Nutrition and Diet for Children and Adults with Down syndrome

Eating a healthy and balanced diet is important for people with Down syndrome. It will ensure they are receiving the correct nutrients and prevent long term health conditions. This factsheet covers nutritional information for children and adults with Down syndrome.

Infant Feeding

Breastfeeding

There are so many benefits to breastmilk, and these can apply even more so to babies with Down syndrome. Breastfeeding a baby with Down syndrome can sometimes present challenges, but with the right information and support, many can breastfeed successfully.

Benefits of Breastmilk

1. Breastmilk boosts your baby’s immune system. This is especially important for babies with Down’s syndrome since they are prone to respiratory and viral infections.
2. Babies with Down’s syndrome can have low muscle tone. The specific sucking action needed during breastfeeding will help strengthen your baby’s lips, tongue, and face. This serves as a steppingstone for eating other foods and speech development.
3. Breastmilk is both food and drink for your baby and it contains all of the nutrients, calories, and fluids your baby needs, but it is also much more than just nutrition. It provides your baby with comfort and warmth and the physical closeness when you are feeding helps create a special bond between you and your baby.

The first days and weeks of breastfeeding are a time for you and your baby to get to know each other and learn together how to breastfeed effectively. As you get to know your baby better, you might discover that there are some specific physical characteristics of babies with Down’s syndrome that may have an impact on your breastfeeding journey. Of course, every baby is unique so you might not encounter all of the challenges mentioned. If your baby has difficulties breastfeeding at first, then ask for support and remember that many mums and babies need extra help to breastfeed and that ongoing support and time can help you both learn how to breastfeed effectively.

If you are having difficulties to begin with, then you can choose to express and feed your baby breastmilk. This can help by giving you both more time to learn whilst also making sure your baby is still getting the benefits of breastmilk and it can also be useful if your baby needs to be apart from you in the early days or if they need feeding by a tube for any reason.

Link in with your health care professional if you need help with breastfeeding, they can refer you to a Lactation Consultant where you can get specialist advice. You can also obtain expert advice on breastfeeding from the HSE Breastfeeding - HSE.ie

Hints and tips for breastfeeding a baby with Down’s syndrome

Low muscle tone

Babies with Down’s syndrome can have low muscle tone and so may have trouble attaching effectively to the breast and staying there for a full feed. Some babies may also have difficulty coordinating their sucking, swallowing and breathing and may gulp or splutter as they feed. They might get less milk for their efforts, and they often get tired quickly. This generally improves with practice and time. The act of breastfeeding will actually improve your baby’s muscle strength. As baby gets stronger and learns to breastfeed more effectively, they will be able to drink more milk. Different feeding positions may help – see above link on breastfeeding or ask your healthcare professional what position could work for you and your baby.

Tongue thrust

If you find your baby has a tongue that sticks out more than usual it can sometimes make breastfeeding harder. You can help by trying to position your baby in a way that encourages them to open their mouth really wide and to keep their tongue down by touching the bottom lip and pressing the chin when they go to attach onto your breast. There are also very simple tongue exercises that can sometimes help. Ask your Healthcare professional if you think these might be useful for you.

Sleepy babies

Some babies with Down’s syndrome can be very sleepy or tire more quickly, especially if they have any issues with their heart. Positioning your baby in a comfortable and supported arrangement can also help your baby get more milk for their efforts, better stimulate your milk supply and mean that they don’t get tired so quickly. You can help by starting your milk flowing before you put your baby to the breast, so that baby will not have to spend energy sucking without any milk coming out. Gentle hand expressing, rolling your nipple between your thumb and forefinger, gentle massage and perhaps a warm face cloth on the breast can help encourage your milk to let down.

Weight gain

Babies with Down’s syndrome can sometimes gain weight slower than other babies. There are specific growth charts available for children with Down’s syndrome so that this can be monitored carefully, especially if your baby also has other medical issues that mean they might gain weight slower than usual. If your baby is having wet and dirty nappies and is happy and content, they are probably getting enough. If you have any concerns about weight gain or whether your baby is getting enough milk, please speak to your healthcare professional.

