Care of Infants and Children With Down Syndrome: Role of the Family Physician

Christopher W. Bunt, MD
Stephanie K. Bunt, PhD

American Family Physician. 2025;111(3):236-244.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Down syndrome is the most commonly diagnosed chromosomal abnormality, occurring in 1 in 640 live births in the United States each year. Prenatally, cell-free DNA screening or integrated screening (combined first and second trimester screening) for aneuploidy is highly sensitive for identifying Down syndrome. The diagnosis should be confirmed at birth with fluorescence in situ hybridization followed by chromosomal karyotyping. Children with Down syndrome have varied degrees of intellectual disability and more health complications than typical children. Newborns with Down syndrome require a cardiac evaluation including echocardiography. Children with Down syndrome should have annual vision and hearing screenings, and laboratory tests for subclinical thyroid disease and hematologic disorders. Clinicians should provide unbiased and comprehensive culturally sensitive information regarding available services and support for children with Down syndrome and caregivers. Enrollment in comprehensive early intervention programs (eg, speech, visual, physical and occupational therapy, and child psychology) enhances development.

CHRISTOPHER W. BUNT, MD, FAAFP, DABFM, is a professor in the Department of Family Medicine at the Medical University of South Carolina College of Medicine, Charleston.

STEPHANIE K. BUNT, PhD, is a managing director of health care practice at McAllister & Quinn, Washington, District of Columbia.

Address correspondence to Christopher W. Bunt, MD, FAAFP, DABFM, at cwbunt@gmail.com.

Author disclosure: No relevant financial relationships.

