Details on awareness of common health concerns on those affected by Downs syndrome. Learn more about Down syndrome here -https://www.nayi-disha.org/article/know-more-about-down-syndrome
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Common health concerns associated with Down syndrome
1. Good health is essential for your child’s
development
VISION • HEARING • ORO-MOTOR • THYROID • HEART • DIGESTION • FEET • INFECTIONS • MUSCLE • SLEEP
Children with Down Syndrome can be healthy and happy!
Common health challenges that parents of children
with Down syndrome need to be aware of
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• Children with DS have a few common health challenges that have been well
identified and reported
• Awareness and continuous monitoring will help reduce the adverse affects on
your child’s health
Some of these common challenges include:
• Problems with vision
• Hearing difficulties
• Oro-motor issues
• Thyroid hormone production in the body
• Heart defects at birth
• Issues with the digestive system
• Foot arch challenges
• Recurrent infections (skin, bladder and respiratory)
• Low muscle tone
• Sleep disturbances
Common health challenges in
children with Down syndrome (DS)
DS cannot be cured,
but, careful
management of
health challenges
can have a big
impact on the quality
of life of your child
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Vision
• Individuals with DS are more likely to experience vision disorders that may
include one or more of the following:
• Common eye defects such as short sightedness, long sightedness,
astigmatism, squint eye
• Developmental cataracts
• Eye-lid inflammation
• Conical cornea – bulge over the cornea of the eye
• Nystagmus – involuntary movement of the eye
Speak to your ophthalmologist (eye
doctor) immediately to assess your
child’s vision, and to get corrective
measures for improving vision
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Hearing
Speak to your ENT specialist (ear, nose, and throat
doctor) immediately to assess your child’s hearing
• Many children with DS experience hearing loss
• Hearing problems can cause a delay in speech and
language skills
• Possible reasons for hearing loss include:
• Recurrent chronic ear diseases, partly due to
anatomical differences and weaker immune systems
• Common problems include wax in the external ear
canal and middle ear, or due to a condition called
“glue ear”
• Sensory-neural hearing loss (occurs in 10% of DS
children)
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Oro-motor parts
• Oral/facial developmental deficits affect the lips, tongue,
teeth, and mouth palate in children with DS
• Low muscle tone makes it difficult for feeding and chewing
• Recurrent infections, often due to low immunity or poor
hygiene, can cause inflammation of the teeth and gums, as
well as tooth decay
• Most children with DS have hyposensitivity issues with
food
• This means that a child with DS may be unable to feel
things in their mouth the way they ought to be felt
• These and other sensitivity concerns can hold the child
back from both feeding properly and speaking clearly
Speak to your dentist to assess your child’s oral health,
and to get appropriate treatment immediately
6. PT = Physiotherapist
OT = Occupational Therapist
ST = Speech Therapist
Work
together
for best
results
PT
STOT
Oro-motor Issues:
THERAPEUTIC
INTERVENTION
Help in
suggesting feeding
and positioning
techniques (of the
child)
Help to build oral
muscle strength
through tools and
exercises beneficial
for both feeding
abilities and
communication
PT + OT:
tackle motor
deficits
OT + ST:
tackle feeding
and oral
sensory
deficits
VISION • HEARING • ORO-MOTOR • THYROID • HEART • DIGESTION • FEET • INFECTIONS • MUSCLE • SLEEP
Therapy provided by PT,
OT and ST often
compliment one another,
& seek to holistically
tackle specific
developmental challenges
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Oro-motor Issues: THERAPEUTIC INTERVENTION
Please consult our video series for detailed information about oro-motor
exercises for speech clarity in children with DS
• Do not hesitate to encourage open dialogue between
your therapists, to address the specific needs of your child
that they will most effectively tackle by working together
• YOU are the central focal point of early intervention
therapy for your child, which you can ensure by
integrating various therapies together rather than
individual attention to any specific therapy at any given
point in time
• Lastly, begin therapy intervention for your child AS EARLY
AS POSSIBLE to ensure maximum benefits for your child’s
development and well-being
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Thyroid
• Hypothyroidism, or low thyroid levels (a
hormone) is common in children with DS
• Symptoms include: fatigue, constipation,
depression, weight gain
• This condition can be effectively treated
through medication, with regular monitoring
of thyroid levels
• Thyroid maintenance in the child’s body can go