Bottle feeding

Many babies with Downs Syndrome will have no problem feeding and can follow general advice on bottle feeding (see https://www2.hse.ie/babies-children/bottle-feeding/) . Some babies with Down syndrome

have a harder time sucking efficiently, due to their low muscle tone. Their mouths may be less ready for feeding, and the extra effort they have to put into drink may make it more challenging to drink a full bottle.

Babies with low muscle tone may need help using the muscle strength and control they have. They often prefer to be fed in a way that requires the least effort, rather than using their muscle control. To help encourage muscle strength, you may need to support your baby to be alert before and during each feed. Here are a few tips to help with this.

• Start the feed when your baby is most awake or
• See if playing with your baby just before feeding helps increase attention for the Play gentle tickle games with fingers. Some parents find that a cool or tepid bath wakes up their baby before feeds. A cool washcloth on the face or gentle tapping around face and mouth may increase readiness for the bottle.
• Some parents find that gently tickling or stretching the muscles around the lips and cheeks helps wake up the mouth.

Positioning

Feed your baby in as upright a position as possible. The more your baby is upright, the more active the muscles become. Be sure that your baby is being fed in a chin tuck position. This position, with the head not too far back and not too far forward, seems to set up the neck and mouth muscles for the strongest sucking response. Try to rest your baby’s head – not neck – on your arm when holding during feeds, which automatically tucks the chin slightly. This position also can be achieved with pillows or arm rests.

Specialised bottles, available commercially, may be used to keep the baby’s head at this angle until the end of the feeding. Ask your Health care professional about specialised bottles.

Paced bottle feeding

Some babies with Down syndrome have further medical complications that may affect good sucking or good nutritional intake. These conditions may require extra assistance. Ask your healthcare professional if you have questions or need more help.

How to give a baby a bottle - HSE.ie

Weaning

As with all infants, weaning your baby onto solid food can be a very positive and exciting experience. Significant feeding and swallowing problems occur in the minority of children. Small, surmountable difficulties can happen as with all babies.

Most infants will be ready to try some solid food at 6 months of age.

It is important to watch for signs of readiness for solids in your infant. The oral feeding that your baby has received over the past 6 months (breast and/or bottle-feeding) has helped to develop your child’s mouth and co-ordination skills in readiness for spoon-feeds.

Look for:

• Ability to sit unsupported
• Good head and neck control
• Ability to move hands to mouth while sitting
• Alertness
• Curiosity – follows your fork!

It is usual to try some puréed fruit or vegetable as the first food. Follow HSE Guidelines for Weaning your Baby onto Solid Food.

Weaning - HSE.ie

Nutrition for young children - HSE.ie

Children with Down syndrome can sometimes encounter problems with both feeding and swallowing for reasons such a low muscle tone, sensory difficulties, low endurance or issues with oral motor skill development.

Postural Control:

Postural stability enables your infant to sit and to actively participate in feeding themselves. It is important that your baby can hold their head up independently or is well supported in their feeding chair at mealtimes. This upright position encourages the mouth and tongue to be in the correct position for accepting food. If your baby has poor core control, try placing rolled towels on either side of their trunk in the highchair to act as wedges. This will allow them to use their hands for exploration.

At Mealtimes:

• Some babies have a lower sensory awareness; they may be trying to say:
• Listen to your infant even when they are not saying anything, they may take longer to chew and swallow Don’t rush them. Understand your child’s nonverbal cues such as pushing the spoon away, turning their head, closing their mouth.
• Promote self-feeding for your baby when they are ready. Allow your child play with a spoon and attempt to feed themselves,
• Keep children at eye-level by putting the highchair beside you or beside the family table so that they can learn by watching everyone.
• Allow for fun and exploration at mealtimes by letting your child smell and taste a variety of
  • I can’t tell where the food is in my mouth
  • I can’t tell when it is chewed enough
  • I can push food out of my mouth

The following are some clues that your baby might be having difficulty around sensation:

• Swallows’ food that isn’t chewed
• Older baby putting non-food items into their
•  Gagging
• Storing food in pocket or
• Drools a lot or is very
• An intolerance of smells, tastes, sounds, temperatures or

You may be invited to attend the Occupational or Speech Therapist around help to support the child with lower sensory awareness.

