Tuesday, 20 December 2011 23:39

Down Syndrome Health Care Guidelines: Ages 13-21 Years

(Based on “Health Supervision for Children with Down Syndrome” as published in Pediatrics August 2011) Ages 13 – 21 Years
  • Thyroid function test annually (FT4 and TSH).
  • Auditory testing (annually).
  • 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: Some athletic organizations might require a C-spine for entry and participation.)
  • Hemoglobin count annually. Include (a) ferritin and CRP or (b) reticulocyte count if there is a concern for iron deficiency or if hemoglobin < 11g.
  • Review signs and symptoms for obstructive sleep apnea.
  • Screen for celiac disease with IgA and TTG-IgA on an annual basis, if symptoms present.
  • Review behaviour and social progress.
  • If a heart condition is identified, monitor for signs and symptoms of congenital heart failure.
  • Ophthalmologic exam, looking especially for keratoconus and cataracts (every 3 years).
  • Low calorie, high-fiber diet. Regular exercise. Monitor for obesity. Consider referral to a dietician, especially for individuals who are “overweight” or “obese.”
  • Use growth charts for Down syndrome. Use body-mass index (BMI) to assess weight proportionality.
  • Continue speech and language therapy, as indicated.
  • Facilitate transition: guardianship, financial planning, behavioural problems, school placement, vocational training, independence with hygiene and self-care, group homes, work settings.
  • Discuss sexual development and behaviours, contraception, sexually transmitted diseases, recurrence risk for offspring.
  • Discuss physical and psychosocial changes through puberty, need for gynaecologic care in the pubescent female.
  • Review signs and symptoms for obstructive sleep apnea.
  • Referral to Down syndrome parent group or family support and resources. Local referral to the Down Syndrome Aim High Resource Center.