American Academy of Pediatrics: Down Syndrome Health Care Guidelines
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Transcript of American Academy of Pediatrics: Down Syndrome Health Care Guidelines
American Academy of Pediatrics:
Down Syndrome
Health Care Guidelines
American Academy of Pediatrics:
Down Syndrome
Health Care Guidelines
by: Nick A. Jernigan, M.D.
ObjectivesObjectives:
• Develop awareness of Down Syndrome Develop awareness of Down Syndrome guidelinesguidelines
• Understand basic categories of screeningUnderstand basic categories of screening
• Know where to look to get the guidelinesKnow where to look to get the guidelines
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/2/442
Birth to 1 month
• First Things First...
• Confirm the diagnosis with a karyotype
• Discuss and Review:
• Hypotonia
• Facial Appearance
Birth to 1 Month: Evaluations
Feeding
Strabismus, Cataracts, Nystagmus
Congenital Hearing Loss
Heart Defects (50% risk)
Duodenal Atresia
Constipation - increased risk of Hirschsprung
Leukemia
Congenital Hypothyroidism
Respiratory Tract Infections
Anticipatory Guidance• Susceptibility of
URI
• ECI
• Parental Support Groups
• DS Support Groups
Strengths of the Child
Positive Family Experiences
Methods of Coping
Recurrence Risk
1 month to 1 year• Physical Exam / Laboratory Studies
• Risk of Serious OM
• Strabismus, Cataracts, and Nystagmus by 6 Months
• Pneumovax
• Newborn thyroid function screen - will repeat at 6 and 12 months, then annually
Anticipatory GuidanceReview growth and development with DS curves
DS Support Groups
Assess familial relationships
ECI
Recurrence Risk
Growth Charts
1 year to 5 years• Good Ol’ H&P
• Risk of OM and Hearing Loss (50-75% between 3-5 yrs of age)
• Check audiogram every 6 months until 3 years if tympanic membranes are not visible
• Obtain x-rays between 3-5 years of age to evaluate atlantoaxial instability
• Thyroid and vision screening yearly
• Discuss sleep apnea, believed to be as high as 50% of children with Down’s
Anticipatory Guidance• ECI
• PT, OT, Speech, Preschool, School Placement, Performance
• Discuss:
• Behavior, Discipline, Sibling Adjustment, Socialization, Recreation, Diet, and Physical Activity
Never Stop Discussing:
Strengths of Child
Positive Family Experiences
Methods of Coping
Recurrence Risk
5 to 13 years
• H&P
• Audiologic and vision screening annually
• Thyroid screening annually
• Discuss dermatologic complications- especially dry skin
• Discuss sleep apnea
Anticipatory Guidance
• School Placement and Developmental Intervention
• Socialization, Family Status, Financial and Guardian Relationships
• Sense of Responsibility
Psychosexual Development
Menstrual Hygiene
Contraception
Females can become pregnant
Males are usually infertile.
13 to 21years• History & Physical
• Audiologic and vision screening annually
• Thyroid screen and CBC annually
• Discuss dermatologic complications
• Discuss sleep apnea
Anticipatory Guidance• Transition of Care
• Vocational Training
Sexuality and Socialization
Contraception
Group Homes and Independent Living Opportunities
Financial and Guardian Relationships
Any Questions?Any Questions?
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/2/442