Health Supervision for Children and Adolescents With Down Syndrome
Pediatrics
Bull, M. J., Trotter, T., et al. (2022).
Pediatrics, 149(5), e2022057010.
This guideline provides age-specific recommendations for the supervision and care of children and adolescents with Down syndrome.
American Academy of Pediatrics
Newborns with Down syndrome should be screened between birth and 1 month for congenital hearing loss with objective tools such as auditory brainstem response (ABR) and otoacoustic emission (OAE). Infants should be rescreened with ABR and/or OAE at 6 months of age.
Infants with Down syndrome who did not pass their newborn hearing screening should be referred for additional hearing assessment that includes visual evaluation of their middle ear and tympanometry. Infants with stenotic canals should be referred to an otolaryngologist for assessment every 3 to 6 months until the tympanic membrane can be visualized. Infants may undergo a behavioral audiogram or ABR testing at 12 months, depending on the child's ability to participate in the assessment.
Infants with Down syndrome who are deaf or hard of hearing should be referred for early intervention support within 48 hours of a hearing loss diagnosis.
In children, 1 to 5 years old, who pass diagnostic hearing testing, "behavioral audiogram and tympanometry should be performed every 6 months until normal hearing levels are established bilaterally by ear-specific testing (usually after 4 years of age)" (p. 10). Children should then undergo behavioral audiometry annually. When behavioral audiometry is unable to identify typical hearing, additional OAE or ABR testing should be conducted, with sedation if needed. Children with hearing loss should be referred to an otolaryngologist who is familiar with stenotic ear canals and otitis media.
Care providers should receive education and counseling regarding fluctuating conductive hearing loss due to otitis media and the relationship between hearing and speech development.
Children with Down syndrome should undergo ear-specific audiologic assessment every year between the ages of 5 and 21 years. For children who experience middle ear disorders, additional hearing evaluation should be conducted after middle ear treatment.
Infants should be promptly referred for a skilled feeding evaluation if they demonstrate one or more of the following characteristics:<br />
<ul>
<li>hypotonia as diagnosed by a pediatrician;</li>
<li>underweight;</li>
<li>slow feeding duration;</li>
<li>choking during feeds;</li>
<li>recurring or persisting respiratory symptoms; or</li>
<li>desaturation events during feeding.</li>
</ul>
Feeding and swallowing assessment may include nonradiologic videofluoroscopic swallow studies even for breastfed infants. Infants may need repeated evaluations, particularly in cases of respiratory symptoms.
Infants with Down syndrome may benefit from feeding support as they develop successful nursing patterns. Infants who sleep for prolonged periods and do not gain weight as expected may need cues to wake and feed.
Infants with Down syndrome should be referred for early intervention with a speech-language pathologist. Children should continue to receive speech-language pathology services to support development.