Some reasons that your baby might encounter problems with the task of moving onto solid food:

• If your baby has a small oral cavity, then food can fall backwards, and they can gag/cough. Present smaller spoonful’s and at slower pace.
• If your baby’s tongue is larger than usual or less mobile, they may find it harder to propel the food backwards. It can help to use smaller spoonful’s, present the spoon towards the back of the mouth or try alternating between a full and empty spoon to allow the baby to clear their mouth.
• Your baby’s palate can be flatter and the arch higher meaning that food can get stuck in the roof of the mouth. Try the empty spoon technique above and offer your baby a drink to clear the mouth after a number of spoonfuls.
• Low tone and open position of the lips means that food can escape
• Lax ligaments and low muscle tone means that your baby can tire easily and find it harder to It may be helpful to prolong the puréed phase of weaning until strength develops. Spoon-feed your baby with smaller portions but a little more often. Make sure that your baby is well supported in their chair.
• When trying to move along with textures, don’t surprise your baby with lumps, gradually introduce small soft lumps into baby’s purées in order to give them time to adapt.

The Baby with a Heart Defect:

The presence of heart defects in about 40% of infants with Down syndrome is another important risk factor contributing to feeding and growth problems. Depending on the type and severity of the heart defect, excessive perspiration, fast and difficult breathing, vomiting and fatigue can occur during feeding. This can result in inadequate food intake and limited weight gain. As a result of increased pulmonary pressure in young infants with heart defects, the typical symptoms of the heart defect may be masked,

and parents can be unaware of the cause of their infant's feeding problem. Early identification of a heart defect in an infant is therefore most important for the accurate description and appropriate intervention of complex feeding problems of some infants with Down syndrome.

Encouraging healthy eating habits in children and adults

Eating a healthy and balanced diet is important for maintaining a healthy weight in children and adults with Down syndrome. It will also provide the right fuel for taking part in their favourite activities and help avoid long term health conditions such as type 2 diabetes, heart disease and obesity.

What does a healthy diet look like?

Children and adults with Down syndrome can follow general healthy eating guidelines. The food pyramid can be used to guide healthy eating habits.

Use the food pyramid for children 1-4 years to plan meals and snacks - Food portion sizes for 1 to 4 year olds - HSE.ie

For older children and adults children follow the adult food pyramid- food-pyramid-simple-version.pdf (hse.ie)

Why is it important for people with Down’s syndrome to eat a healthy diet?

Eating a wide variety of foods provides the energy and nutrients children and adults with Down syndrome need to stay healthy. In addition, people with Down’s syndrome are more prone to gaining weight due to a slower metabolism. This means that it can be easier for people with Down’s syndrome to gain weight, making them more susceptible to the long-term health conditions associated with being overweight or obese. Following a healthy balanced diet can help to maintain a healthy weight.

How do you encourage healthy eating?

There are many ways you can help support a person with Down’s syndrome to eat a healthier diet. People with Down’s syndrome may find it hard to think about long-term consequences, so they may not understand the importance of making healthy choices about their diet. People with Down’s syndrome often like routine and can struggle with large changes, so making small changes to a person’s daily routine regularly will improve their long-term eating habits. It is very important to encourage participation in exercise and sport for helping to achieve and maintain a healthy weight and for the many other health and psychological benefits.

For tips and advice on healthy eating see the links below

Nutrition for young children - HSE.ie

How to eat well - HSE.ie

Healthy Eating | safefood

Coeliac disease: Coeliac disease is more common in people with Down syndrome. Dietary intervention is required to manage coeliac disease with the implementation of a gluten-free diet for life. If you think that you or your child may have coeliac disease, then please talk to your health care professional. For more information on coeliac disease, see our fact sheet Coeliac Disease GIG diet sheet (indi.ie) or Coeliac Society of Ireland

Diabetes: Diabetes is more common in people with Down syndrome. A healthy balanced diet is important to help control diabetes and prevent long term complications. For more information, see our fact sheets on Diabetes Food Facts - INDI Diabetes Ireland

If you require further information about diet and nutrition for children and adults with Down syndrome, or for a referral to a dietitian, please contact your doctor, or the Irish Nutrition and Dietetic Institute (INDI) at 01 2804839 or www.indi.ie.

Updated by members of the Children and Adult Disability Interest Group of the INDI May 2023.

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