The National Down Syndrome Congress gratefully acknowledges the contributions by Allen Crocker, M.D. for his development of this HealthWatch chart. It is presented here with his permission.

Concern: Cervical spine abnormality
Clinical Expression: (1) Atlantoaxial instability, (2) potential neck or long-tract signs
When Seen: X-ray by 3 yrs; repeat in middle childhood
Observed Prevalence: (1) 10% +/- (2) 1-2% +
Management: Neurologic, orthopedic help; possible restriction, fusion

Concern: Congenital heart disease
Clinical Expression: AV canal defects, auricular or ventricular septal defects, Tetralogy of Fallot
When Seen: Newborn or first year
Observed Prevalence: 40-50%
Management: Cardiac consultation, echocardiography, surgical repair, SBE prophylaxis

Concern: Delayed growth
Clinical Expression: Typically at or near the third percentile for general population
When Seen: Throughout
Observed Prevalence: All
Management: Use DS growth charts, early nutritional support; check thyroid, heart

Concern: Developmental delays
Clinical Expression: Some global delay, variable degrees; specific language problems
When Seen: 1st year, continues
Observed Prevalence: All
Management: Early intervention, educational planning, speech/language therapy

Concern: Emotional problems
Clinical Expression: Inappropriate behavior, depression, other emotional disturbances
When Seen: Mid to late childhood, adult life
Observed Prevalence: Common
Management: Family guidance, aid in transitions, mental health assistance

Concern: Hearing concerns
Clinical Expression: Serious otitis media, small canals, mostly conductive impairment
When Seen: Check by 6 months; review regularly in early years
Observed Prevalence: Up to 50% at some times, 10% sensorineural
Management: Audiology, tympanometry, ENT consultation

Concern: Hypotonia
Clinical Expression: Reduced muscle tone, increased range of joints, motor function problems
When Seen: Throughout life; improvement with maturity
Observed Prevalence: All
Management: Guidance by physical therapy; early intervention; adapted physical education

Concern: Ocular problems
Clinical Expression: (1) refractive errors, (2) strabismus, (3) cataracts
When Seen: Eye exam by 6-12 months, then follow-ups
Observed Prevalence: (1) 50%, (2) 35%, (3) 5%
Management: Look for cataract; ophthamologic consultation

Concern: Overweight
Clinical Expression: Excessive weight gain
When Seen: Preschool and adolescent years
Observed Prevalence: Common
Management: Lifestyle adjustment, including diet and activity

Concern: Premature senescence
Clinical Expression: Behavioral changes, functional losses
When Seen: 5th,6th decades
Observed Prevalence: No Credible Observations (increased rate)
Management: Special support

Concern: Seizure disorders
Clinical Expression: Primary generalized (also hypsarrhythmia)
When Seen: Any time
Observed Prevalence: 5-10%
Management: EEG,neurologic consultation

Concern: Thyroid disease
Clinical Expression: Hypothyroidism (rare hyper-), decreased growth & development
When Seen: Some congenital; most 2nd+ decade; check at 2-3 years, repeat
Observed Prevalence: 15%
Management: Endocrine consult, replacement therapy as needed

Additional variable occurrences include congenital obstruction, Hirschsprung disease, leukemia, alopecia areata, keratoconus, hip dysplasia, diabetes mellitus, missing teeth, obstructive sleep apnea, and mitral valve prolapse.