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Tuesday, 20 December 2011 23:38

Down Syndrome Health Care Guidelines: Ages 5 -13 Years

(Based on “Health Supervision for Children with Down Syndrome” as published in Pediatrics August 2011) Ages 5 – 13 Years
  • Thyroid function test annually (FT4 and TSH). Hemoglobin count annually. Include (a) ferritin and CRP or (b) reticulocyte count if there is a concern for a diet low in iron or if hemoglobin < 11g.
  • Review signs and symptoms of myopathy. If myopathy 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: Athletic organizations might require a C-spine for entry and participation.)
  • Trampoline use should be avoided in all children with or without Down syndrome under age 6 and only occur under professional supervision over age 6.
  • Use growth charts for Down syndrome. Use body-mass index (BMI) to assess weight proportionality.
  • Low calorie, high fiber diet; regular exercise. Consider referral to a dietician, especially for individuals who are “overweight” or “obese.”
  • Auditory testing (annually).
  • Monitor for obstructive airway; sleep apnea. Review signs and symptoms for obstructive sleep apnea.
  • If a heart condition is identified, monitor for signs and symptoms of congenital heart failure.
  • Eye examination (every 2 years).
  • Screen for celiac disease with IgA and TTG-IgA on an annual basis, if symptoms present.
  • Review behaviour and social progress.
  • Discuss self-help skills, attention-deficit/hyperactivity disorder (ADHD), obsessive- compulsive disorder (OCD), wandering off, and transition to middle school.
  • Discuss physical and psychosocial changes through puberty, need for gynaecologic care in the pubescent female. Talk to adolescents and their families about the recurrence risk of Down syndrome if they were to become pregnant. Birth control and prevention of sexually transmitted diseases should be discussed with patients and their families. Sexuality education should be emphasized.
  • Review dermatologic issues.
  • Discuss complementary and alternative therapies.
  • Continue speech therapy, physical therapy, occupational therapy, as needed.
  • Referral to Down syndrome parent group or family support and resources. Local referral to the Down Syndrome Aim High Resource Center.