Part I: Clinical Practice Guidelines With Down Syndrome From Birth to 12 Years

Susan N. Van Cleve, MSN, RN, CPNP; William I. Cohen, MD


J Pediatr Health Care. 2006;20(1):47-54. 

In This Article

5 Years to 12 Years: Late Childhood


  • Review parental concerns and current level of functioning. Discuss school progress, Individual Education Plan, and any additional services child is receiving in school (e.g., occupational and speech therapy).

  • Review recent illnesses, hospitalizations, or symptoms of health problems, with special attention to recurrent URIs or obstructive sleep apnea.

  • Review socialization, family status, and relationships, including financial arrangements and guardianship.

  • Review thyroid screening and audiologic, dental, and ophthalmologic evaluations.

Physical Examination

  • Growth parameters (height, weight, and BMI) should be charted as previously described.

  • A general neurologic examination should be performed as described previously, with special attention for hyperreflexia, presence of Babinski sign, disturbance of gait, bowel and/or bladder abnormalities, weakness in hands, or neck pain.

  • Perform Tanner staging for boys and girls. Perform a testicular examination as recommended in routine pediatric care because repeated examinations desensitize the child and reinforce the importance of the examination to the family. Adolescents and young adults with DS are at a greater risk for testicular cancer (Cohen, 1999).

  • Perform a skin examination looking for dry skin or any other skin problems. Children with DS commonly have very dry skin.

Laboratory Tests and Consultations

  • Thyroid function tests; free T4 and TSH yearly.

  • Annual audiologic and ophthalmologic evaluations.

  • Dental examination every 6 months.

Anticipatory Guidance

  • Discuss the development of age-appropriate social skills and the development of a sense of responsibility. Parents should be encouraged to give their children household responsibilities and promote active participation in self-care skills.

  • Discuss psychosexual development, physical and sexual development, menses, and menstrual hygiene. Refer for classes on puberty for special needs children and their parents, if available.

  • Discuss the importance of a well-balanced diet and routine exercise.

  • Encourage good dental hygiene with twice-a-day tooth brushing.

  • Monitor the family's need for supportive care or counseling, respite care, and behavior management techniques.



Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: