(Based on “Health Supervision for Children with Down Syndrome” as published in Pediatrics August 2011)
Neonatal (Birth - 1 Month)
- Review parental concerns. Chromosomal karyotype; genetic counselling, if not done prenatally.
- Check for signs and symptoms of gastrointestinal tract blockage (e.g., duodenal web, duodenal atresia, or Hirschsprung disease).
- Use growth charts for Down syndrome.
- If constipation present, evaluate for limited diet or fluids, hypotonia, hypothyroidism, gastrointestinal malformation, or Hirschsprung disease.
- Radiographic swallowing assessment if marked low muscle tone, slow feeding, choking with feeds, recurrent or persistent respiratory symptoms, failure to thrive. Consider feeding referral, if needed.
- Referral to Pediatric Cardiology including an Echocardiogram. If a heart condition is identified, monitor for signs and symptoms of congenital heart failure.
- Car seat evaluation to evaluate for apnea, low heart rate, or oxygen desaturation prior to discharge from the hospital at birth if child is hypotonic or has had cardiac surgery.
- Complete blood count (CBC) to rule out transient myeloproliferative disorder (TMD) or polycythemia.
- Review feeding history to ensure adequate caloric intake. Children with Down syndrome can usually nurse, and many can breastfeed successfully. Consider lactation consultation.
- Thyroid function tests – check on results of state-mandated screening at birth. Add TSH is the state-mandated screening only included T4 results.
- Newborn hearing screen – auditory brainstem response (ABR) or otoacoustic emission (OAE) – to assess for hearing loss.
- Discuss risk for respiratory infections.
- Discuss complementary and alternative therapies.
- Discuss cervical spine positions, especially for anaesthesia or surgical or radiologic procedures.
- Review signs and symptoms of myopathy. If myopathy signs exists, obtain neck X-rays (C- spine).
- Eye exam for cataracts.
- Discuss value of Early Intervention (infant stimulation) and refer for enrolment in local program.
- Referral to Down syndrome parent group or family support and resources. Local referral to the Centre du syndrome de Down
.
(Based on “Health Supervision for Children with Down Syndrome” as published in Pediatrics August 2011)
