[Skip to Content]
[Skip to Content Landing]

Down Syndrome for the OtolaryngologistA Review

To identify the key insights or developments described in this article
1 Credit CME

Importance  There are many features of Down syndrome that prompt referral to an otolaryngologist. As the lifetime prevalence and life expectancy of individuals with Down syndrome increase, it is increasingly likely that otolaryngologists will have the opportunity to care for patients with Down syndrome.

Observations  A confluence of characteristics common to Down syndrome may be associated with issues in the head and neck, from infancy through adulthood. Hearing concerns range from narrow ear canals and cerumen impactions to eustachian tube dysfunction, middle ear effusion, cochlear malformations, and conductive, sensorineural, and/or mixed hearing loss. Immune deficiency, hypertrophy of Waldeyer ring, and hypoplastic sinuses may complicate and develop into chronic rhinosinusitis. Speech delay, obstructive sleep apnea, dysphagia, and airway anomalies are also common among this patient population. Because these concerns may necessitate otolaryngologic surgery, it is vital for otolaryngologists to familiarize themselves with anesthetic concerns, including cervical spine instability, in patients with Down syndrome. Comorbid cardiac disease, hypothyroidism, and obesity may also affect these patients and otolaryngologic care.

Conclusions and Relevance  Individuals with Down syndrome may visit otolaryngology practices at all ages. Otolaryngologists that familiarize themselves with the head and neck manifestations that are common among patients with Down syndrome and know when to order screening tests will be able to provide comprehensive care.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: January 1, 2023.

Published Online: March 2, 2023. doi:10.1001/jamaoto.2023.0001

Corresponding Author: Claire M. Lawlor, MD, Department of Otolaryngology, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (cmlawlor@childrensnational.org).

Conflict of Interest Disclosures: None reported.

