Feeding skills tend to be delayed in the young child with Down's syndrome, but the sequence of the emergence of the skills is the same as that for other children if appropriate learning opportunities are provided.
Infants with Down's syndrome have a smaller oral cavity, which makes it easier for liquids to spill from the sides of the mouth. If a child is hypotonic, the tongue is likely to flatten out when the child sucks instead of forming a groove around the nipple, so the child will have a weak suck, may gag, and milk will leak from the mouth. Feeding will be exhausting, and particularly when the child has a cardiac defect, the child may have difficulty taking in enough milk to meet energy requirements. Tube feeding may be necessary until the child develops better tongue control. As infants with Down's syndrome are often placid, sleepiness may be overlooked and feeding will be easier if the infant is wide awake. Extra support for the infant during feeding, and in particular supporting the infant's chin to help steady the jaw, can help encourage intake. Because of the benefits of breast feeding, it is essential that nursing mothers are given help and advice when their infants have initial difficulties. Breathing during feeding may be helped if the mouth and nose are cleared of mucus with a syringe before feeding.
As with other children, it is important to introduce textured food when the child is developmen-tally ready, and information should be provided to parents and caregivers regarding both appropriate expectations and helpful feeding techniques as well as dietary advice. In children with Down's syndrome, poor neuromotor control of the tongue may result in the continued use of pureed food. There may be slow initiation of the swallow response, possibly because of hypotonic pharyn-geal muscles, and oral sensitivity problems may also make the transition to textured foods difficult. Persistent feeding problems merit multidisci-plinary assessment and therapy. Impaired swallow can result in food being aspirated and contribute to respiratory problems. The presence of the tongue protrusion reflex past the age of 12-18 months can result in delayed progression to solid food and can contribute to malocclusion of teeth. Also, dental abnormalities can exacerbate difficulties with chewing and can contribute to poor nutrition because children who have problems chewing may be offered soft, often high-energy food and be given little opportunity to accept meats, fresh fruits, and vegetables, which are lower in energy.
Fresh fruit and vegetables also provide the non-starch polysaccharide that can help prevent the constipation common in Down's syndrome. Prunes, fruit juices, and water between meals also help with constipation. Because the hypotonia in Down's syndrome also contributes to sluggish bowel habits, this is another reason for children and adults to be encouraged to take part in physical activity. If constipation does not respond to dietary management, there should be a medical assessment to exclude gastrointestinal and thyroid problems.
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