a long way in improving his/her overall health
Speak to your Endocrinologist (hormone
specializing doctor) and/or Pediatrician
immediately to monitor your child’s
hormone levels at regular intervals and
to start treatment
Thyroid gland
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Heart
• A majority of individuals with DS have a heart
defect medically called the atrial septal
defect
• This birth defect appears as a hole in the
heart wall separating the two chambers
Speak to your Cardiologist (heart
doctor) and/or pediatrician
immediately to understand if your child
qualifies for immediate surgery to
rectify the defect
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Digestion
Digestive system issues occur in children with DS because of:
• Inherent structural complications in the gastrointestinal (GI)
tract (such as in the esophagus, anus, small intestine or colon)
• Weakness in the muscles involved in the act of chewing
• Presence of a small oral cavity
• Restricted movement of the tongue
• Weak muscle coordination
• Misaligned teeth
• Weak digestive enzymes in the gut
• The inability of the body to digest wheat protein gluten (called
gluten intolerance), thus causing digestive problems. (see next
slide)
Speak to your Pediatrician and Nutritionist about dietary
changes that can help reduce digestive distress in your
child
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Digestion
• Digestive issues can include the inability of the body to digest
“wheat protein,” or gluten, this is called gluten intolerance
• Some children with DS have an intolerance to gluten at a
higher rate than typical children, though this isn’t a common
issue.
• Symptoms of gluten intolerance can include:
increased frequency of stool • bad smelling stool •
vomiting • pain in abdomen • bloating • irritability • loss
of weight • constipation • distended abdomen
• Unless proven otherwise, don't withdraw wheat from your
child's diet, but do speak to your pediatrician and nutritionist
*Consult Nayi Disha’s nutrition booklet and audio series (Hindi)*
Speak to your Pediatrician and Nutritionist about dietary
changes that can help reduce digestive distress in your
child
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Digestion
• Constipation is common in persons with DS, and is mainly due
to:
low muscle tone • thyroid malfunctions • weak
digestive enzymes • faulty feeding habits
• Dietary modifications can help overcome constipation
• Oro-motor exercises from an OT (occupational therapist) can
help in improving muscle strength and coordination
• For infants, allowing them to engage in “tummy time”
strengthens their upper body and can help them cope with
digestive problems
*Consult Nayi Disha’s nutrition booklet and audio series (Hindi)*
Speak to your Pediatrician and Nutritionist about dietary
changes that can help reduce digestive distress in your
child
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Foot Arch
Speak to your Orthopedic surgeon for concerns related to the foot arch. Also
consult your Physiotherapist for exercises to strengthen foot arch muscles.
Weight evenly
distributed
Weight shifts to the
inside of the foot sole
NORMAL FOOTFLAT FOOT
• Children with DS also may present a foot
deformity that causes the arch of the foot to
remain flat, as opposed to the arch seen in
typical children, due to loose ligaments and low
muscle tone
• The arch in the foot is meant to distribute the
body weight equally, thus reducing strain on the
bones, muscles and ligaments, promoting body
flexibility
• The flatness of the arch of the foot hampers the
ability to walk, run and jump by impairing
balance
• Visit Dr. Nina Piysh’s blog for activities that can
help strengthen muscles that form the foot arch
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Body immunity and infections
• Low immunity is a common concern in children with DS
• This increases the risk for recurrent infections in the body of the child
• Ways to manage recurring infections:
proper hygiene • diet rich in immunity boosters • drinking adequate
water • adequate intake of Omega 3 & 6 FA • avoiding processed
and packed food
Respiratory infections
• Common in the first 5 years
• Also due to fluid accumulation in the ear of the child
• Prone to frequent incidents of cold and cough
Consult a
Pediatrician
Skin infections
Consult a
Pediatrician
Bladder infections
• For more information about nutritional means to
manage urinary infections, see our nutrition booklet
Consult a
Dermatologist
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Muscle Tone
• Poor muscle tone contributes to the delays in walking
and crawling in children with DS
• These individuals also appear to have weak joints due
to ligament problems
• The is often the reason for delayed motor milestones in
these children
• However, note that even with low muscle tone issues,
children with DS can learn to participate in physical
activities like other children by strengthening their
muscles with physiotherapy exercises.
