What is Down syndrome? Down syndrome is a set of physical and mental traits caused by a gene problem that happens before birth. Children who have Down syndrome tend. Gastroesophageal Reflux Disease Diet : Gi. Care. com. Author: Frank W. Jackson, M. D. Purpose. The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus. Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus. These symptoms include heartburn, chest discomfort, and bitter fluid flowing up into the mouth. Chest discomfort can occur. If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur. This entire problem is called GERD (Gastroesophageal Reflux Disease). A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD. Nutrition Facts. A diet designed to prevent or reduce acid reflux is usually easy to follow. The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations. So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council. A vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, tomato, etc. Special Considerations. The lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms: Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux. Do not lie down immediately after eating. Avoid late evening snacks. Avoid tight clothing and bending over after eating. Eat small, frequent portions of food and snack if needed. Lose weight if overweight. Obesity leads to increased reflux. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful. The following foods aggravate acid reflux, and should be avoided. The following foods irritate an inflamed lower esophagus and may need to be limited or avoided. ![]() Little kids love spinning in place until they fall down. But when we're talking about our dogs, there's really no good reason for loss of balance. So why do dogs fall. Causes of Nausea & Dizziness Dizziness, or feeling unbalanced or lightheaded, and nausea, the feeling that precedes vomiting, are symptoms of numerous of condi. What Are the Major Mental Health Related Concerns in Persons With Down Syndrome? At least half of all children and adults with Down syndrome face a major mental. Children who have Down syndrome learn differently than other children. Once we discover techniques that help, however, they can often learn the same things that come. Spicy or acidic foods may not be tolerated by some individuals. Food Groups. Group. Recommend. Avoid. Milk or milk productsskim, 1% or 2% low- fat milk; low- fat or fat- free yogurtwhole milk (4%), chocolate milk. Vegetablesall other vegetablesfried or creamy style vegetables*, tomatoes. Fruitsapples, berries, melons, bananas, peaches, pearscitrus*: such as oranges, grapefruit, pineapple. Breads & grainsall those made with low- fat contentany prepared with whole milk or high- fat l. Meat, meat substituteslow- fat meat, chicken, fish, turkeycold cuts, sausage, bacon, fatty meat, chicken fat/skin. Fat, oilsnone or small amountsall animal or vegetable oils. ![]() Sweets & dessertsall itmes made with no or low fat (less than or equal to 3 g fat/serving)chocolate, desserts made with oils and/or fats. Beveragesdecaffeinated, non- mint herbal tea; juices (except citrus); wateralcohol, coffee (regular or decaffeinated), carbonated beverages, tea, mint tea. Soupsfat- free or low- fat basedchicken, beef, milk, or cream- based soups*Individually determined. Helping Babies who Have Down Syndrome Learn to Breastfeed. Helping Babies who Have Down Syndrome Learn to Breastfeed The breastfeeding experience is one of the first hands- on lessons that we as parents learn with our children. Sometimes these lessons do not come easily, as when our son with Down syndrome was born. I forget that he has physical traits of Down syndrome because he’s just my son. He is my breastfed son. ![]() I will explore some of the common physical conditions our children have and their impact on breastfeeding, how swaddling and breastfeeding positions can help, as well as other aids and techniques. You may also want to read articles on this website that concern breastfeeding: milk flow, milk supply, lactogenic foods and herbs. Once we discover techniques that help, however, they can often learn the same things that come naturally to other babies and children. They may need to be taught in a step- by- step fashion, and they need support until they are able to do things efficiently on their own. Medical advancement has come far recently as well, and the life expectancy of our children has risen from an average life span of 2. There are exceptions though, and breastfeeding can work from the early days and weeks without apparent difficulty. In the meantime, a mother can protect her milk supply by pumping and storing her breastmilk. When her baby is strong enough to take full feedings at the breast, the pumping mother will be able to nurse him. Signs and Symptoms of Common Challenges. The symptoms listed here are intended only as a checklist. They are not present in all children who have Down syndrome, and they can range from very mild to very severe. ![]() ![]() ![]() Typical and Severe Symptoms of Gerd: Dealing with Symptoms of Acid Reflux Disease. ![]() ![]() ![]() Low Muscle Tone. Low muscle tone, also known as hypotonia, can present itself with “floppy” limbs, head, and a protruding tongue. Physical Therapy (PT) will help develop your baby’s overall muscle tone. The expert to look to for help is a Speech Pathologist who is trained in feeding issues and oral motor therapy in children who have Down syndrome. As the baby develops muscle strength and gains coordination with Physical Therapy (PT) and Occupational Therapy (OT), you’ll start to see important milestones, such as correct latch and effective drinking coordination in your baby. Non- Rhythmic Suck. Due to lack of coordination, some babies have a unique sucking sequence. Most mothers who have previously had a breastfeeding baby will notice the difference. Weak reflexes for sucking and swallowing can present as gagging and coughing during a feeding. This too will improve as baby gains strength with ongoing PT and OT. Arching. Arching backwards can be caused by low muscle tone, though it is also frequently impacted by GERD- reflux (below). In cases of low muscle tone, these babies can often be helped by swaddling, described later in this article. The baby may also be more comfortable nursing in a more upright and well- supported position. This in turn leads to arching. Providing your baby with physical support in a comfortable position can reduce their need to do this. Swaddling often does the trick. You may also want to think about your seating, and sit in an open chair rather than a chair that allows your baby to resume feet- bracing and arching. For instance, the so- called Australian position, where the mother is reclined on her