Health and developmental risks

Children with Down syndrome face some of the same health risks as their non-disabled peers but face a much higher risk of specific congenital abnormalities that impact their health status. For example, they are significantly more likely to develop the following medical problems:

• Heart defects
  
• Immune system impairments
  
• Respiratory disorders
  
• Gastroesophageal reflux
  
• Obstructive sleep apnea
  
• Ear and eye issues
  
• Underactive thyroid gland (hypothyroidism)
  
• Cancer of blood-forming cells, such as leukemia.
  
• Increased risk of developing Alzheimer disease when older

Children with Down Syndrome also may have the following developmental issues:

• Growth problems
• Speech and language development later and more slowly than in children without Down syndrome.
  
• Speech may be difficult to understand
  
• Behavioral issues can include attention problems, obsessive/compulsive behavior, and stubbornness or tantrums.
  
• A small percentage have autism spectrum disorders
  
• A gradual decline in thinking ability (cognition) as they age, usually starting around age 50.

https://medlineplus.gov/genetics/condition/down-syndrome/

Overview of the health care management of a child with Down syndrome recommended by the American Academy of Pediatrics.

Elements of medical care include the following:

• Genetic counseling
  
• Standard immunizations and well-child care
  
• Management of specific manifestations of Down syndrome and associated conditions (e.g., endocrine, infectious, cardiac, respiratory, neurologic, psychiatric, dermatologic, and dental disorders)
  
• Early intervention programs (may improve the social quotient)

Special considerations in adolescents are as follows:

• Ongoing monitoring measures, including the annual audiological evaluation and annual ophthalmologic evaluation
  
• Continuing management of manifestations of the syndrome and associated conditions
  
• Discussion of issues related to the transition to adulthood
  
• Vocational training

Appropriate surgical management of associated conditions should be provided, as follows:

• Timely surgical treatment of cardiac anomalies is crucial for optimal survival
  
• Prompt surgical repair is necessary for gastrointestinal (GI) anomalies, most commonly, duodenal atresia and Hirschsprung disease
  
• Surgical intervention may be essential to stabilize the upper segment of the cervical spine if neurologic deficits are clinically significant
  
• Congenital cataracts must be extracted soon after birth and subsequent correction with glasses or contact lenses provided
  
• Careful anesthetic airway management is needed because of the associated risk of cervical spine instability
  
• Adenotonsillectomy may be performed to manage obstructive sleep apnea

https://pediatrics.aappublications.org/content/128/6/1212.3

In a systematic review of the literature, O'Leary et al. (2018) found individuals with Down syndrome died about 28 years younger than the general population. The leading causes of death were congenital heart anomalies and respiratory conditions. The following influenced the earlier death rates:

• Congenital heart anomalies
  
• Comorbidities
  
• Low birthweight
  
• Black and minority ethnicity
  
• Younger maternal age
  
• Poorer parental education.

References

American Academy of Pediatrics, Bull, M. J. (2011). Health Supervision for Children With Down Syndrome. Pediatrics. 128(2),393-406.

O'Leary, L., Hughes-McCormack, L., Dunn, K. & Cooper, S.A.(2018). Early death and causes of death of people with Down syndrome: A systematic review. J Appl Res Intellect Disabil. 31(5):687-708.

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