What is one common challenge associated with children with Down syndrome that can influence eating patterns?

What is Down Syndrome?

Down Syndrome is a genetic disorder, the cause of which is not yet known. It is estimated that in Ireland approximately 1 in 546 children are born with Down Syndrome.

What Effect Does it Have?

The range of abilities of children and adults with Down Syndrome is very wide. It is difficult to predict at birth the degree of disability a child may have. With appropriate support and encouragement each person with Down Syndrome can reach their individual potential.

Growth:

Children with Down Syndrome have a different growth pattern to that of the general population, their average height is shorter, their head circumference is smaller and their growth rate is slower between ages of 3 – 36 months.

It is essential that growth in children with Down Syndrome is carefully monitored. Height and weight should be plotted using the growth charts specifically designed for children with Down Syndrome from birth to 18 years.

Feeding:

Infants and children with Down Syndrome can have feeding and drinking difficulties. A smaller oral cavity and low muscle tone in the facial muscles can be contributing factors. In addition, the tongue may appear larger due to a high arched palate, a smaller oral cavity and reduced muscle tone in the tongue. Teeth tend to appear at a later stage. Many children are mouth breathers due to smaller nasal passages, and may have difficulties coordinating sucking, swallowing and breathing whilst feeding. All of these factors can impact on how a child develops efficient oral and feeding skills.

Mothers of infants with Down Syndrome may have no difficulty breast feeding, whereas other mothers may choose to bottle feed their child. Some infants have no difficulty with the introduction of solid foods and follow the normal weaning process successfully. Sometimes parents prefer to delay the weaning process, depending on their child’s feeding skills.

Infants who have increased oral sensitivity often have difficulty accepting new tastes and textures - intervention by a Speech and Language Therapist at an early stage will encourage oral motor and feeding skills. Some infants with Down Syndrome may require the support of a Paediatric Dietitian for feeding difficulties, poor weight gain, weaning advice, and oral sensitivity.

Overweight:

Excessive weight gain is a problem for many older children and adults with Down Syndrome. Adolescents with Down Syndrome do not have the same growth spurt as adolescents in the general population. Adolescents and adults with Down Syndrome tend to be shorter than their peers, and have a lower resting metabolic rate of 10-15% than the general population which further predisposes to weight gain.

Down Syndrome and Diet-Related Issues

Heart Defects: 40-50% of babies with Down Syndrome have congenital heart defects ranging from a heart murmur to more severe conditions requiring cardiac surgery. Infants requiring cardiac surgery will benefit from the intervention of a Paediatric Dietitian to provide nutrition support prior to and post corrective cardiac surgery.

Thyroid Disorder: Thyroid disorder (usually hypothyroidism) occurs more frequently in people with Down Syndrome than in the general population. Blood testing to check thyroid function is normally carried out annually up to five years of age, and at least once every two years thereafter throughout life. Weight gain is a feature of hypothyroidism. Thyroid function should always be checked in those with rapid weight gain.

Coeliac disease: Coeliac disease is more common in people with Down Syndrome. Dietary intervention is required to manage coeliac disease with the implementation of a gluten-free diet for life. For more information on coeliac disease, see our fact sheet “Coeliac disease and a gluten-free diet.”

Diabetes: Diabetes is more common in people with Down Syndrome. A healthy balanced diet is important to help control diabetes and prevent long term complications.

Constipation: Children with Down Syndrome have generalised low muscle tone, which predisposes them to constipation. The onset of walking and improvement in abdominal muscle tone can help to alleviate difficulties with constipation. Ensuring an adequate fluid intake and eating a variety of fibre rich foods can help manage constipation. In addition laxative medication may be required.

Structural Problems of the Gut: Structural problems of the gut are more common in infants and children with Down Syndrome and generally require surgical intervention and support from a specialist dietitian.

Infection: Infants and children with Down Syndrome can be more vulnerable to infection, in particular chest, ear, nose, throat a nd eye infections. Repeated infections requiring antibiotics can impact on a child’s appetite. Inclusion of a daily probiotic yoghurt or probiotic yoghurt drink may promote the growth of healthy bacteria in the gut following antibiotics. Loss of appetite and food refusal because of illness can impact on a child’s nutritional status, growth and well-being.

