executive function and regulation challenges are common

Many people with FASDespecially when CNS effects are significantstruggle with what’s often called “executive functioning”: planning, working memory,
impulse control, flexible thinking, and cause-and-effect learning. A child may know a rule today and still break it tomorrow, not from defiance, but
because the brain skills needed to carry that rule into a new context are shaky.

In classrooms, this can look like: inconsistent performance, difficulty with transitions, trouble managing time, emotional “big reactions,” or
challenges learning from consequences. Support often focuses on structure, repetition, predictable routines, and environment changesnot just “try harder.”

Down syndrome: global developmental differences with variability and strengths

Down syndrome is typically associated with mild-to-moderate intellectual disability, but abilities vary widely. Many individuals benefit from early
intervention, speech therapy, and educational supports. Some common learning patterns include stronger social engagement and visual learning relative to
expressive language and certain memory tasksthough each person’s profile is unique.

Medical issues: what clinicians commonly screen for

Down syndrome: higher likelihood of certain health conditions

People with Down syndrome have increased risk for some medical concerns, and many pediatric practices follow structured “health supervision” guidance
(screening and follow-up) that may include:

• Congenital heart defects and cardiac follow-up
• Hearing and vision screening (ear infections and vision issues can be common)
• Thyroid testing and monitoring
• Sleep concerns (including sleep-disordered breathing)
• Gastrointestinal differences (in some individuals)

FASD/FAS: variable health issues, plus long-term functional needs

FASDs vary widely. Alongside learning and behavior needs, some individuals may have medical issues involving the heart, kidneys, bones, hearing, or
vision. Many supports focus on reducing “secondary challenges” (like school disruption or mental health strain) by combining early diagnosis, stable
supports, and appropriate educational services.

Diagnosis: how doctors tell them apart

Down syndrome: screening vs. diagnostic tests

During pregnancy, families may be offered screening tests (which estimate likelihood) and diagnostic tests (which can
confirm). Screening can include blood tests and ultrasound markers; diagnostic testing may involve procedures like chorionic villus sampling (CVS) or
amniocentesis. After birth, diagnosis is typically confirmed with chromosome testing.

FASD/FAS: a clinical diagnosis based on pattern and history

There’s no single blood test that “proves” FASD. Diagnosis usually involves:

• Detailed medical/developmental history (including possible prenatal alcohol exposure, when available)
• Physical exam for growth patterns and, in FAS, the characteristic facial features
• Neurodevelopmental assessment (learning, behavior, adaptive skills)
• Ruling out other causes that can look similar

Because exposure history isn’t always known (for example, in adoption or foster care contexts), clinicians often focus on the total clinical picture and
functional needsso supports can begin sooner rather than waiting for “perfect” information.

Treatment and support: what actually helps day-to-day

Neither FASD nor Down syndrome has a “cure,” but both can have excellent outcomes with the right supports. The practical difference is that the support
plan is tailored to the child’s profile.

Support commonly used for both

• Early intervention (birth to 3 in many U.S. states) and developmental therapies
• Speech-language therapy (communication, feeding, social language)
• Occupational therapy (fine motor, sensory supports, daily living skills)
• Physical therapy (motor skills, strength, coordination)
• Individualized education plans and classroom accommodations when needed

Support that’s especially central in FASD

• Predictable structure: consistent routines, visual schedules, clear transitions
• Environment-based strategies: reduce cognitive load, simplify choices, repeat instructions
• Behavior support that assumes skill gaps: “can’t yet” over “won’t”
• Protective factors: early diagnosis, special education support, stable/nurturing caregiving

Support that’s especially central in Down syndrome

• Medical monitoring aligned to Down syndrome health guidance (hearing, vision, thyroid, heart, etc.)
• Communication supports that build expressive language and clarity
• Strength-based learning (visual supports, repetition, social motivation)
• Community inclusion and skills building for independence across the lifespan

Prevention and risk: the part everyone wants explained clearly

Down syndrome: not preventable, but risk patterns exist

Down syndrome is a chromosomal difference and generally is not preventable. The chance increases with maternal age, but Down syndrome
can occur at any maternal age. Prenatal screening can estimate likelihood; diagnostic testing can confirm.

FASD: preventable, and the message is simple

Major medical organizations and public health agencies emphasize: there is no known safe amount, safe time, or safe type of alcohol during
pregnancy. If someone is pregnant or trying to become pregnant, avoiding alcohol is the safest choice.

If a person drank before realizing they were pregnant, the most useful next step is not panicit’s talking to a healthcare professional
and getting prenatal care. Support works best when it starts early and stays compassionate.

