Children with Trisomy 21 or Down Syndrome can be at increased risk for feeding and swallowing problems. This is primarily due to anatomical differences, such as low tone. Low oral muscle tone (weak muscles in the mouth including the lips, cheeks, tongue) can result in weak lip closure, poor suction on the bottle nipple, strong tongue thrust and poor chewing. These problems can be diagnosed and treated with an oral motor assessment and clinical swallow evaluation performed by a speech pathologist.

The most concerning feeding and swallowing issue for children with low tone is aspiration, or the ingestion of food and/or drink into the airway. The act of aspirating typically results in an alerting sensation or a cough response. However, a recent study from the Children’s Hospital of Colorado reported that children with Down Syndrome are at higher risk for silent aspiration, which is when food or drink enter the airway without eliciting a sensation or a cough response. Silent aspiration can only be detected and diagnosed by a test. The two tests that evaluate swallowing are the modified barium swallow study (MBSS) (this might also be called a videofluorscopic swallowing study) or a fiber optic endoscopic evaluation of swallowing test (FEES), either of which can be conducted by a trained speech pathologist. Left untreated, aspiration can result in health problems including pneumonia, chronic cough, low grade fevers, congestion, dependence on supplemental oxygen and poor weight gain.

What does this mean for parents?

  • Not every child with Down’s syndrome has aspiration. However, parents of children with Down’s syndrome should understand that their child has an increased risk for swallowing problems and that sometimes aspiration is silent meaning there are no obvious symptoms when the child is swallowing.
  • Children with low oral motor tone can have difficulty with the mouth skills needed to manipulate a bottle, cup or solid foods.
  • Parents should seek an evaluation from a speech pathologist for feeding and swallowing skill development and get treatment early to prevent long term consequences.

If parents are concerned, they should request a referral from their pediatrician for a feeding and swallowing evaluation from a trained speech pathologist.

Jackson A, Maybee J, Moran M, Worlter-Warmerdam K, Hickey F. Clinical Characteristics of Dysphagia in Children with Down Syndrome. Dysphagia. 12 July 2016 doi: 10.1007/s00455-016-9725-7

Written by Sarah Studley, MS, SLP-CCC, one of our speech pathologist’s on the UNC Pediatric Feeding Team who specializes in pediatric feeding and swallowing intervention.