A Nutritional Perspective
by Julia Markham, M.S., R.D., L.D.
Linear growth (length, height) is delayed in children with Down syndrome beginning even before they are born. This deficit in linear growth continues throughout infancy to the age of 3 years. During mid-childhood, growth is closer to normal, but still slower than for children without Down syndrome. At adolescence, children with Down syndrome experience an adolescent growth spurt, but to a lesser degree than do children in the general population. Average adult height for individuals with Down syndrome is lower than that for a non-Down syndrome adults.
A tendency to be overweight is seen in children and adolescents with Down syndrome beginning in infancy. This is because gains in weight are greater than gains in length and height during the growing period. It is important to monitor growth and to prevent obesity from developing. Most children with Down syndrome have calorie needs lower than those for children in the general population. It is therefore important that the diet be high in needed nutrients with "junk" foods being limited. Exercise is also an important factor in helping to control weight. It is recommended that older individuals with Down syndrome who will be going into independent living be taught food selection and food preparation skills.
Soon after birth, many infants with Down syndrome experience feeding difficulties. These may be related to low muscle tone, placidity, and/or weak sucking and rooting reflexes. However, most children do eventually acquire breast or bottle feeding skills. It is important to persevere longer than usual before giving up on a particular method of feeding.
Tongue-thrusting also may persist until well after the first or second year of life, delaying progression to solid foods. Caretakers may interpret tongue-thrusting as an indication of food refusal. Sometimes the readiness for chewing or for self-feeding skills is not recognized on the part of caretakers, which can result in delays in advancement in these skills.
Sometimes other problems can develop—such as food refusal and unacceptable behavior around food. Professional guidance is often recommended in assisting families and caretakers to help children with Down syndrome progress with chewing and feeding skills and any behavior problems surrounding food.
Constipation is a common problem in individuals with Down syndrome. This may be due to several factors including low muscle tone, lack of physical activity, or a diet low in fiber. A diet high in fiber and fluid is recommended. Such a diet would include such high-fiber foods as fruit and vegetables and foods made from whole grains.
Tooth shape and size abnormalities are common in Down syndrome, and when they interfere with chewing, the nutritional status of the child can be affected. Sweet, chewy foods should be avoided to help prevent dental caries.
The major objectives of dietary management in Down syndrome are:
- promotion of the development of self-feeding skills
- prevention of obesity
Cronk, C.E., & Anneren, G. (1992). Growth. In S.M. Pueschel (Ed.), Biomedical concerns in persons with Down syndrome (Chapter 3). Baltimore: Paul H. Brookes Publishing Co.
Patterson, B., & Ekvall, S.W. (1993). Down syndrome. In S.W. Ekvall (Ed.), Pediatric nutrition in chronic diseases and developmental disorders (Chapter 16). New York: Oxford University Press
Pipes, P.L. (1992). Nutritional Aspects. In S.M. Pueschel (Ed.), Biomedical concerns in persons with Down syndrome (Chapter 4). Baltimore: Paul H. Brookes Publishing Co.
The article above is reproduced from the Down Syndrome Guide disseminated by the Down Syndrome Clinic at Kennedy Krieger Institute. In accordance with federal copyright restrictions, the contents of this booklet may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 George Capone, M.D.
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