Learning difficulty (average intelligence quotient [IQ] of 50)
Hypothyroidism common
Impaired immune function
Increased risk for leukemia
Early-onset dementia (in one-third)
Therapeutic management
Available therapies
Surgery to correct congenital anomalies
Evaluation of hearing and sight
Periodic testing of thyroid function
Nursing alert
Persistent neck pain
Loss of established motor skills and bladder or bowel control
Changes in sensation
Prognosis
Life expectancy for those with Down syndrome has improved in recent years but remains lower than for the general population.
Many individuals with Down syndrome survive to 60 years of age and beyond
As the prognosis continues to improve for these individuals, it will be important to provide for their long-term health care and social and leisure needs.
Care management
Supporting child’s family at time of diagnosis
Infants with Down syndrome are usually diagnosed at birth
Parents should be informed of the diagnosis at this time
Parental responses to the child may greatly influence decisions regarding future care.
Some families willingly take the child home
Others consider foster care or adoption.
The nurse must answer questions regarding developmental potential carefully because the responses may influence the parents’ decision.
The nurse should share the available informative sources (e.g., parent groups, professional counseling, and literature) to help the family learn about Down syndrome
Preventing of physical problems
Parents perceive hypotonicity of muscles and hyperextensibility of joints, almost flaccid extremities resemble the posture of a rag doll to their bodies as evidence of inadequate parenting.
The extended body position promotes heat loss, because more surface area is exposed to the environment.
Encourage the parents to swaddle or wrap the infant snugly in a blanket before picking up the child to provide security and warmth.
The nurse also discusses with parents their feelings concerning attachment to the child, emphasizing that the child’s lack of clinging or molding is a physical characteristic and not a sign of detachment or rejection.
Decreased muscle tone compromises respiratory expansion.
The underdeveloped nasal bone causes a chronic problem of inadequate drainage of mucus.
The constant stuffy nose forces the child to breathe by mouth, which dries the oropharyngeal membranes, increasing the susceptibility to upper respiratory tract infections.
Inadequate drainage resulting in pooling of mucus in the nose also interferes with feeding.
Because the child breathes by mouth, sucking for any length of time is difficult.
When eating solids, the child may gag on the food because of mucus in the oropharynx.
Parents are advised to clear the nose before each feeding; give small, frequent feedings; and allow opportunities for rest during mealtime.
Parents need to know that the tongue thrust is not an indication of refusal to feed but a physiologic response.
Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth.
Dietary intake needs supervision.
Decreased muscle tone affects gastric motility, predisposing the child to constipation.
Dietary measures, such as increased fiber and fluid, promote evacuation.
The child’s eating habits may need scrutiny to prevent obesity.
Height and weight measurements should be obtained on a serial basis.
Assist in prenatal diagnosis and genetic counseling
Offer prenatal testing and genetic counseling to women of advanced maternal age and those who have a family history of the disorder.
