The the first 6 months of life, breast milk

The aim of this section is to
provide information, strategies, and tools to promote and enhance healthy
living for people with Down’s Syndrome, their families, and those who support
them. With appropriate support and encouragement
each person with Down Syndrome can reach their individual potential.

Breastfeeding
and Weaning

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In the first 6 months of life,
breast milk provides the specific nutritional needs necessary for the rapid
growth and development of a child. However, some mother’s may decide against
breastfeeding and opt for formula feeding. This may be due to a medical issue,
her own comfort level, lifestyle or personal choice. Regardless if a child is
breastfed or formula fed, feeding is an important time for mother and child,

It is advised that ‘weaning’
is introduced at six months for both breastfed and formula fed infants, in line
with the World Health Organisations recommendations. Weaning is the
introduction of soft non-choking solid foods into a child’s diet. This process
may be delayed depending on the child’s feeding abilities.

Feeding
Problems

Infants and children with Down
Syndrome can have feeding and drinking difficulties. Common feeding concerns in
people with DS include:  

·        
Difficulty coordinating mouth movements for
swallowing

·        
low muscle tone in the facial muscles.

·        
the tongue may appear larger due to a high
arched palate, a smaller oral cavity and reduced muscle tone in the tongue.

·        
Teeth tend to appear at a later stage.

·        
Many children are mouth breathers due to
smaller nasal passages, and may have difficulties coordinating sucking,
swallowing and breathing whilst feeding.

All of these factors can
impact on how a child develops their feeding skills. Infants who have increased
oral sensitivity often have difficulty accepting new tastes and textures when
weaning. Therefore, intervention by a Speech and Language Therapist at an early
stage may help encourage oral motor and feeding skills.

It is important to realise
that the birth of a baby, whether they have Down’s Syndrome or not, require the
same basic nutritional needs. When the child begins to grow and develop, they
will start to maintain the same diet and nutritional needs as someone who doesn’t
suffer with the syndrome. It’s important to keep a balanced diet and achieve
the correct proportion of nutrients: Carbohydrate, fat, protein, calcium, iron,
vitamins and water. However, parents also need to be aware that this is also
the time that a child with Down’s syndromes diet may need altered due to underlying
health reasons that may occur depending on the severity of the disease.

Diseases
and Disorders that may occur in Down’s Syndrome Patients:

·        
Food Intolerances and Allergies  

·        
Obesity

·        
Thyroid Disorder

·        
Diabetes

·        
Coeliac

·        
Constipation

 

Obesity

Excessive weight gain is a
problem for many children and adults with Down Syndrome. Children with Down
syndrome are twice as likely to be overweight or obese compared to those
children unaffected. They also burn calories at a slower rate and are
frequently diagnosed with an under-active thyroid which can contribute to
weight gain. Adolescents with Down Syndrome do not have the same growth spurt
as adolescents in the general population. Adolescents and adults with Down
Syndrome tend to be shorter than their peers, and have a lower resting
metabolic rate of 10-15% than the general population which further predisposes
to weight gain.

Prevention
of Obesity

A dietician should be able to
assist in prevention and management of obesity. To keep obesity at bay, feed
children nutrient dense foods and limit junk food without nutritional value. A
good rule of thumb is to eat ‘real food’ found in nature, and avoid man-made
‘food’ as much as possible.

Taking part in regular
physical activity can greatly reduce weight gain and the negative health
implications that are associated with us.

It is important that the
family encourage//s a less sedentary lifestyle and promote exercise. Some
activities that a child with Down syndrome may enjoy include:

·        
Dance classes

·        
Sports teams

·        
Fun exercise classes

·        
Active video games e.g. wii

·        
Family outings

Children with Down Syndrome
tend to prefer non-competitive activities that do not require ability matched
teammates (Menear 2007). These activities allow them to enjoy exercise without
feeling they are in competition and are therefore more likely to be sustained.
The most important aspect is that the child has fun, if they don’t enjoy
themselves it will be difficult to get them to participate in physical
activity, therefore allowing for weight gain. Some of the possible consequences
of obesity include: high blood pressure, heart attack and stroke.

