DOWN SYNDROME HEALTH CARE GUIDELINES
Based on “Health Supervision for Children with Down Syndrome” published in Pediatrics (Vol. 128, No. 2, August 1, 2011. pp. 393 -406.)
- Thyroid function test annually (TSH).
- Annual ear-specific auditory testing.
- Annual Review signs and symptoms of myelopathy. If myelopathic signs exists, obtain neck X-rays (C-spine). Contact physician if change in gait, change in the use of arms or hands, change in bladder function, neck pain, head tilt, torticollis, or new-onset weakness. (Note: Some athletic organizations might require a radiograph of the C-spine for entry and participation.)
- Hemoglobin count annually. Include (a) ferritin and CRP or (b) reticulocyte hemoglobin. (CHr if there is a concern for iron deficiency.
- Review signs and symptoms for obstructive sleep apnea.
- Review for symptoms of celiac disease and obtain IgA and TTG-IgA if symptoms present.
- Review behavior and social progress.
- Examine annually for acquired mitral and aortic valvular disease in older patients with Down syndrome.
- Ophthalmologic exam, looking especially for keratoconus and cataracts (every three years).
- Use typical growth charts from Centers for Disease Controls (CDC), available at www.cdc.gov/growthcharts. Use body-mass index (BMI) to assess weight proportionality. Maintain healthy diet and structured exercise program.
- Continue speech and language therapy, as indicated.
- Facilitate transition: guardianship, financial planning, behavioral problems, school placement, vocational training, independence with hygiene and self-care, group homes, work settings.
- Discuss sexual development and behaviors, contraception, sexually transmitted diseases, recurrence risk for offspring.
- Discuss physical and psychosocial changes through puberty, need for gynecologic care in the pubescent female.
- Review signs and symptoms for obstructive sleep apnea.
- Referral to local Down syndrome parent group or family support and resources, as indicated. Referral to NDSS.