Obesity in Children with Down Syndrome: Background and Recommendations for Management

Julie Murray, MSN, BA, RN, CPNP; Patricia Ryan-Krause, MS, MSN, RN, CPNP


Pediatr Nurs. 2010;36(6):314-319. 

In This Article


Physical Activity

Providers can help children with Down syndrome prevent excess weight gain and promote weight loss by encouraging increased vigorous activity. Increasing participation in sustained vigorous physical activity prevents obesity and its negative health implications (Whitt-Glover et al., 2006). Ordoñez, Rosety, and Rosety-Rodriguez (2006) enrolled 22 overweight and obese adolescent males with Down syndrome in an exercise program consisting of three, one-hour aerobic exercise sessions weekly for three months. The reduction in mean value of fat mass was statistically significant (31.8% ± 3.7% to 26% ± 2.3%) by the end of the study.

Helping children become more active begins by counseling families to limit sedentary activities and identify any barriers to increased activity. Suggestions for activity include using exercise balls, going on family outings, and modifying traditional games, such as kickball, to increase movement and participation. Other ideas consist of prompting families and children to obtain gym memberships, attend fun exercise classes, play active video games (such as "Dance Dance Revolution®"), attend summer camp, and join sports teams with local youth leagues or the Special Olympics. Sports offered by the Special Olympics programs are year-round and include swimming, basketball, figure skating, cycling, skiing, tennis, and softball. To initiate involvement in this program, visit the Special Olympics' Web site for more information (www.specialolympics.org). Ultimately, the health care provider, child, and family must create a plan to increase activity together, or compliance will be minimal.

When making recommendations to families, the child's developmental status in addition to cardiac and musculoskeletal issues associated with Down syndrome must be taken into account. For example, teens with Down syndrome report they prefer to participate in activities, such as jogging or yoga, that do not require ability-matched teammates or opponents (Menear, 2007). These activities allow teens to enjoy the physical and social benefits of exercise without being concerned about performance or competition. Teens with Down syndrome may also be less interested in participating in "special" or adapted activities because they desire to be part of a peer group and not feel different (Menear, 2007). Whatever the activity and age of the child, the most important consideration is that the child has fun. If the child does not enjoy the activity, exercising will become a stressor and a battle for the family instead of an opportunity for the child to have fun, relate to others, and build new skills.

The child should be adequately screened for orthopedic anomalies and cardiac conditions prior to vigorous physical activity. Any musculoskeletal problems in children with Down syndrome must be addressed prior to participation in athletics to prevent musculoskeletal injury. If a child is found to have cervical instability, the family must be counseled regarding the importance of abstaining from contact sports, such as hockey, soccer, and gymnastics (Platt, 2001). Parents should also be counseled to ensure their child wears wellfitting shoes to avoid complications of foot anomalies; the use of proper footwear, such as lace-up sneakers with arch support or properly fitted cleats and skates, may prevent more serious injuries resulting in the need for surgical intervention and termination of the exercise program (Concolino et al., 2006; Platt, 2001). Additionally, if the child displays patellofemoral instability on examination, he or she should wear a patellar sleeve while participating in physical activity to prevent injury (Winell & Burke, 2003).

While most children now receive complete cardiac corrective surgery early in life and have excellent cardiac function, if the child or adolescent has a cardiac condition, clearance from a cardiologist must be obtained. The child, family, and coaches should be educated to recognize warnings of distress, such as palpitations, syncope, lightheadedness, and dyspnea. Attention to these warning signs may avoid potential episodes of cardiac arrest or cerebrovascular accidents.

Although costly, consulting with exercise physiologists may provide information about community programs or help develop individualized home exercise plans for families who are unable to commit to more structured activities. Increased physical activity is more likely to be sustained if it is fun and enables the child to socialize with peers in a non-competitive manner.


Children with Down syndrome should eat a balanced diet with vitamin and mineral supplementation (Luke, Sutton, Schoeller, & Roizen, 1996). Caloric restriction to prevent obesity or promote weight loss is recommended due to their decreased metabolic rate (Roizen, 2002). Limiting portion sizes or identifying consumption of foods with hidden sugar, such as cereals and beverages, serve as basic strategies to reduce caloric intake. Encouraging families to limit fast food dining to once per month is also an effective way to decrease the amount of calories consumed.

Although caloric restriction may be a key factor, parents must be warned against the tendency to control their child's feeding practices. The provider should encourage parents to talk about how they perceive their child's weight, assess their concern, and counsel them to avoid pressuring children to eat during mealtimes. Parents should also be educated about chewing difficulties in children with Down syndrome and provided with ideas of healthy, soft food alternatives, such as yogurt, steamed vegetables, and pureed fruits (Hennequin et al., 2005). Finally, parents should be discouraged from using foods as rewards or punishments.

Nutritionists may assist with family education. They serve as excellent resources regarding appropriate portion sizes, child-friendly food products, and healthy snacks. After talking with families, nutritionists may help to establish a meal plan and assist in identifying ways of altering maladaptive feeding behaviors or negativism in the child. In children with Down syndrome who also have celiac disease, a nutritionist is essential to assure the elimination of gluten from the child's diet (Allen, 2004).


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