  1. 1.Presson AP, et al. Current estimate of Down syndrome population prevalence in the United States. J Pediatr. 2013;163(4):1163-1168.
  2. 2.Mai CT, et al. National population-based estimates for major birth defects, 2010–2014. Birth Defects Res. 2019;111(18):1420-1435.
  3. 3.Centers for Disease Control and Prevention. Living with Down syndrome. Accessed January 22, 2025. https://www.cdc.gov/birth-defects/living-with-down-syndrome/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/birthdefects/downsyndrome/data.html
  4. 4.National Down Syndrome Society. Facts, myths, & truths about Down syndrome. Accessed January 22, 2025. https://ndss.org/myths-truths
  5. 5.Bull MJ, et al. Health supervision for children and adolescents with Down syndrome. Pediatrics. 2022;149(5):e2022057010.
  6. 6.Kucik JE, et al. Trends in survival among children with Down syndrome in 10 regions of the United States. Pediatrics. 2013;131(1):e27-e36.
  7. 7.Schieve LA, et al. Health of children 3 to 17 years of age with Down syndrome in the 1997–2005 national health interview survey. Pediatrics. 2009;123(2):e253-e260.
  8. 8.National Down Syndrome Society. Preferred language guide. Accessed January 22, 2025. http://www.ndss.org/Down-Syndrome/Preferred-Language-Guide/
  9. 9.Skotko BG, et al. Family perspectives about Down syndrome. Am J Med Genet A. 2016;170A(4):930-941.
  10. 10.Schieve LA, et al. A population-based assessment of the health, functional status, and consequent family impact among children with Down syndrome. Disabil Health J. 2011;4(2):68-77.
  11. 11.Tenenbaum A, et al. Hospitalization of children with down syndrome. FrontPublicHealth. 2014;2:22.
  12. 12.Screening for fetal chromosomal abnormalities: ACOG Practice Bulletin, Number 226. Obstet Gynecol. 2020;136(4):e48-e69.
  13. 13.Alldred SK, et al. First trimester serum tests for Down's syndrome screening. CochraneDatabaseSystRev. 2015(11):CD011975.
  14. 14.Alldred SK, et al. First and second trimester serum tests with and without first trimester ultrasound tests for Down's syndrome screening. CochraneDatabaseSystRev. 2017(3):CD012599.
  15. 15.Alldred SK, et al. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. CochraneDatabaseSystRev. 2017(3):CD012600.
  16. 16.American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 88, December 2007. Invasive prenatal testing for aneuploidy. Obstet Gynecol. 2007;110(6):1459-1467.
  17. 17.Gil MM, et al. Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol. 2019;53(6):734-742.
  18. 18.Skotko BG, et al. Prenatal diagnosis of Down syndrome: how best to deliver the news. Am J Med Genet A. 2009;149A(11):2361-2367.
  19. 19.Halliday J, et al. Has prenatal screening influenced the prevalence of comorbidities associated with Down syndrome and subsequent survival rates? Pediatrics. 2009;123(1):256-261.
  20. 20.Dimopoulos K, et al. Cardiovascular complications of Down syndrome: scoping review and expert consensus. Circulation. 2023;147(5):425-441.
  21. 21.Stanley MA, et al. Clinical identification of feeding and swallowing disorders in 0–6 month old infants with Down syndrome. Am J Med Genet A. 2019;179(2):177-182.
  22. 22.Santoro SL, et al. Surgical, medical and developmental outcomes in patients with Down syndrome and cataracts. SAGEOpenMed. 2017;5 : 2050312117715583.
  23. 23.De Schrijver L, et al. Prevalence and etiology of sensorineural hearing loss in children with down syndrome: a cross-sectional study. Int J Pediatr Otorhinolaryngol. 2019;116:168-172.
  24. 24.Bull MJ, Engle WA. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics. 2009;123(5):1424-1429.
  25. 25.Pierce MJ, et al. Characterization of thyroid abnormalities in a large cohort of children with Down syndrome. HormResPaediatr. 2017;87(3):170-178.
  26. 26.Tunstall O, et al. Guidelines for the investigation and management of transient leukaemia of Down syndrome. BrJHaematol. 2018;182(2):200-211.
  27. 27.Tenenbaum A, et al. Anemia in children with down syndrome. Int J Pediatr. 2011;2011:813541.
  28. 28.Zemel BS, et al. Growth charts for children with Down syndrome in the United States. Pediatrics. 2015;136(5):e1204-e1211.
  29. 29.Centers for Disease Control and Prevention. Growth charts for children with Down syndrome. Accessed January 22, 2025. https://www.cdc.gov/birth-defects/hcp/down-syndrome-growth-charts/index.html
  30. 30.Muse C, et al. Supplement to the JCIH 2007 position statement: principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Pediatrics. 2013;131(4):e1324-e1349.
  31. 31.Feldman PM, et al. Prospective study of thyroid function in the first year of life in infants with Down syndrome. EurJPediatr. 2023;182(6):2903-2911.
  32. 32.Swigonski NL, et al. Screening for celiac disease in asymptomatic children with Down syndrome: cost-effectiveness of preventing lymphoma. Pediatrics. 2006;118(2):594-602.
  33. 33.National Institute for Health and Care Excellence. Otitis media with effusion in under 12s. NICE guideline 233. August 30, 2023. Accessed January 22, 2025. https://www.nice.org.uk/guidance/ng233
  34. 34.Umfress AC, et al. Prevalence of ocular pathology on initial screening and incidence of new findings on follow-up examinations in children with trisomy 21. Am J Ophthalmol. 2019;207:373-377.
  35. 35.Haseeb A, et al. Down syndrome: a review of ocular manifestations. Ther Adv Ophthalmol. 2022;14 : 25158414221101718.
  36. 36.Roizen NJ, et al. A community cross-sectional survey of medical problems in 440 children with Down syndrome in New York state. J Pediatr. 2014;164(4):871-875.
  37. 37.Manikam L, et al. Respiratory tract infection-related healthcare utilisation in children with Down's syndrome. Infection. 2020;48(3):403-410.
  38. 38.Lewanda AF, et al. Patterns of dietary supplement use in children with Down syndrome. J Pediatr. 2018;201:100-105.e30.
  39. 39.Centers for Disease Control and Prevention. RSV immunization guidance for infants and young children. Accessed January 22, 2025. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/infants-young-children.html
  40. 40.Mitra S, et al. Hospitalization for respiratory syncytial virus in children with Down syndrome less than 2 years of age: a systematic review and meta-analysis. J Pediatr. 2018;203:92-100.e3.
  41. 41.Burgoyne K, et al. Efficacy of a reading and language intervention for children with Down syndrome: a randomized controlled trial. J Child Psychol Psychiatry. 2012;53(10):1044-1053.
  42. 42.Wasant P, et al. Factors influencing development of Down syndrome children in the first three years of life: Siriraj experience. J Med Assoc Thai. 2008;91(7):1030-1037.
  43. 43.Bonnier C. Evaluation of early stimulation programs for enhancing brain development. Acta Paediatr. 2008;97(7):853-858.
  44. 44.Connolly BH, et al. A longitudinal study of children with Down syndrome who experienced early intervention programming. Phys Ther. 1993;73(3):170-179 , discussion 179–181.
  45. 45.Hart SJ, et al. Detection of iron deficiency in children with Down syndrome. Genet Med. 2020;22(2):317-325.
  46. 46.Shott SR, et al. Obstructive sleep apnea: should all children with Down syndrome be tested? Arch Otolaryngol Head Neck Surg. 2006;132(4):432-436.
  47. 47.Hatch-Stein JA, et al. Body composition and BMI growth charts in children with Down syndrome. Pediatrics. 2016;138(4):e20160541.
  48. 48.Ryan C, et al. Dermatologic conditions in Down syndrome. Pediatr Dermatol. 2021;38(Suppl 2):49-57.
  49. 49.Hengartner AC, et al. Evaluation of 2011 AAP cervical spine screening guidelines for children with Down Syndrome. Childs Nerv Syst. 2020;36(11):2609-2614.
  50. 50.Molloy CA, et al. Differences in the clinical presentation of trisomy 21 with and without autism. J Intellect Disabil Res. 2009;53(2):143-151.
  51. 51.DiGuiseppi C, et al. Screening for autism spectrum disorders in children with Down syndrome: population prevalence and screening test characteristics. JDevBehavPediatr. 2010;31(3):181-191.
  52. 52.Dressler A, et al. The autistic phenotype in Down syndrome: differences in adaptive behaviour versus Down syndrome alone and autistic disorder alone. Funct Neurol. 2011;26(3):151-158.
  53. 53.Burke LM, et al. Gynecologic issues of adolescents with Down syndrome, autism, and cerebral palsy. J Pediatr Adolesc Gynecol. 2010;23(1):11-15.
  54. 54.Couwenhoven T. Teaching Children with Down Syndrome About Their Bodies, Boundaries and Sexuality (Topics in Down Syndrome). Woodbine House, Inc.; 2007.
  55. 55.Centers for Disease Control and Prevention. CDC contraceptive guidance for health care providers. Accessed January 22, 2025. https://www.cdc.gov/reproductivehealth/contraception/contraception_guidance.htm
  56. 56.Bunt CW, Bunt SK. Role of the family physician in the care of children with Down syndrome. Am Fam Physician. 2014;90(12):851-858.

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