Dental disease, auditory and visual impairments, hypothyroidism, and orthopedic issues also can occur to children with Down syndrome at a higher rate than children without Down syndrome.
Dental disease
Gingivitis, periodontal disease, orthodontic problems, and bruxism (tooth grinding) are more common in individuals with Down syndrome than the general population and often cause tooth loss.
However, dental caries are less common. With the impaired immunity and valvular disorders common in people with Down syndrome, periodontal disease is a particular health risk.
Nurses can play an important role by identifying and reporting early signs of periodontal disease and encouraging good dental hygiene and regular check-ups. Because many children with Down syndrome have motor impairments that can interfere with good oral hygiene, it is important to check periodically to see that the youngster is using proper techniques for brushing and flossing.
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Because dental caries are not a significant problem for people with Down syndrome, the nurse doesn't need to focus on oral hygiene.
Auditory Impairments
Sixty to 80% of children with Down syndrome have hearing impairments at some point during their childhood. As many of these youngsters cannot identify or communicate this impairment, it is essential that professionals working with this population diligently screen for hearing loss. The next section of this program includes some specific recommendations for evaluating the hearing function at different ages.
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Nurses working with patients with Down syndrome should regularly screen for hearing impairment and make referrals for further evaluation and treatment.
Visual Impairments
Children with Down syndrome are at significant risk for some vision disorders, including the following:
Because parents of children with Down syndrome often deal with several medical and developmental problems, visual impairments can be overlooked. Without good vision, the child is at much higher risk for developmental delays and is more isolated from the environment.
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Cataracts are common in older adults with Down syndrome but are not an issue in early childhood.
Thyroid Disease
Ten to 40% of persons with Down syndrome have hypothyroidism, and hyperthyroidism is slightly more common than in the general population. Symptoms may be subtle and may be confused with features associated with Down syndrome. For example, lethargy, cognitive impairments, and skin dryness are often seen in children with Down syndrome, even when thyroid function is normal. It is essential to ensure that these youngsters are screened regularly for thyroid disorders.
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When working with a child with Down syndrome, nurses should assume that cognitive impairments and a sedentary lifestyle are normal and unavoidable.
Orthopedic Abnormalities
About 14% of individuals with Down syndrome have increased cervical spine mobility at the first and second vertebrae levels. This is a condition known as atlantoaxial instability (AAI). Most are asymptomatic, but about 10% of those with AAI have symptoms of spinal cord compression (neck pain, torticollis, change in gait, loss of upper body strength, or changes in bowel/bladder functioning).
To prevent further complications, it is essential for nurses familiar with the child to report any of these changes to the primary health care provider as soon as they occur. Nurses can also guide the child and family into exercise and sports options for persons with AAI. For example, Special Olympics, Inc. bars athletes with AAI from competing in equestrian sports, diving, alpine skiing, snowboarding, and other sports that increase the risk for spinal cord compression.
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Children with Down syndrome and AAI should not participate in organized sports or other forms of therapeutic recreation.
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