Down syndrome in Child
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Synopsis

Down syndrome is a genetic disorder caused by trisomy of all or part of chromosome 21. Characteristic facial features include mild microcephaly, upslanting palpebral fissures, small nose with flat nasal bridge, small ears, and epicanthal folds. Other physical features include hypotonia, short neck with loose skin folds, single palmar creases, wide gap between first and second toes ("sandal gap"), and short stature. The degree of intellectual disability is variable.
Patients are at greater risk for atlantoaxial instability, hypothyroidism, constipation, gastroesophageal reflux disease, congenital heart disease, leukemia, impaired immune system, obstructive sleep apnea, hearing deficits, vision loss, seizures, dysphagia, pulmonary hypertension, type 1 diabetes, alopecia, celiac disease, juvenile idiopathic arthritis, vitiligo, and Alzheimer disease pathology / early-onset dementia. Life expectancy is 58.6 years. Major causes of mortality are congenital heart disease (in early childhood) and respiratory infections (in childhood and adulthood).
Patients are at greater risk for atlantoaxial instability, hypothyroidism, constipation, gastroesophageal reflux disease, congenital heart disease, leukemia, impaired immune system, obstructive sleep apnea, hearing deficits, vision loss, seizures, dysphagia, pulmonary hypertension, type 1 diabetes, alopecia, celiac disease, juvenile idiopathic arthritis, vitiligo, and Alzheimer disease pathology / early-onset dementia. Life expectancy is 58.6 years. Major causes of mortality are congenital heart disease (in early childhood) and respiratory infections (in childhood and adulthood).
Codes
ICD10CM:
Q90.9 – Down syndrome, unspecified
SNOMEDCT:
41040004 – Complete trisomy 21 syndrome
Q90.9 – Down syndrome, unspecified
SNOMEDCT:
41040004 – Complete trisomy 21 syndrome
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Differential Diagnosis & Pitfalls
- Edwards syndrome (Trisomy 18)
- Patau syndrome (Trisomy 13)
- Wolf-Hirschhorn syndrome – Characteristic facial appearance includes flat nasal bridge and high forehead referred to as "Greek warrior helmet" appearance.
- Angelman syndrome – Clinical clues may include severe language impairment, happy demeanor, hand-flapping, and ataxia.
- Rett syndrome – This is almost exclusively seen in females and characterized by postnatal microcephaly and regression of language and purposeful hand movements in early childhood.
- Williams syndrome
- Smith-Lemli-Opitz syndrome
- Cri-du-chat syndrome (5p minus [5p-] syndrome) – Infants often have a characteristic "catlike" cry.
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Last Reviewed:04/05/2018
Last Updated:10/19/2022
Last Updated:10/19/2022