Speak to your Physiotherapist about exercises that can improve
brain-body coordination to improve your child’s muscle tone as early
as possible
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Muscle Tone
• In typically-developing children, body weight falls on the
child’s bones and muscles equally when standing
• In children with DS, who have weak muscle tone, body
weight will fall on his/her bones and joints, which may
result in bending of the vertebral column and cause
premature degeneration of the joints
Note to parents:
• Parents should not be hasty or put undue stress on the
child to achieving motor milestones such as standing or
walking
Speak to your Physiotherapist about exercises that can improve
brain-body coordination to improve your child’s muscle tone as early
as possible
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Muscle Tone: THERAPEUTIC INTERVENTION
PT = Physiotherapist
OT = Occupational Therapist
PT OT
PT + OT:Helps strengthen large
muscles and big joints.
Helps achieve skills such
as walking, running,
cycling, balancing,
jumping, etc.
Helps tone the small muscles
and smaller joints.
Helps achieve self-care daily
living skills such as brushing,
bathing, filling bottles,
playing with rattle, turning
pages, folding cloths and
buttoning, etc.
The best
results come
from working
together
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Muscle Tone: THERAPEUTIC INTERVENTION
Note to parents:
• Typically physiotherapy/occupational therapy
sessions are conducted a couple of times per
week
• A good therapist (physiotherapist/occupational)
will provide you with a roadmap and explain
activities/exercises to be done at home with your
child
Always remember, you as parents play a key role in
the child's development and are the best teachers
Speak to your Physiotherapist about exercises that
can improve brain-body coordination to improve
your child’s muscle tone as early as possible
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Sleep patterns
Speak to your ENT specialist (ear, nose and
throat doctor) about managing sleep
disturbances in your child
• Disturbances in breathing pattern during sleep (called sleep apnea), is one of
the most common challenges in persons with DS
• The most common causes of sleep apnea in children with DS are:
• Difference in anatomy of the tongue, nose, and passage
• Inflamed adenoids and tonsils
• Nasal block
• Lower respiratory tract infection and/or congestion
• Backward falling of tongue in sleeping posture (due to low muscle tone)
• Obesity
• Weak respiratory muscle coordination.
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Sleep patterns
• Measures to help limit the impact of sleep apnea on your child include:
• Train a habit of sleeping at 40* in recline and on one side
• Giving a drop of normal saline in both the nostrils at bedtime
• Supplementing a diet that builds immunity
• Removal of adenoids if found inflamed but NOT tonsils (there are
separate criteria to remove tonsils. Do not be hasty in removing tonsils.
They are the SAFEGUARDS for your child’s immunity)
• Water vapour inhalation twice a day (especially before going to bed)
• Hot water compress for young kids
• There are options of reconstructive surgeries available, for e.g. CPAP
We need to weigh the extent of problems created by sleep apnea and
the cost, danger and effectiveness of the solutions we are opting for to
overcome the concerned problems
21. VISION • HEARING • ORO-MOTOR • THYROID • HEART • DIGESTION • FEET • INFECTIONS • MUSCLE • SLEEP
• The health concerns commonly seen in children
with DS may appear multifold
• But, with early identification and appropriate
intervention several health challenges can be
managed effectively, thus improving the quality of
life of your child
This content has been developed in collaboration with the Down Syndrome Federation of
India (DSFI). DSFI is a parent support group started by Dr. Surekha Ramachandran in order
to help persons with Down syndrome and their families to come to terms with Down
syndrome.
Nayi Disha Resource Centre is an online information resource platform that supports
families of persons with Intellectual and Developmental Disabilities (IDD).
Our consultant Pediatrician, Dr.Nina Piyush Vaidya (M.B D.Ped, PGDGC) has offered expert
advice and guidance in consolidating this information.