In a Nebraska town, with a population of just 14 people, four stores sold more than four million beer cans in a space of a year.

The most frequent customers in Whiteclay are from Pine Ridge Indian Reservation, across the border in South Dakota, where alcoholism is rampant, despite strict rules banning booze.

Even when women get pregnant, they carry on drinking, and it leads to their children being born with deformities and blood alcohol levels.

One in four children in the Native American community are born with fetal alcohol syndrome, which causes stunted growth, facial impairments and prevents the sufferer's mental ages from developing.

A.J. Boesem, 9, left, follows his brother, Dontae, 13, around as he puts his clothes into his locker in Newell, South Dakota. The pair both suffer from fetal alcohol syndrome and were born on the nearby Pine Ridge Indian Resveration - where problems with alcohol are rampant

Nora Boesem of Newell, South Dakota (center left) readies her nine children for school as she tube feeds her son, A.J., nine, while her son, Jeremy, nine, hugs her. She has fostered 93 children in 15 years - all of the suffer from fetal alcohol syndrome

Many have hyperactive or have attention disorders, suffer from learning disabilities, and can sometimes be smaller than other children.

Nora Boesem, a former pediatric nurse who lives in the town of Newell, has fostered 93 children in 15 years, all of them suffering from the illness.

She told the Omaha News Herald: 'This is decimating this reservation. You're seeing a population that is affected very, very hard by the alcoholism there.

'It will continue to get worse unless something happens,'

Alcohol is banned on the reservation and the tribe has accused the nearby stores as well as manufacturers: Anheuser-Busch, Molson Coors Brewing Company, MillerCoors LLC and Pabst Brewing Company of illegally selling millions of cans of beer to members of the tribe.

The Connecticut-sized reservation is home to 40,000 residents and has struggled with alcoholism for generations, despite the ban in place since 1832.

It also spans some of the most impoverished areas in the country.

The reservation includes South Dakota's Shannon County, which U.S. census statistics place as the third-poorest in the nation. It has a median household income of $27,300 and nearly half of the population falls below federal poverty standards.

Mark Boesem, three, (left), his brother, Jeremy, nine, and his sister, Frannie, 11, play at their home in Newell, South Dakota. All the Boesem children have fetal alcohol syndrome, an illnesses that causes stunted growth, facial impairments and prevents the sufferer's mental ages from developing

Alcohol is a very serious problem for the Oglala Sioux Tribe.

The vast majority of Whiteclay's beer store customers have no legal place to consume alcohol since it's banned on Pine Ridge, which is just north, and state law prohibits drinking outside the stores.

The Native American community took the four stores to court in 2012, but the case was thrown out.

The nearest town that allows alcohol is more than 20 miles south.

According to the News Herald the Oglala Sioux Tribe has recognized that there is a problem and has launched efforts to address the issue.

Among those is a program to educate women about the consequences of drinking while pregnant.

Boesem and her husband Randy lost several children to miscarriages, so turned to adoption.

They told the News Herald that the more children they brought into their home, the easier it got for them to take care of them.

Now they look after six children, and all of them come from the Pine Ridge Reservation.

In Whiteclay, Nebraska, there are only four beer stores for a population of 14, yet more than four million beers were sold in 2012. Most of the customers come from the nearby Pine Ridge Reservation where drinking is meant to be banned

Annemarie Johnson (center) an occupational therapist with Black Hills Special Services Cooperative, works with Arianna Boesem, four, (left) and her brother, Mark, three, at their home in Newell, South Dakota

One son, Mark, 3, has tantrums and screams endlessl. Another boy, Dontae, 13, was born with a blood-alcohol level of .185, more than twice the legal limit to drive.

A.J., 9, was born at 25 weeks with methamphetamine and marijuana in his blood and his wrists are deformed.

His twin sister died in childbirth.

One of the problems the family have faced is the inability of children with fetal alcohol syndrome to understand that there behavior is wrong.

Seventeen-year-old Donovan died of asphyxiation after wrapping a rope around his neck while playing the 'pass out' game, they told the News Herald.

Another son, Vincent, 24, is 6ft 1in, has the mental age of a six-year-old and was passed among 19 foster homes before the Boesems took him in.

Vincent, who has an IQ of 68, stole a car a week after leaving his foster home. Boesem believes he doesn't understand the consequences of his actions.

A child's organs development early in a mother's pregnancy, so the more they drink the worse the outcomes can be.