Fetal Alcohol spectrum disorders are extremely common. The clinical impact and societal effects are tremendous. Prevention and treatment of these disorders begins with an accurate diagnosis. All health care providers who work with children (and adults) with special health care needs should be alert to these findings. The key to early diagnosis is to always keep the diagnostic possibility in the broad differential diagnoses of growth and developmental disorders. As with most conditions, early recognition and intervention is associated with better outcomes. Once an FASD is identified in a specific patient, prompt referrals and enrollment in indicated services are necessary to get the best outcomes. In this article we review the diagnostic criteria and clues to prompt early identification of FASDs. We also discuss the therapeutic options shown to be most effective for this group of individuals.