First Year 1 – 12 months

Development

Children with Down syndrome always go forward in their development – physically, intellectually and emotionally, becoming more competent with each passing year. Children with Down syndrome vary in their rate of development; they go along at a slightly slower speed than other children and arrive at each stage of development a little later, staying at that stage for longer.
It does not matter how far behind other children a child with Down syndrome is developing – what is important is that they are maintaining a constant rate of development, however fast or slow that may be. As with all children is its not recommended to compare your child’s development as they will all continue to develop at their own pace, and they need to be encouraged to do so.

Medical

History:

• Review parental concerns.
  
• Question about respiratory infections (especially otitis media);
  
• For constipation, use aggressive dietary management and consider Hirschsprung disease if resistant to dietary changes and stool softeners (passing of large stools clinically rules out HIrshsprung disease).
  
• Solicit parental concerns regarding vision and hearing.

Exam:

• General neurological,
  
• Neuromotor, and musculoskeletal examination;
  
• If unable to visualize tympanic membranes refer to ear, nose and throat (ENT) specialist,

Lab and Consults:

• Evaluation by a pediatric cardiologist including echocardiogram (if not done in newborn period): remember to consider progressive pulmonary hypertension in Down syndrome patients with a VSD or atrioventricular septal defect who are having little or no symptoms of heart failure in this age group.
  
• Auditory brainstem response test (ABR) by 3 months of age if not performed previously or if previous results are suspicious.
  
• Pediatric ophthalmology evaluation by six months of age (earlier if nystagmus, absent reflex, strabismus or indications of poor vision is present).
  
• Thyroid function test (TSH and T4), at 6 and 12 months of age.
  
• Evaluation by ENT specialist for recurrent otitis media as needed.

Developmental:

• Discuss early intervention and refer for enrollment in local program (if not done during the neonatal period). This usually includes physical and occupational therapy evaluations and a developmental assessment.
  
• SLP services initiated here
  
• Child tax credit forms, FSCD plan (will require physician letter regarding private SLP services)

Recommendations:

• Continue family support
  
• Continue SBE prophylaxis for children with cardiac defects.** guidelines attached**
  
• Immunization according to routine schedule, including influenza, children under one year are eligible for RSV prophylaxis ** updated criteria attached**