back, and the baby is lying face down on her breasts. Gastro Esophageal Reflux Disease(GERD)Gastro Esophageal Reflux Disease, also known as GERD or reflux, is another common reason for arching. It is very common in children who have Down syndrome due to low muscle tone in the trunk, trachea, and esophagus. GERD can present itself very clearly as vomiting, or in the “silent form” with arching while gulping, coughing while feeding, and an “erp’ing” sound in the back of the throat. When babies experience pain because of untreated reflux, they may eventually refuse the source of the pain - - the breast! This is called breast refusal. Untreated, reflux can cause erosion of the esophagus by stomach acid that is brought up during a reflux episode. Also, if the child aspirates thin liquids into the lungs, which can be determined with a swallow study, they are more prone to respiratory problems that can lead to pneumonia. As with reflux, if a baby associates aspiration with feeding at the breast, he can start to refuse the source of pain, the breast. As well, there are several alternative options for providing breastmilk to a baby with aspiration challenges. By keeping a diary of what she eats and drinks, many mothers discover “trigger foods” to eliminate from their diet, and the baby’s reflux improves. The baby may also be given a medication if needed. Aspiration. As mentioned above, if the child aspirates thin liquids into the lungs, which can be determined with a swallow study, they are more prone to respiratory problems that can lead to pneumonia. A swallow study will determine how thick the liquid needs to be for the child's specific swallow dysfunction. There are special commercial thickeners that can be added to breastmilk (or any liquid) to a nectar or honey consistency depending on the child's diagnosis. Sometimes, a baby cannot feed from the breast or bottle due to the danger of aspiration while feeding, and a feeding tube may be necessary. Aspiration problems can be helped with oral motor therapy by a trained Speech Pathologist trained in treating babies with swallow problems. This reduces the danger of aspiration. Use stage three nipples or cross- cut nipples to enable the baby to drink thickened milk. Over or Under- Sensitive to Stimulation. This is common for babies who have Down syndrome. Some babies respond better and nurse for longer periods of time in a dark, quiet environment where they can concentrate fully on the task at hand. Other babies respond better to loud, exciting music with a bouncy beat and being pat on the back to help keep them stimulated and awake during a feeding. Sleepy Babies. Our babies tend to be sleepy and to fall asleep at the breast before they get a chance to get the hindmilk – the creamy, calorie- rich milk that comes later in a feed, and that is important to a baby’s neural development and weightgain. Pre- pumping the foremilk, or expressing until a letdown begins, can help the baby use less energy to start the flow of milk. This shut down mode can help him cope. If the baby is awake when mothers starts feeding, but goes to sleep immediately or very soon, she can try changing something about the feeding situation. For instance, a dark or a light room, turning off music or turning it on, not rocking when nursing, or adding in a rocking motion, swaddling the baby or unswaddling the baby, holding the baby upright, or laying him on the mother’s chest while she is laying on her back. The baby’s reactions will help a mother discover just what works best for her baby. A baby that is sleepy or squirmy or a pokey eater may be less so when he is comfortable.” Often, our sleepy babies do not “cue” when they are hungry and the mother may need to take a more scheduled approach. It may be necessary to wake and rouse the baby to breastfeed every 2 to 2 . Breastfeeding a baby with Down syndrome “on demand” often needs to be saved for later when the child is able to cue and is not as sleepy. A Breast Pump can Help Baby and Mother. Pre- pumping the foremilk, or expressing until a letdown begins, can help sleepy babies use less energy to start the flow of milk. This will allow them to use their energy to drink the milk that is already flowing and to get the hindmilk before tiring out. Milk Flow. All babies have a preference for milk flow, faster or slower. Breast compression can help increase the speed of milk flow, and the so- called “scissors hold” can slow the flow. Remember, babies with reflux and with swallow issues will probably want a slower flow. There are many breastfeeding positions that may be best for your child, some more conventional than others. See an IBCLC for help finding the positions that are best for your baby. Swaddling for Low Muscle Tone. If the baby with low muscle tone is not in a good position, or is not receiving enough body support, it can take much longer to complete a feeding, both with a bottle or breast. Swaddling has been shown to help our babies feed by mouth faster if they have low energy levels or seem to spend much of their time trying to hold up their loose bodies. It is hard to describe holding a baby who has low muscle tone. If you hold the child out in front of you to coo at them, their arms will hang down unnaturally toward the floor. They have very loose joints and ligaments. When being held, in the cradle hold for instance, their arms can easily get wrapped up behind them literally resting their wrist on their spine while the shoulder is twisted up. They don’t show any pain with these rubber band antics. Just holding a baby with low tone is very difficult. I’ll go into more detail about swaddling a low tone baby, but first, I’d like to discuss our personal story. He also had three holes in his heart making his energy levels low; sucking alone wore him out. I was lucky that he preferred to taste his milk rather than being fed directly into his stomach with a tube. However, trying to keep his mouth latched onto the bottle, and trying to hold up his limp body limbs, as well as dealing with his tendency to arch from reflux and low tone was time consuming and frustrating. Without swaddling, feeding could take a long time: three straight hours to drink three ounces from a bottle. Just in time to start another three ounces. I cried for joy the first time this happened. The difference was so dramatic. In talking with other mothers who use this technique, I found it was helpful for many of them, too. However, it will not be the best technique for all babies. Remember that these are only suggestions, and that only your experience with your baby will prove what is best and right for her.
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November 2017
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