Feeding and Nutrition


Feeding Issues

  • Feeding difficulties are common in children and people with Down syndrome, occurring in about 80% children, particularly during infancy. (Stanley et al. 2018) Hence an enquiry regarding a child’s feeding should be made at each clinic visit, particularly in the first year of life.
  • Factors contributing to feeding difficulties are multi-factorial, related to hypotonia, poor sensory perception, oro-motor coordination, dentition, underlying medical conditions e.g., gastroesophageal reflux, congenital heart disease, prematurity, respiratory and cow’s milk protein intolerance etc. (Stanley et al. 2018)
  • Over 50% of children with Down Syndrome aspirate silently. If aspiration is suspected this should be investigated further. (Jackson et al., 2016, O’Neill et al 2013)
  • The use of cervical auscultation to detect subtle audible wet pharyngeal sounds (SAWPS-CA) by an experienced and skilled speech and language therapist may be a useful tool to detect early asymptomatic aspiration, especially during infancy. (Himali De Silva et al 2020)
  • Most feeding difficulties can be managed conservatively and managed by multi-disciplinary approach along with specialist feeding speech and language therapists, dietitians, occupational therapist, paediatricians etc.
  • Naso-gastric/naso-jejunal feeding may be needed in infancy, particularly if there are associated medical problems, e.g., congenital heart disease.
  • Gastrostomy feeding is rarely needed long term.
  • Mothers should be supported to breast feed if they wish to do so.


  • The nutritional requirements of children and people with Down syndrome is similar to the general population.
  • There is some evidence to suggest that osteoporosis is more commonly found in people Down syndrome. It is important to encourage regular physical activity and optimum intake of calcium and vitamin D from a young age to prevent osteoporosis.
  • There is no evidence to suggest that additional supplementation with antioxidants or high dose vitamins improves developmental outcome.
  • The growth of children should be monitored on Down syndrome specific growth charts.


  1. H De Silva et al,. The use of cervical auscultation to detect subtle audible wet pharyngeal sounds (SAWPS-CA) as a screening tool for silent aspiration in infants with trisomy 21 ADC 2021, http://dx.doi.org/10.1136/archdischild-2021-rcpch.478
  2.  Jackson, A et al. Clinical Characteristics of Dysphagia in Children with Down Syndrome. 2016; 31:663-671
  3. O’Neill, AC et al. Pharyngeal Dysphagia in children with Down Syndrome. Otolaryngology- Head & Neck Surgery; 2013;149 (146-150)
  4. Stanley, MA et al. Clinical identification of feeding and swallowing disorders in 0–6-month-old infants with Down Syndrome. Am J Med Genet. 2019;179A:177-182
  5. Nallapeta et al Audit on cow’s milk protein intolerance in children with Down syndrome. ADC 2018103 (Suppl 1): A171.1-A171http://dx.doi.org/10.1136/archdischild-2018-rcpch.410
  6. J Ellis et al Supplementation with antioxidants and folinic acid for children with Down’s syndrome: randomised controlled trial BMJ. 2008 Mar 15; 336(7644): 594–597


Dr Shiela Puri, Consultant Community Paediatrician, Leeds Community Healthcare NHS Trust

Himali De Silva, Specialist Speech and Language Pathologist, Guys and St Thomas’s Hospital, London

Last updated: 7.1.2022

DSMIG Guidance

Growth charts for children with Down DSMIG Guidelines Basic Medical Surveillance Essential for people with Down syndrome: Growth

Joint DSMIG/RCPCH UK/Republic of Ireland cross-sectional growth reference charts.

Last updated: 2012

Growth Chart Fact Sheet

Why we need special charts for children with Down syndrome and how to use the charts to monitor children’s growth, including premature babies and older infants and children. It also includes some advice on growth in puberty and over-weight and obesity.

Last updated: 2012

Presentations at DSMIG Meetings

Materials from meetings are available for members only who need to log in to access them. For details on how to become a member click here.

Additional Resources

Down syndrome Ireland


Oesophageal aspiration in Children with Down syndrome

Asha Nair World Down Syndrome Congress 2012


Resting energy expenditure and adiposity accretion among children with Down syndrome a 3-year prospective study

Hill et al Eur J Paed Nutr 2013


Effect of Cows Milk Protein Intolerance on Recurrent Respiratory Tract Infections in Down syndrome

Priya Chandershekar, World Down Syndrome Congress 2012


Breast feeding a Baby with Down syndrome.

Canadian Down Syndrome Society.



Down Syndrome Scotland


Nutritional supplementation in Down syndrome: theoretical considerations and current status. Dev Med Child Neurol 2000;42:207-13 Ani C, Grantham-McGregor S, Muller D. 


Supplementation with antioxidants and folinic acid for children with Down’s syndrome: randomised controlled trial BMJ 2008 Mar 15; 336(7644): 594–597 J Ellis et al