Introduction: Children with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder associated with cognitive, emotional, and learning impairments have an increased likelihood of experiencing behavioral and socio-emotional difficulties and historical trauma. Methods: Using the interRAI Child and Youth Mental Health instrument, this study examined associations between FASD, polyvictimization, daily cognitive decision-making, family functioning, and externalizing problems in 18,701 children and youth from 4 to 18 years of age (M[subscript age] = 12.33, SD[subscript age] = 3.53). Results: Children with FASD, compared to children without FASD, were at an increased risk of being polyvictimized, were more likely to endorse greater difficulties with daily cognitive decision-making and family dysfunction, and scored higher on proactive and reactive aggression. Conclusion: The findings highlight the increased risk of individual and familial difficulties in children diagnosed with FASD. The limitations and clinical implications are discussed to inform further research and assist in the development of trauma-informed clinical interventions.