The title of the book harks back to Michael Dorris's seminal work The Broken Cord (1987) which eloquently brought this ‘hidden' population into the light. However, the metaphorical umbilical cord is not truly broken, and the unique neurodevelopmental disorder resulting from prenatal alcohol exposure will continue to be one ghost in our delivery rooms, nurseries, and lives which haunts us. Why a different ‘knot'? Because management becomes knotted with the origins of the infant's prenatal life, whether they are birthed, fostered, adopted, either same culture or inter-country adopted. The ‘knot' (as in ‘Not it'), also speaks to medical professionals and society's continued ambivalence to acknowledging another inconvenient truth. Maternal drinking in pregnancy causes Alcohol Related Neurodevelopmental Disorder (ARND) whether dysmorphic, called Fetal Alcohol Syndrome (FAS), or non dysmorphic, ARND itself. These are both transgenerational developmental psychiatric disorders. The prevalence of ARND continues to be under-recognised as it is mainly presented as a faceless 'hidden disability' (masquerading as ADHD, Mood Disorder or ASD), rather than a facial dysmorphic disorder. The subtle denial and minimisation of transgenerational alcohol abuse is aided only by diagnosing the far less frequent dysmorphic ARND (FAS). This creates a false security across social classes concerning alcohol's true transgenerational epigenetic effect. Thus, the real financial costs and health care burden of trans-generational ARND , with an international prevalence of 1 in 100 live births, is avoided.