Feeding a Baby with Down Syndrome
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Welcoming a baby into the world is an incredible experience, and when that little one happens to have Down syndrome, the journey becomes even more unique.
As a parent, you want to provide the best possible care for your child, including ensuring they receive the proper nutrition and feeding.
Feeding challenges are fairly common among babies with Down syndrome, but with the proper knowledge and strategies, you can help your little one thrive. In this post, my goal as a pediatric dietitian is to guide parents through the process of feeding a baby with Down syndrome by offering practical tips, helpful insights, and expert advice to facilitate healthy eating habits.
What is Down syndrome?
Down syndrome occurs when a person has a full or partial extra copy of chromosome 21. According to the Centers for Disease Control and Prevention, approximately one in every 772 babies in the United States is born with Down syndrome, making Down syndrome the most common chromosomal condition.
“Common physical traits of Down syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm,” according to the National Down Syndrome Society.
Each person with Down syndrome is unique, however, and may have these characteristics in varying degrees, or sometimes not at all.
Down syndrome is a lifelong condition and can often be associated with other health conditions, including a higher incidence of infection, respiratory, cardiac, thyroid, vision, and hearing problems. However, getting help from specialists like speech, occupational and physical therapists early on will help babies with Down syndrome to improve their physical and intellectual abilities as they grow.
Feeding challenges in babies with Down syndrome?
Feeding challenges are often observed in babies with Down Syndrome due to low muscle tone, sensory issues, food refusal, low endurance, and potential gastrointestinal complications. Understanding these challenges is crucial for developing effective strategies to support the nutrition and development of a baby with Down syndrome.
In babies with Down syndrome, oral-motor, and sensory issues can affect their ability to eat as well.
A protruding tongue, poor muscle tone, and atypical oro-motor development can contribute to speech and feeding difficulties by causing disorganized and weak sucking patterns.
Babies with Down syndrome also have a higher risk of pneumonia and aspiration, which is unintentionally sucking food or liquid into the airway.
It is important to notify your pediatrician if your child is showing signs of swallowing difficulties while feeding, such as watery eyes, coughing, choking, congestion, and chronic respiratory illnesses.
Can infants with Down syndrome breastfeed?
Absolutely. The American Academy of Pediatrics recommends breast milk as the sole source of nutrition for the first six months. Breastfeeding provides many benefits to all babies and can be especially beneficial for a baby with Down syndrome.
Breast milk contains natural antibodies that strengthen babies’ immune systems, which is particularly important for babies with Down syndrome, who have higher rates of respiratory and ear infections.
Additionally, breastfeeding strengthens babies’ jaw and facial muscles, which supports later speech and language development. It also provides skin-to-skin contact, a form of sensory stimulation that helps with bonding between mother and baby.
Most babies with Down syndrome can successfully breastfeed; however, some common challenges typically present within the first few months but will usually improve with time and assistance from specialists.
It may be difficult for a baby with Down syndrome to latch onto a breast initially due to low muscle tone and a protruding tongue. Working with a lactation consultant or other feeding specialist can help make the latch easier and more effective.
Some children with Down syndrome are unable to get adequate calories through breastfeeding alone, especially if they have other health conditions such as congenital heart disease.
Using a breast pump and feeding expressed breast milk can help keep up mom’s milk supply throughout the process and working with a pediatrician or dietitian to supplement feedings with additional breastmilk or formula may be necessary.
Due to their low muscle tone, providing good head and neck support is important to prevent your baby from tiring quickly. The best positions for this are the cross-cradle hold, football hold, and the dancer hand.
Babies with Down syndrome also tend to be sleepier than other infants, so caregivers will likely need to work harder to keep the baby awake during feedings.
Try removing their clothes for feedings, gently stroking their hands and feet with a damp washcloth, keeping lights dim while feeding so they aren’t closing their eyes due to bright lights, and switching breasts more frequently.
Feeding should provide quality time for a parent and child to bond. If you find that you are having trouble with breastfeeding or aren’t sure your baby is getting enough milk, be sure to check in with your pediatrician or lactation consultant for further help with breastfeeding.
How to bottle-feed a baby with Down syndrome?
Bottle feeding a baby with Down syndrome can present similar issues associated with breastfeeding. Because babies with Down syndrome tend to have a weaker suck and have less endurance when feeding, it is important to know how to best position and feed them to help improve their swallowing ability and develop oral-motor control.
Bottle feeding a baby with Down syndrome does not typically require special bottles; however, it is helpful to place your baby in a more upright position with a supported head and neck to reduce the risk of ear and upper respiratory infections.
Slow to medium-flow nipples are recommended to allow your baby more control over the amount of milk coming from the bottle. It can also be helpful to use a bottle that prevents excessive air intake, as babies with weaker suck patterns can ingest more air than other babies.
Jaw support can be given by gently placing your index finger on your baby’s cheek and your third finger under the jaw. This can help to maintain a good latch and also helps to reduce wide, ineffective up and down jaw movements.
When can babies with Down syndrome start solid foods?
As with any other baby, it is important to make sure a baby with Down syndrome is showing signs of readiness for starting solids, which usually emerge around 6 months of age.
