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Controversies in Therapies for Children with Down Syndrome

Controversial therapies are not restricted to treatment of the developmental disabilities. This group of disorders has many features, however, that make the families more amenable to embracing unorthodox on poorly proven approaches. These include the chronic and pervasive nature of the problems, the unavailability of more orthodox therapies, and the pressures in society to move from traditional medicine to concepts of health and disease treatment based on diet, exercise, and psychologic approaches.

Critical review of the evidence available for children with Down syndrome provides no support for the use of orthomolecular therapy, 5-hydroxytryptophan, thyroid supplementation, or growth hormone. There is no documentation that early-intervention programs improve cognitive performance. There may be other important favorable outcomes of these programs involving both the child and parents, however, and studies are needed in this area.

Plastic surgery to normalize the major physical stigmata of Down syndrome has been performed most frequently in Europe. There are major philosophic issues involved, and there is, as yet, not enough information to allow development of a costbenefit analysis. A new controversy concerning atlantoaxial dislocation and participation in athletics has arisen. Here again, more studies are needed before complex issues concerning social policy, medical care, and professional liability can be sorted out.

The pediatrician's approach should be one of presenting all available information to the child's parents at the appropriate time. The roots of the controversy should be discussed, and the family helped toward a decision that best meets their needs and those of the child. Even if the physician is not in agreement with the decision, it is important to continue to follow the child and provide ongoing monitoring, support, and guidance.

This article has been cited by other articles:

				W. C. Cooley and J. M. Graham JR Common Syndromes and Management Issues for Primary Care Physicians: Down Syndrome An Update and Review for the Primary Pediatrician Clinical Pediatrics, April 1, 1991; 30(4): 233 - 253. [PDF]