What are the problems children with down syndrome might face

The child with Down syndrome is in need of the same kind of medical care as any other child. The pediatrician or family physician should provide general health maintenance, immunizations, attend to medical emergencies, and offer support and counseling to the family. There are, however, situations when children with Down syndrome need special attention.

1. Sixty to 80 percent of children with Down syndrome have hearing problems. Therefore, audiologic assessments at an early age and follow-up hearing tests are indicated. If there is a significant hearing loss, the child should be seen by an ear, nose and throat specialist.

2. Forty to 45 percent of children with Down syndrome have congenital heart disease. Many of these children will have to undergo heart surgery and often will need long term care by a pediatric cardiologist.

3. Intestinal abnormalities also occur at a higher frequency in children with Downsyndrome. For example, a blockage of the food pipe (esophagus), small bowel (duodenum), and at the anus are not uncommon in infants with Down syndrome. These may need to be surgically corrected at once in order to have a normal functioning intestinal tract.

4. Children with Down syndrome often have more eye problems than other children who do not have this chromosome disorder. For example, 3 percent of infants withDown syndrome have cataracts. They need to be removed surgically. Other eyeproblems such as cross-eye (strabismus), near-sightedness, far-sightedness and other eye conditions are frequently observed in children with Down syndrome.

5. Another concern relates to nutritional aspects. Some children with Down syndrome, in particular those with severe heart disease often fail to thrive in infancy. On the other hand, obesity is often noted during adolescence and early adulthood. These conditions can be prevented by providing appropriate nutritional counseling and anticipatory dietary guidance.

6. Thyroid disfunctions are more common in children with Down syndrome than in normal children. Between 15 and 20 per cent of children with Down syndrome have hypothyroidism. It is important to identify individuals with Down syndrome who have thyroid disorders since hypothyroidism may compromise normal central nervous system functioning.

7. Skeletal problems have also been noted at a higher frequency in children with Down syndrome, including kneecap subluxation (incomplete or partial dislocation), hip dislocation, and atlantoaxial instability. The latter condition occurs when the first two neck bones are not well aligned because of the presence of loose ligaments.

Approximately 15 percent of people with Down syndrome have atlantoaxial instability. Most of these individuals, however, do not have any symptoms, andonly 1 -2 percent of individuals with Down syndrome have a serious neck problem that requires surgical intervention.

8. Other important medical aspects in Down syndrome, including immunologic concerns, leukemia, Alzheimer disease, seizure disorders, sleep apnea and skin disorders, may require the attention of specialists in their respective fields.