These signs include the ability to remain seated upright with minimal support, holding the neck/head relatively steady, picking up larger items and putting them to the mouth, and showing an interest in foods.
It can be challenging for babies with low muscle tone to sit and eat independently for extended periods. To improve their posture, try holding your baby upright on your lap or use small, rolled-up towels on either side of their hips to prevent slumping in the high chair.
It is also important to make sure their feet are stabilized on a footrest to improve head, trunk, and arm function.
When first introducing foods to your baby, choose soft foods that are easy to swallow. A few examples include eggs, yogurt, pureed butternut squash, and applesauce. If spoonfeeding, leave the spoon in your baby’s mouth until they seal their lips to help them take an active role in eating and learn to remove food on their own.
Can a baby with Down syndrome do baby-led weaning?
Yes! Promoting self-feeding skills is crucial for the overall development of babies with Down syndrome. Baby-led weaning may provide many benefits for babies with Down syndrome because it promotes earlier self-feeding skills as well as increases jaw strength with earlier chewing.
As a registered dietitian with specialized training in infant feeding, I recommend using strategies and techniques to encourage self-feeding, such as introducing finger foods, role-modeling utensil use, and offering appropriate food textures.
If you take a baby-led weaning approach, you can feed your baby longer strips of soft, easily mashable foods such as ripe avocado, steamed sweet potato, or banana. Once a baby is able to pick up foods with their thumb and forefinger (also called the pincer grasp) around 9 months of age, it is helpful to feed smaller pieces of soft foods that are cut to the size of a chickpea.
For younger babies who have a hard time picking up foods that are slippery, try rolling the food in ground flaxseed, cornmeal, baby cereal, or bread crumbs.
If you would like more information on baby-led weaning, check out my online course for parents, based on my best-selling book, which will walk you through the process of starting solids using a baby-led approach.
Which cups are best for babies with Down syndrome?
Many parents in my practice have questions about which cup to transition to when their babies are starting solids. I recommend using an open cup (with help, if needed) starting at 6 months of age and progressing to a straw cup soon after. Both open cups and straw cups are ideal for strengthening the jaw, lip, tongue, and facial muscles.
One of my favorite cups for teaching young babies to drink from an open cup is the Ezpz tiny cup* because it is perfect for small hands. When introducing a straw cup, if your child is having difficulty learning how to suck water out of the straw, try using a HoneyBear training cup* or siphoning water into the straw with your finger and placing the straw on their lips until they understand where the liquid is coming from.
How to solve feeding issues in babies with Down?
During meals, feeding difficulties in babies with Down syndrome may include prolonged or lack of chewing, overstuffing the mouth, and pocketing food. It is important to note that spitting out food is very common when learning to eat solids and is not necessarily a sign of feeding difficulty.
If your baby is overstuffing their mouth, place only 2-3 bites of food on the plate or tray at a time and continue to offer small servings based on their hunger cues. Having a plate full of food can make it more difficult to control the amount of food going into their mouths.
For babies with low muscle tone, you can give them breaks by alternating spoon-feeding with preloaded spoons they can use for self-feeding. Some of my favorite spoons for self-feeding are the NumNum* and Nooli spoons*.
It is also important to remember that until a child has molars and has had plenty of experience chewing and swallowing, avoid hard, round foods that are the size of a child’s airway. A few examples of the top choking hazards for kids under age 4 include hard candies, popcorn, grape tomatoes, grapes, hot dogs, marshmallows, raw carrots, whole nuts, and globs of peanut butter.
Tips for feeding a baby with Down syndrome
Consistency and structure are essential to helping a baby with Down syndrome feel secure and excited about feeding.
Here are a few tips:
Allow time for exploration during mealtime by letting your baby touch, smell, and taste foods on their own
Eat with your baby, preferably at their eye level, so that they can watch you to model eating skills
Practice responsive feeding by paying attention to their hunger and fullness cues; babies with Down syndrome may take longer to chew and swallow foods
Time meals for when your baby is not too tired, hungry, full, sick, or fussy
Make sure your baby is sitting upright in the high chair, with hips and knees at 90-degree angles; adding a small pillow at the back or a couple of rolled-up dish towels on either side of the hips can help
Encourage “mouth play” with different textured teething toys to improve sensory development and jaw strength
Try to avoid wiping your baby’s face frequently during meals; food on the lips and face provides helpful sensory information for babies who are learning about their bodies
Limit overstimulating lights and sounds during meals to prevent sensory overload when practicing a new skill
Every baby is different, and especially when feeding a baby with Down syndrome, what works for one baby’s feeding challenges may not work for another. Be sure to follow up with your feeding therapy team for more information and individualized tips!
For more information on Down syndrome, check out the National Down Syndrome Society or the National Association for Down Syndrome.
If you’re interested in learning more about how and when to integrate foods into your baby's diet, as well as how to reduce the risk of food allergies during infancy, check out my new baby-led feeding cookbook!
If you're looking for personalized nutrition support for your babies or kids, I am currently accepting new clients in my virtual private practice and would love to work with you.
Please comment below with any questions. Thanks for reading!