Practical “when to ask” guide for families

If you’re a parent or caregiver (or a teacher who’s gently nudging a family toward support), these are reasonable questions to bring to a clinician:

• What evaluations do we need (developmental pediatrics, genetics, psychology, speech/OT/PT)?
• Should we consider chromosome testing to confirm or rule out a genetic condition?
• What school supports fit this child’s learning profile (IEP/504, speech services, classroom accommodations)?
• Which medical screenings should we do now (hearing, vision, heart, thyroid, sleep)?
• What behavior supports focus on skills and environment rather than punishment?

Quick note: this article is educational, not personal medical advice. Diagnosis and care should be handled with a qualified healthcare professional who
knows the individual child.

Common myths (and quick reality checks)

Myth: “They’re basically the same because both affect learning.”

Reality: Similar outcomes can happen through very different pathways. Down syndrome is chromosomal; FASD is related to prenatal alcohol
exposure. Support plans should match the underlying profile and needs.

Myth: “If you don’t see the facial features, it can’t be FASD.”

Reality: Many people on the FASD spectrum do not have the full facial pattern of FAS, but can still have meaningful brain-based effects
that require support.

Myth: “Down syndrome always means severe disability.”

Reality: Abilities vary widely. With appropriate supports and healthcare, many people with Down syndrome lead full, meaningful lives with
friendships, schooling, work, and community involvement.

Experiences that families and educators often describe (about )

The most honest thing anyone can say about comparing FAS and Down syndrome is this: the diagnosis matters, but the day-to-day reality is usually shaped
by supports, expectations, and how well the environment fits the childnot just the label.

Families raising a child with Down syndrome often describe an early period that’s heavy on medical logistics. Some babies need extra monitoring for
heart differences, hearing checks, feeding support, or frequent appointments. Once routines settle, many parents talk about steady progressmilestones
arriving on a different timeline, not a cancelled timeline. They’ll tell you that therapy becomes less of a “fix” and more of a toolbox: physical therapy
for strength and coordination, speech therapy for clearer communication, occupational therapy for daily living skills. Many also mention that school success
improves dramatically when teachers use visual supports, repetition, and patient pacing. A common theme is pride in small-but-real wins: putting on shoes
independently, reading a short passage, ordering food at a restaurant, joining a sports team, or performing in a school concert. The victories may look
different than another child’s, but they’re victories all the same.

Experiences around FASD, especially when the child has significant executive function challenges, can feel different. Caregivers often say the hardest
part isn’t intelligenceit’s inconsistency. A child might explain a rule perfectly at breakfast and then “forget” it at lunch. Parents sometimes describe
feeling judged in public because behaviors can look like stubbornness or “bad parenting,” when the real issue is brain-based regulation. Teachers may
notice that typical discipline strategies don’t work well: consequences don’t reliably change behavior if the child can’t connect cause and effect in the
moment. What tends to help is the unglamorous stuff: predictable routines, short instructions, frequent breaks, reduced distractions, and lots of practice
in small steps. Families often report that life gets easier when adults stop asking, “Why won’t you?” and start asking, “What support is missing here?”

Another shared experienceacross both conditionsis that early identification can change everything. Parents who access early intervention services often
describe a turning point: less confusion, fewer battles, and more teamwork. They learn how to advocate in school meetings, how to set realistic goals, and
how to celebrate progress without comparing their child to a neighbor’s kid who’s sprinting down a different road. Many also emphasize community: support
groups, disability-inclusive activities, and clinicians who speak respectfully and practically. When families feel seen and supported, kids usually do
betterbecause the adults around them are calmer, clearer, and more consistent.

If you take one “experience-based” lesson from the comparison, let it be this: Down syndrome and FASD are not the same condition, but both benefit from
the same big ideameet the child where they are, build supports around how they learn, and keep expectations ambitious enough to inspire but realistic
enough to succeed.

Conclusion

“Fetal alcohol syndrome vs. Down syndrome” is a useful comparison only if it leads to clarity. Down syndrome is a chromosomal condition (trisomy 21)
confirmed through genetic testing. Fetal alcohol syndrome is part of FASDs caused by prenatal alcohol exposure and diagnosed clinically through a pattern
of features and neurodevelopmental findings. They can share developmental challenges, but they differ in cause, physical patterns, medical screening needs,
and the most effective support strategies. The best next stepwhether you’re a caregiver, educator, or healthcare professionalis not guessing. It’s
getting the right evaluation and building the right supports early.

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