Thyroid Disorder

Thyroid problems are
caused by autoimmunity, this is when antibodies that are produced start to
attack their own thyroid gland causing it to work less effectively. Thyroid
disorder occurs in around 1 in 10 people with Down’s syndrome, usually in the
form of hypothyroidism. This means their thyroid gland which is responsible for
controlling your metabolism, the rate at which your body uses up energy, is
underactive. Hypothyroidism can be treated with medication to replace the
lacking thyroxine hormone.

Symptoms of an underactive
thyroid gland can include:

Tiredness                                                      Weight gain

Slow physical and mental
reactions         Dry skin and hair

Delayed growth and
development of a child

However, it is also possible
that a child can develop hyperthyroidism. The overactive form is less common
than the underactive gland. If they thyroid is overactive, excessive thyroxine
is produced. Symptoms include: Weight loss, increased appetite, diarrhoea and
breathlessness.

A simple blood test can identify
if someone has a thyroid disorder. Once diagnosed, treatment is generally
straightforward.

Diabetes

Diabetes
is a disease in which the body’s ability to produce or respond to the hormone
insulin is impaired, resulting in abnormal metabolism of carbohydrates and
elevated levels of glucose in the blood. 6% of the UK population have
either Type 1 or Type 2 diabetes. The main symptoms of diabetes include:

·        
Weight loss (Type 1)

·        
Frequent urination, especially at night

·        
Increased thirst

·        
Tiredness

·        
Blurred vision

Type 1: Usually develops at a
young age and may occur even earlier in those with Down’s syndrome. This form
involves using insulin injections to stabilise blood sugar levels.

Type 2: This more common form
is linked to being overweight.  Healthy
eating, exercise and weight management can help prevent the development of Type
2 diabetes. If already developed, these small changes can help manage blood
glucose levels. However, an inability to manage weight is common problem among
Down’s syndrome patients. Therefore, insulin injections may need to be
considered.

Coeliac

Coeliac disease in which a
person has a bad reaction to gluten, a protein
found in wheat, barley and rye. The wall of the small bowel becomes inflamed
and its lining becomes flat and this makes it harder for the body to absorb
vitamins, minerals and calories.  Coeliac disease is another
autoimmune disease people with Down’s Syndrome have a higher chance of
developing. Therefore, it has been suggested to avoid the introduction of
gluten containing foods until at least the age of 18-24 months when a child’s
digestive system is more developed.

Common symptoms to look out
for:

Diarrhoea                              Bloating

Tiredness                              Not growing at the
expected rate

Weight
loss                           Abdominal
pain

The only treatment for coeliac
disease is to eat a gluten-free diet. Foods that are naturally gluten-free
include: Fruit, meat, eggs and nuts.

It’s important to look for
“Gluten-Free” on the packaging, this means the manufacturer has ensured there
is no trace of gluten present.

A dietician will be able to
help carers, patients and the child understand which foods are suitable to eat
and which to avoid, and how to plan meals.

 

Constipation

Problems with the
gastrointestinal tract can be either due to abnormal structure i.e. the organs
are formed differently from usual, or part of the tract may not be functioning
to its full potential. Gastrointestinal tract abnormalities appear in 12% Down
Syndrome children. Children with Down Syndrome are predisposed to constipation
due to their generalised low muscle tone.

To prevent and alleviate
constipation:

A parent should offer regular drinks and
foods high in water content to ensure an adequate fluid intake. Some of
these include: fruit, yoghurt and smoothies. A thickening agent can be
added to fluids to change the consistency, it can then be offered from a
spoon to improve fluid intake.
Include a range of fibre-rich foods in the
diet such as fruit, vegetables, pulses, wholegrain cereals and wholemeal
bread.
Encourage regular activity where possible
to stimulate the bowel and strengthen the stomach muscles. Constipation
often improves when younger children start walking.
Some children with Down Syndrome may
require prescribed laxative medication to alleviate their difficulties
with constipation.

Food Intolerances
and Allergies

·        
Some
parents of children with Down Syndrome often wish to exclude cow’s milk from
their child’s diet due to symptoms such as blocked or runny nose, wheeze or
colic

·        
Contrary
to widespread belief, cow’s milk has not been scientifically proven to increase
mucous production. There is no reason to exclude cow’s milk from a child’s diet
unless a cow’s milk allergy has been proven.

·        
Unsupervised
dietary restriction can affect a child’s growth, and bone health, leading to
nutritional deficiency and failure to thrive. It is advised to seek
professional advice from your G.P. or a dietitian before milk is excluded from
a child’s diet.