Feeding and Nutrition


Feeding Issues

  • Feeding difficulties are common in children and people with Down syndrome, occurring in about 50% children, particularly during infancy.
  • Factors contributing to feeding difficulties are multi-factorial, related to hypotonia, oro-motor coordination, dentition, underlying medical conditions e.g. congenital heart disease, cows milk protein intolerance etc.
  • 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.
  • Aspiration can be seen and is often silent, if aspiration is suspected this should be investigated further.
  • 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 are similar to the general population; although there is some evidence to suggest that the resting energy expenditure is 10% less than the general population.
  • There is some evidence to suggest that osteoporosis is more commonly found in people Down syndrome. It is therefore important to encourage regular physical activity and optimum intake of calcium and vitamin D from a young age.
  • There is no evidence to suggest that additional supplementation with anti-oxidants or high dose vitamins improves developmental outcome.
  • The growth of children should be monitored as per the DSMIG Growth guidelines.

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.


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