Abstract FASD is a complex neurodevelopmental disorder related to prenatal alcohol exposure. A diagnosis of both inclusion and exclusion it is one that has been frequently missed due to the complexity of the overlap in symptoms with other conditions. It is only by careful evaluation of features, ruling out and ruling in symptoms that a confident diagnosis can be made. Whilst FASD remains one of the most common causes of developmental delay, having been first recognized in 1973, many aspects remain unclear and under investigation. The rates of the disorder have been recognized to be as high as 3–8% of the population depending on the group studied. When considering poor understanding and recognition of the disorder alongside uncertain individual exposure risk prevention of the disorder remains a challenge. The article will focus on the background, exposure risk, pathology and clinical evaluation and management of this disorder.