Special Aspects of Nutritional Assessment in Down Syndrome

History

The patient's medical and feeding history should be obtained to identify issues which may have an impact on growth and feeding (Tables 22-7. 22-8. and 22-9).

Growth

Down syndrome growth charts should be used to plot growth (see Appendix E). Weight for length/height should

Table 22-7. Medical Diagnoses Associated with Down Syndrome

Cardiac anomalies

Intestinal malformations (eg, duodenal atresia. Hirschsprung's disease)

Increased incidence of infections (ear. respiratory) Endocrine (diabetes, hypothyroidism) Orthopedic (atlantoaxial instability, hip dislocation) Dental (delayed/missing dentition) Increased risk of leukemia Hearing loss

Table 22-8. Nutritional Risk Factors Associated with Down Syndrome

Poor weight gain (cardiac anomalies, recurrent infections, hypothyroidism) Obesity

Constipation (hypotonia, hypothyroid, fluid loss) Delayed oral motor skill development Delayed feeding skill development Selective intake

Reduced activity (hypotonia, orthopedic concerns) Behavior difficulties

Table 22-9. Common Oral-Motor Feeding Difficulties Associated with Down Syndrome

Weak lip seal on nipple (fluid loss) Tongue protrusion/thrust

Delayed chewing (secondary to delayed dentition and/or prolonged tongue thrust) Difficulty with texture transition

Difficulty with thin liquids (increased fluid loss and coughing/ sputtering)

be plotted with NC'HS growth charts as this parameter is not available on the Down syndrome growth chart.

Nutrient Requirements

Energy. Given the short stature inherent to Down syndrome. it has been determined that caloric requirements lor children with Down syndrome aged 5 to 12 years should be based on body height rather than body weight to avoid overestimating'1 (see Table 22-2). It is important to note that obesity is a significant nutritional risk factor for children with Down syndrome, with approximately 25'/i being affected.7 Prevention should therefore be the focus by promoting healthy eating habits early in life and avoiding use of food as a reward for good behavior. Regular physical activity such as swimming or dancing should also be encouraged.

Protein. Protein requirements for children w ith Down syndrome should be assessed using the Recommended Dietary Allowance (RDAl based on sex and age.

Vitamins/Minerals. There is much controversy surrounding variations in v itamin and mineral requirements for children with Down syndrome. Studies to date have not shown any increased requirements due to Down syndrome itself. One study, however, showed that 80'/} of the children in the study had problems related to food intake or feeding, including excessive calorie intake and low intakes of iron, calcium, vitamin C. and lluid.7 If diet intake is limited due to selective food intake, a multiv itamin with iron may be indicated. Supplementation with additional nutrients beyond a standard multivitamin is not indicated at this time. Children who may be receiving supplementation at levels well above the RDA should be monitored to insure intake does not reach toxic levels.

Fluid. Extra lluid may be indicated for children with Down syndrome who have constipation.

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