Sleep patterns :

Anatomic and immunologic differences predispose school-aged children to obstructive sleep apnea. This can lead to behavioral problems, pulmonary hypertension, failure to thrive, gastrointestinal reflux, and chronic lung aspiration with subsequent frequent lung infections. The way to test is through polysomnography.

The treatment of obstructive sleep apnea is usually removal of adenoid and/or tonsils. In severe cases, a procedure called 'uvulopalatopharyngoplasty' (UPP) is performed: this is basically for children with floppy soft palates. Some children also have a narrowing of the laryngotracheal area, which explains some failures after surgery. Other surgeries to enlarge the midfacial area have also been proposed for severe cases.

In adults and children in whom surgical treatment has failed or was not indicated one therapy is continuous partial airway pressure.

Toilet training :

The average age for toilet training with Down's syndrome is approximately 36 months. Routine toilet training techniques are effective. It will take longer, however to train a child with Down's syndrome and additional positive reinforcement will be necessary.

Children with Down's syndrome may suffer from constipation secondary to generalized muscle flaccidity and low activity levels. Dietary corrections, occasional use of bulk laxatives, and increase in exercise can alleviate this problem.

Discipline :

Children with Down's syndrome are not usually more difficult to discipline than normal children. Parents must be encouraged to remember that discipline needs to be appropriate for the child's developmental age, however and not their chronological age. 

Child care :

Day care should provide appropriate social, cognitive, and physical stimulation for the child with Down's syndrome. Primary care providers should be aware of resources in their community to which parents may be referred to assist with day care placement 

All young children who attend group day care are more likely to experience a greater number of illnesses, have more frequent hospitalizations.

If the individual child has proven to be highly susceptible to infections, a home care setting is recommended.

Schooling :

A variety of options for academic placement ranging from mainstreaming to residential placement exist. Parents and teachers working together to create a supportive environment can ensure that the child has some social and academic successes.

Sexuality :

Individualized instructions about self-care skills, biologic changes, social implications, and contraception is paramount so that both appearance of sexual impropriety and the risk of being sexually exploited is minimized. Genetic counseling for both parents and child is necessary, because although men are virtually always will be sterile, women are capable of reproducing.