Function Problems

Eating difficulties Babies with Down syndrome often have difficulties with eating, particularly if they are born prematurely. This may be a result of low muscle tone (hypotonia) and oral muscular difficulties with coordinating sucking and swallowing. Eating problems can also be associated with other medical problems. For instance, babies with Down syndrome may also have heart problems that could cause them to tire easily, or be short of breath and not able to eat adequately. There are many methods that may help with eating problems including holding the baby in different positions while they eat, stimulating the baby to suck such as stroking their cheek, and, in bottle fed babies, trying different nipples or bottles. Sometimes the baby is not able to eat adequately despite these measures and it may be necessary to feed the baby via a naso-gastric tube for a while. This is a small, flexible tube that is passed into the nostril, down the esophagus and into the stomach. This is usually only necessary for a short period of time. Gastro-esophageal reflux This occurs when food that had already passed into the stomach and beyond comes back up into the esophagus and may be vomited up. Most healthy babies (and even older children and adults) experience this occasionally. It is more common in babies because their diet is made up of liquids and therefore more easily brought back up. Babies with Down syndrome are more likely to have reflux, likely because the muscles of the stomach and esophagus that push food along seem to work less effectively. Symptoms may be very mild and are able to be managed with simple methods such as holding the baby in an upright position after they are done eating. However, if the vomiting is considerable the child may not gain weight. Also the acid contents of the stomach irritate the lower esophagus and can cause discomfort and sometimes bleeding from the esophageal wall. This in turn may cause anemia. In these cases, medical treatment is necessary. Different types of medicine are normally used, often in combination. They work in a number of ways - by preventing the stomach contents flowing back, by neutralizing the stomach acid, and by improving the gastrointestinal motility. Rarely these measures won't be enough to control the problem and an operation to tighten up the area between the esophagus and stomach could be necessary. Malabsorption This is a condition in which the bowels are unable to absorb particular nutrients from food. This causes a depletion of some nutrients and poor digestion. Children with malabsorbtion problems also experience serious vitamin and mineral deficiencies. While supplementation may help, if the gut can’t absorb the nutrients from food, they will have similar difficulties absorbing supplements as well. It is important for parents to work with their child’s healthcare practitioner to determine the best course of action regarding nutrient deficiencies and supplementation. Celiac Disease is a type of malabsorption that is more common in Down syndrome. This condition is, in essence, a food allergy or intolerance to the protein called gluten. Gluten is the common name for the proteins in specific grains that are harmful to persons with celiac disease. These proteins are found in ALL forms of wheat (including durum, semolina, spelt, kamut, einkorn and faro) and related grains rye, barley and triticale and MUST be eliminated. Also to be noted is that some people may be sensitive to corn and soy products since the proteins in corn and soy are similar in make up. When people with celiac disease eat foods containing gluten, an immune-mediated toxic reaction is created causing damage to the small intestine and does not allow food to be properly absorbed. Even small amounts of gluten in foods can affect those with celiac disease and cause health problems. Damage can occur to the small bowel even when there are no symptoms present. Infants, toddlers, and young children often exhibit growth failure, vomiting, abnormal stools, bloated abdomen, tiredness, and behavioral changes. The following are some of the related health problems that may occur as a result of celiac disease: Iron deficiency anemia Early onset osteoporosis Vitamin K deficiency associated with risk for hemorrhaging Vitamin and mineral deficiencies Central and peripheral nervous system disorders - usually due to unsuspected nutrient deficiencies Pancreatic insufficiency Intestinal lymphomas and other GI cancers (malignancies) Neurological manifestations Gall bladder malfunction Specific antibody blood tests help identify the presence of CD and are the initial step in screening and should include the following tests: Endomysial antibody (EMA-IgA) Tissue transglutaminase antibody (tTG - IgA/IgG) Anti-gliadin antibody (AGA-IgG, AGA-IgA) Total serum IgA The exception is children under the age of 2 years in which tTG and EMA may not be present. Parents should talk to their child’s doctor regarding these tests. It is essential that patients with positive antibody tests, and those with an IgA deficiency have a small bowel biopsy (which is performed endoscopically) to confirm the diagnosis and assess the degree of damage to the villi in the intestinal lining. Because celiac disease is a chronic disorder, the only treatment is the lifelong adherence to the gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves over time. Medication is usually not required. A child diagnosed with celiac disease should have medical follow-up to monitor the clinical response to the gluten-free diet. Adapting to the gluten-free diet requires lifestyle changes. It is essential to read labels and learn how to identify foods that are appropriate for the gluten-free diet and do not contain gluten.