Obesity in children and adolescents is a growing health crisis. More than 15 percent of American children are overweight, which puts them at risk for numerous health problems.
Children with Down syndrome are no exception. In fact, they are even more likely to be overweight than their peers without Down syndrome. Research has shown that as many as 50 percent of children with Down syndrome between the ages of 1 month and 18 years are overweight. While the exact reason for this is unknown, there are a variety of contributing factors, including:
- Lower basal metabolic rate. Studies have shown that people with Down syndrome burn fewer calories while resting than individuals without Down syndrome.
- Hypothyroidism. Individuals with Down syndrome have a higher likelihood of having thyroid disorders that can cause weight gain.
- Hypotonia (poor muscle tone) and heart defects. These may cause a delay in achievement of motor milestones and limited physical activity. Later there may be medically imposed limitations on sports activities or organized play, which reduces opportunities to burn calories.
- Short stature. Children with Down syndrome are shorter in stature than their peers without Down syndrome, and because of this they need less food intake. Consumption of even a small amount of excess calories can result in weight gain.
Ironically, many children with Down syndrome have difficulty putting on weight as infants. Problems with sucking and swallowing related to hypotonia or weakness due to heart problems often reduce food intake. Later, tongue thrust problems and delay in tooth eruption may slow the progression of diet from milk to solid foods.
While it’s not inevitable that children with Down syndrome will become obese, learning the proper prevention skills may pose a challenge for parents who spent months trying to help their child gain weight, says Catherine Conway, MS, RD, CDN, CDE, chief of nutritional services at YAI/National Institute for People with Disabilities in New York. It’s also a challenge for the child who must be careful about food selections. “In the world we’re in, they want to eat like everyone else,” Conway says.
What can you do to help your child with Down syndrome maintain a healthy weight? Here are some ideas:
Young children can learn good eating habits when they’re served a variety of healthy foods at each meal and at snack time. Be sure to include these important basics in your child’s diet: lean meats or meat substitutes such as tofu or peanut butter, fruits and vegetables in a variety of colors, whole grain breads, cereals and pastas and milk or milk products such as yogurt and cheese. Children with Down syndrome, like all children, will choose the appropriate amounts and types of food throughout the day if they are given good selections. To offset any lack in vitamins and minerals, most health experts suggest a daily multivitamin.
Involve your child in meal planning and preparation, advises Conway. Children who help with their own meals and snacks not only learn about healthy foods but also have an opportunity to practice fine motor skills, color recognition and counting. Even very young children can help stir the muffin batter or pick up vegetables to top a salad.
Don’t underestimate the value of a family meal, either, says Joan Medlen, RD, LD, who has a private practice in Oregon and is the mother of a child with Down syndrome. “The family meal is a tremendous teaching time,” Medlen says. “It’s a time to come together around a well-planned meal [and] to learn about food.”
Your own eating habits are important, too; parents are essential models of good eating behaviors. Even if you love potato chips and soda, keep these things out of the house. Limit high calorie, less nutritious foods such as cakes, pies and candy to special occasions. If you want to serve dessert, serve something nutritious, yet appealing to children. “Make pretty fruit cups,” suggests Conway.
Rather than limiting food intake, which may cause a nutritional deficiency in children under age 18, children with Down syndrome can maintain a healthy weight by increasing their physical activity, says Medlen. This can involve small, simple daily changes such as having your child walk with you to a nearby destination, rather than riding in the car, or taking the stairs rather than the elevator. Try to find and plan family activities that involve movement, such as biking, hiking or playing tag or catch.
Older children with Down syndrome can be involved in setting their own eating and weight goals. They can also begin to learn that people who are shorter need less food than someone who is taller, says Conway.
A good motivator for achieving or maintaining a healthy weight is finding “the hook,” Conway says. That is, determine what the healthy body size will accomplish: fitting into a favorite outfit or playing a sport with sufficient energy, for example.
Older children can be more involved in meal planning and preparation, too. They can help with shopping and can use simple recipes even if they involve more pictures than words. “One picture is worth a thousand words,” says Conway, who uses digital pictures of foods to assist with shopping and cooking.
Medlen agrees. She suggests limiting recipes to no more than five ingredients and using color-coded measuring cups and spoons for cooking. Another tip: Make only enough food for the meal. “If there are leftovers, we eat them,” Medlen says.
Exercise continues to be an important part of healthy weight maintenance for older children with Down syndrome. They can now become more involved in team sports or join a gym. In addition, they can help with chores that involve physical activity, such as mowing the lawn, raking leaves or working in the garden.
Both Medlen and Conway emphasize that achieving and maintaining good nutrition and a healthy weight is a matter of positive behavior support. “They want to be healthy,” Medlen says. “They just need the tools.”