Immune dysfunction :

The significant changes in the immune systems of children with Down's syndrome have significant implications for the primary care provider. Specifically, all infections need to be treated aggressively because negative sequelae are more likely to develop. There is a greater incidence of diseases like diabetes, autoimmune diseases, and juvenile rheumatoid arthritis. A child should be thoroughly investigated if he develops any signs and symptoms. Parents need to be educated about the signs and symptoms and the need to seek treatment promptly.

Upper respiratory tract infections :

Children with Down syndrome are prone to upper respiratory tract infections due to narrow openings to paranasal sinuses. These should be promptly treated as untoward sequelae like otitis media, pneumonia are more likely to develop. In children with congenital heart disease parents may confuse an upper respiratory tract infection for congestive heart failure. These children should be examined at the first sign of symptoms. Also these children need subacute bacterial endocarditis treatment.

The narrow trachea can result in recurrent croup. In addition, infants with Down's syndrome have an increased likelihood of tracheomalacia.

Behavioral changes :

Behavioral problems may be caused by a variety of conditions like:

• Thyroid dysfunction
  
  
• Obstructive sleep apnea
  
  
• Neurodegeneration
  
  
• Congestive heart failure
  
  
• Disturbed home environment
  
  
• Overstimulation
  
  

Trials of antidepressants and antipsychotics may be advised after thorough evaluation.

Gastrointestinal symptoms :

Complaints of persistent vomiting, constipation, or chronic diarrhea should be carefully pursued as pyloric stenosis and Hirschsprung's disease is more common in these patients. Constipation may be due to inadequate peristalsis, poor diet, lack of exercise, or thyroid dysfunction.

Gastroesophageal reflux (GER) occurs in infants with DS, as it does in the typical population. In addition to spitting up and vomiting, some children have respiratory symptoms, such as cough, stridor, wheezing and pneumonia. GER must be part of the differential diagnosis for these conditions, and appropriate treatment given.

Celiac disease occurs in from 7 to 16% of children with DS, though many of these studies are from European sources. Individuals with DS are predisposed to this condition because of the known increased incidence of autoimmune disorders. Screening is best accomplished using IgA antiendomysium antibodies, following up positive results with a villous biopsy. Symptoms usually resolve following institution of a gluten-free diet.

Drug interactions :

Down's syndrome is associated with functional abnormalities in the neurotransmitter enzyme systems, with the cholinergic and noradrenergic systems particularly vulnerable. Caution is advised if atropine, pilocarpine, or other related medications are to be given.

Psychiatric disorders:

Major depressive disorder, autism, attention deficit hyperactivity disorders, and conduct disorders may be observed at an increased frequency in persons with Down's syndrome.

Therapeutically, it is important to make specific diagnosis, since a number of interventions are available.

Skin disorders :

Awareness of the nature and prevalence of certain skin disorders in persons with Down's syndrome ensures accurate and timely diagnosis and treatment. Seborrheic dermatitis, ichthyosis, and tinea pedis are easily recognized and managed with available medications. Atopic dermatitis may be severe enough to interfere with daily living. Lifestyle modifications are often necessary and include changes in bathing habits, clothing, and use of topical corticosteroids and lubricants.