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If there's one thing you should know about me, it's that I LOVE oral anatomy. In fact, it seems like every other post I write has to do with either oral function or oral anatomy and the impact each has on infant feeding.

What better way to kick off the first blog post in this multi-part series than by covering one of the things that interest me the most?!

As I mentioned in the series introduction, assessing feeding ability in a baby with down syndrome is no different than in a baby without it.

If you're expecting and desire to breastfeed, I want to reassure you that most babies with DS breastfeed just fine. Some may only need a little extra support to maximize their natural feeding abilities, while others may require a bit more guidance. Nonetheless, creating a human milk feeding plan for all babies with DS is doable.

But because there are some variations in anatomy and function that may pose more of a challenge to navigate, I want to discuss these anatomical and physiological difference so that you will have a better understanding of how you can best support your baby's specific feeding abilites.

Babies who have down syndrome may have one or more of the following:

• Oral Motor Hypotonia (Low oral tone)

• A flaccid tongue in conjunction with a small jaw leading to the appearance of an "oversized" tongue

• Decreased sucking reflexes, a weak suck, or both.

• Low stamina

• Laryngomalacia aka floppy Larynx

• Heart defects

Oral Motor Hypotonia (low tone)

Even though each baby with DS is unique, some of the "typical" characteristics associated with Down Syndrome are as a result of Oral Motor Hypotonia: Open mouth posture, protruding tongue, reduced facial creases etc.

This low tone may influence breastfeeding by affecting how well your baby can latch and how well they can stay attached.

Your baby's ability to maintain a proper seal, make smooth jaw motions (grading), place their tongue in the appropriate spot for effective feeding , and coordinate the suck/swallow/breathe pattern may all be impacted by their oral hypotonia.

We will discuss the techniques you can use to help them compensate during feeding in part two, and we will talk about the therapies available to you to work on their oral tone in part three. Stay tuned!

Small Jaw

While low tone is responsible for an open mouth posture, the tongue's appearance is a direct result of the small jaw size. Many people may assume (incorrectly) that babies with Down Syndrome have a tongue that is too large (macroglossia), when in fact it's the small size of the surrounding oral cavity and the flaccidity of the tongue that gives it that appearance.

Additionally, some babies have a high arched palate and poor midface development, which also contributes to the appearance of the tongue as being too big for the mouth.

Some parents report that they feel that their baby's tongue "gets everywhere" preventing successful latching. Other's may have initial latching challenges due to having a nipple size that doesn't fit well in their baby's small oral space. Luckily, just as in breastfeeding babies who don't have down syndrome, this tends to improve with time.

Decreased sucking reflexes/Weak suck

If your baby has decreased reflexes, it means they may not exhibit the expected primitive reflexes used in feeding such as the rooting, gape, or sucking. The most important reflex in ensuring sufficient transfer is the sucking reflex, which is initiated when the junction of the hard and soft palate (the roof of the mouth) is stimulated.

If your baby has a weak suck, it means that they are not creating enough intra-oral pressure or maintaining suction to effectively remove as much milk as they need.

Both situations, especially when occurring in conjunction with one another, can impact how efficient your baby is at feeding, be it at the breast or the bottle.

Some babies with DS may need an NG tube to help with feeding as they develop and refine their feeding skills which can be very discouraging to parents who desire to provide 100% of their baby's nutrition directly at the breast.

Because breastfeeding provides the perfect opportunity for practicing oral-motor skills, waking up any depressed reflexes and strengthening a weak suck, regardless of how effective your baby is initially at nursing, it's encouraged to be a part of your daily routine.

Low stamina

Another aspect of infant feeding that may get better with time is how much stamina your baby has when eating. Babies with Down Syndrome often get tired quickly during feeding; it makes sense as eating is a surprisingly complex and labor-intensive activity!

Laryngomalacia

Laryngomalacia, like the all other things discussed, are not exclusive to babies with Down's Syndrome. The primary sign of a floppy Larynx is a high pitched squeak upon inhalation called stridor. And though it can sound scary, it usually poses no issues.

Fun fact: Laryngomalacia is the most frequent cause of noisy breathing babies!

So why do I mention it?

Babies with DS may be more likely to have stridor, and because some babies might need a bit of support during nursing to prevent airway issues, I wanted to mention it in part one. Part two will bring you all the practical information to help you navigate Laryngomalacia if you baby deals with it.

Heart defects

Heart defects are common in babies with Down Syndrome; roughly half of all babies with DS will have some form of cardiovascular system abnormality.

Heart defects can lead to tiredness and poor oxygenation, which can cause or contribute to poor feeding ability. Small frequent feeds tend to work best for babies with heart defects, but we will get more into that in the next post!

If you've been reading up on what to expect regarding breastfeeding your baby after a diagnosis of Downs syndrome, nothing I've said in this post may be new to you. However, I wanted to start at the basics for anyone early in their research journey and create a baseline of knowledge from which to build upon.

Part Two : Strategies for Breastfeeding

Found this post helpful? See anything I missed? Please leave a comment below!!