Food Intolerances and Allergies: Some parents of children with Down Syndrome often wish to exclude cow’s milk from their child’s diet due to symptoms such as blocked or runny nose, wheeze, irritability, colic, crying.

Contrary to widespread belief, cow’s milk has not been scientifically proven to increase mucous production. There is no reason to exclude cow’s milk from a child’s diet unless a cow’s milk allergy has been proven. Goat’s milk and rice milk are not recommended for children. The protein in goat’s milk may be nutritionally inferior to that in cow’s milk. Rice milk is not suitable for children under the age of 4 ½ years. Soya infant formula is not suitable for infants under six months and is rarely recommended for children under one year of age. Soya milk substitute is not recommended as a main drink for children under two years of age.

Unsupervised dietary restriction can affect a child’s growth, and bone health, leading to nutritional deficiency and failure to thrive. It is advised to seek professional advice from your G.P. or a dietitian before milk is excluded from a child’s diet.

Vitamins and Minerals: There is no conclusive evidence to support the addition of vitamin and mineral supplements in the diet of an individual with Down Syndrome. Additional vitamins and minerals in the diet do not improve health status or intellectual functioning. It can be dangerous to exceed any recommended dose of vitamins or minerals.

What Can I Do?

Weaning: As for the general population solids should be introduced to a baby’s diet between 17 and 26 weeks. If weaning is delayed beyond 26 weeks, in particular the introduction of iron rich foods, there may be a risk of iron deficiency anaemia. To provide additional iron, some infants continue to drink infant formula and delay the transition to cow’s milk until eighteen months of age. Achieving the daily nutritional requirement for iron will reduce the risk of iron deficiency anaemia and low iron stores. You should consult with your Public Health Nurse, GP or Dietitian if for any reason weaning is delayed.

Underweight: For infants and children whose weight is faltering, providing more nutrient-rich food can improve their nutritional intake. For infants who are weaning, extra calories can be added to food by using breast milk or infant formula, in place of water, to blend home made pureed meals or to mix into dried baby food. Butter, full fat spread or oils such as olive oil, sunflower oil or rapeseed oil can be added to pureed vegetable and potato.

Children require small, regular, calorie-rich meals. Using calorie-rich household ingredients to add to foods will provide additional calories e.g. oil, butter, full fat spreads, cream, cream cheese, grated cheese, sugar. Some children may require the support of a suitable paediatric nutritional supplement. There is a wide range of special supplements available for children.

Constipation: To prevent and alleviate constipation:

• Offer regular drinks to ensure an adequate fluid in take. Some infants and younger children with Down Syndrome often have difficulty achieving their daily fluid requirement.
• If necessary, a thickening agent can be added to fluids. This changes the consistency to a semi-solid, which can be offered from a spoon to improve fluid intake.
• Aim to incorporate plenty of fluid into your child’s diet by including foods with a high water content such as fruit, yoghurt, yoghurt drinks, smoothie drinks, custard, milk pudding, jelly, ice cream and frozen ice lollies.
• Include a range of fibre-rich foods in the diet such as fruit, vegetables, pulses, wholegrain cereals and wholemeal bread.
• Encourage regular activity where possible to stimulate the bowel and strengthen the stomach muscles. Constipation often improves when younger children start walking.
• Some children with Down Syndrome may require prescribed laxative medication to alleviate their difficulties with constipation.

Overweight

A sensible approach to eating and regular exercise will help to encourage a healthy lifestyle and prevent weight gain in childhood and later life. Using the Food Pyramid as a guide to healthy food choices, choosing appropriate food portions sizes, avoiding excessive amounts of high fat and high sugar foods will help maintain a healthy weight. Referral for dietetic intervention may be necessary for guidance with weight loss.

If you require further information about diet and Down Syndrome, or for a referral to a dietitian, please contact your GP, Paediatrician/Physician, or the Irish Nutrition and Dietetic Institute (INDI) at 01 2804839 or www.indi.ie.

Updated by members of the Disability and Mental Health Interest Group, December 2012

Review date: December 2014

© 2013 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.

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