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This is a summary of the Health Care Guidelines for Individuals with Down syndrome and can be placed in the front of a family's medical record book or in the front of a medical chart for rapid consultation. The original version was prepared in 1989 by Dr. Allen Crocker. Click here for a version suitable for printing (no headings, buttons, or banners).

A record sheet has been prepared to go along with the guidelines. Click here to view this record sheet.

Concern	Clinical Expression	When Seen	Observed Prevalence	Management
Congenital heart disease	AV canal defects, auricular or ventricular septal defects, Tetralogy of Fallot	Newborn or first year	40-50%	Cardiac consultation,echocardiography,surgical repair, SBE prophylaxis
Hypotonia	Reduced muscle tone,increased range of joints, motor function problems	Throughout life;improvement with maturity	All	Guidance by physical therapy;early intervention;adapted physical education
Delayed growth	Typically at or near the third percentile for general population	Throughout	All	Use DS growth charts, early nutritional support; check thyroid, heart
Developmental delays	Some global delay, variable degrees; specific language problems	1st year, continues	All	Early intervention, educational planning, speech/language therapy
Hearing concerns	Serious otitis media, small canals, mostly conductive impairment	Check by 6 months; review regularly in early years	Up to 50% at some times, ? 10% sensorineural	Audiology, tympanometry, ENT consultation
Ocular problems	(1) refractive errors, (2) strabismus, (3) cataracts	Eye exam by 6-12 months, then follow-ups	(1) 50%, (2) 35%, (3) 5%	Look for cataract; ophthamologic consultation
Cervical spine abnormality	(1)Atlantoaxial instability, (2) potential neck or long-tract signs	X-ray by 3 yrs; repeat in middle childhood	(1) 10% +/- (2) 1-2% +	Neurologic, orthopedic help; possible restriction, fusion
Thyroid disease	Hypothyroidism (rare hyper-), decreased growth & development	Some congenital; most 2nd+ decade; check at 2-3 years, repeat	15%	Endocrine consult, replacement therapy as needed
Overweight	Excessive weight gain	Preschool and adolescent years	Common	Lifestyle adjustment, including diet and activity
Seizure disorders	Primary generalized (also hypsarrhythmia)	Any time	5-10%	EEG,neurologic consultation
Emotional problems	Inappropriate behavior, depression, other emotional disturbances	Mid to late childhood, adult life	Common	Family guidance, aid in transitions, mental health assistance
Premature senescence	Behavioral changes, functional losses	5th,6th decades	No Credible Observations (increased rate)	Special support

Additional variable occurrences include congenital obstruction, Hirschsprung disease, leukemia, alopecia areata, keratoconus, hip dysplasia, diabetes mellitus, missing teeth, obstructive sleep apnea, and mitral valve prolapse.