de Graaf  G , Buckley  F , Skotko  BG .  Estimates of the live births, natural losses, and elective terminations with Down syndrome in the United States.   Am J Med Genet A. 2015;167A(4):756-767. doi:10.1002/ajmg.a.37001PubMedGoogle ScholarCrossref
Antonarakis  SE , Skotko  BG , Rafii  MS ,  et al.  Down syndrome.   Nat Rev Dis Primers. 2020;6(1):9. doi:10.1038/s41572-019-0143-7PubMedGoogle ScholarCrossref
Parker  SE , Mai  CT , Canfield  MA ,  et al; National Birth Defects Prevention Network.  Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006.   Birth Defects Res A Clin Mol Teratol. 2010;88(12):1008-1016. doi:10.1002/bdra.20735PubMedGoogle ScholarCrossref
Hans  PS , Belloso  A , Sheehan  PZ .  Parental satisfaction with health services provided to children with Down syndrome in north-west England: an ENT perspective.   J Laryngol Otol. 2007;121(4):382-386. doi:10.1017/S0022215106003355PubMedGoogle ScholarCrossref
Patel  TA , Nguyen  SA , White  DR .  Down Syndrome as an indicator for pediatric otolaryngologic procedures.   Int J Pediatr Otorhinolaryngol. 2018;112:182-187. doi:10.1016/j.ijporl.2018.07.007PubMedGoogle ScholarCrossref
Down  JL .  Observations on an ethnic classification of idiots. 1866.   Ment Retard. 1995;33(1):54-56.Google Scholar
Lejeune  J , Gautier  M , Turpin  R .  [Study of somatic chromosomes from 9 mongoloid children].   C R Hebd Seances Acad Sci. 1959;248(11):1721-1722.PubMedGoogle Scholar
Chin  CJ , Khami  MM , Husein  M .  A general review of the otolaryngologic manifestations of Down Syndrome.   Int J Pediatr Otorhinolaryngol. 2014;78(6):899-904. doi:10.1016/j.ijporl.2014.03.012PubMedGoogle ScholarCrossref
Ramia  M , Musharrafieh  U , Khaddage  W , Sabri  A .  Revisiting Down syndrome from the ENT perspective: review of literature and recommendations.   Eur Arch Otorhinolaryngol. 2014;271(5):863-869. doi:10.1007/s00405-013-2563-4PubMedGoogle ScholarCrossref
de Graaf  G , Buckley  F , Skotko  BG .  Estimation of the number of people with Down syndrome in the United States.   Genet Med. 2017;19(4):439-447. doi:10.1038/gim.2016.127PubMedGoogle ScholarCrossref
Shott  SR .  Down syndrome: common otolaryngologic manifestations.   Am J Med Genet C Semin Med Genet. 2006;142C(3):131-140. doi:10.1002/ajmg.c.30095PubMedGoogle ScholarCrossref
Strome  M .  Down’s syndrome: a modern otorhinolaryngological perspective.   Laryngoscope. 1981;91(10):1581-1594.PubMedGoogle ScholarCrossref
Sanchez-Gomez  MC , Dundon  K , Deng  X .  Evaluating data quality of newborn hearing screening.   J Early Hear Detect Interv. 2019;4(3):26-32.PubMedGoogle Scholar
Earley  MA , Sher  ET , Hill  TL .  Otolaryngologic disease in Down syndrome.   Pediatr Clin North Am. 2022;69(2):381-401. doi:10.1016/j.pcl.2022.01.005PubMedGoogle ScholarCrossref
Barr  E , Dungworth  J , Hunter  K , McFarlane  M , Kubba  H .  The prevalence of ear, nose and throat disorders in preschool children with Down’s syndrome in Glasgow.   Scott Med J. 2011;56(2):98-103. doi:10.1258/smj.2011.011036PubMedGoogle ScholarCrossref
Shott  SR , Joseph  A , Heithaus  D .  Hearing loss in children with Down syndrome.   Int J Pediatr Otorhinolaryngol. 2001;61(3):199-205. doi:10.1016/S0165-5876(01)00572-9PubMedGoogle ScholarCrossref
Park  AH , Wilson  MA , Stevens  PT , Harward  R , Hohler  N .  Identification of hearing loss in pediatric patients with Down syndrome.   Otolaryngol Head Neck Surg. 2012;146(1):135-140. doi:10.1177/0194599811425156PubMedGoogle ScholarCrossref
Rosenfeld  RM , Tunkel  DE , Schwartz  SR ,  et al.  Clinical practice guideline: tympanostomy tubes in children (update).   Otolaryngol Head Neck Surg. 2022;166(1_suppl)(suppl):S1-S55. doi:10.1177/01945998211065662PubMedGoogle ScholarCrossref
Bull  MJ , Trotter  T , Santoro  SL ,  et al; COUNCIL ON GENETICS.  Health supervision for children and adolescents with Down syndrome.   Pediatrics. 2022;149(5):e2022057010. doi:10.1542/peds.2022-057010PubMedGoogle ScholarCrossref
De Schrijver  L , Topsakal  V , Wojciechowski  M , Van de Heyning  P , Boudewyns  A .  Prevalence and etiology of sensorineural hearing loss in children with Down syndrome: a cross-sectional study.   Int J Pediatr Otorhinolaryngol. 2019;116:168-172. doi:10.1016/j.ijporl.2018.10.048PubMedGoogle ScholarCrossref
Paulson  LM , Weaver  TS , Macarthur  CJ .  Outcomes of tympanostomy tube placement in children with Down syndrome: a retrospective review.   Int J Pediatr Otorhinolaryngol. 2014;78(2):223-226. doi:10.1016/j.ijporl.2013.10.062PubMedGoogle ScholarCrossref
McDermott  AL , Williams  J , Kuo  MJ , Reid  AP , Proops  DW .  The role of bone anchored hearing aids in children with Down syndrome.   Int J Pediatr Otorhinolaryngol. 2008;72(6):751-757. doi:10.1016/j.ijporl.2008.01.035PubMedGoogle ScholarCrossref
Clarós  P , Remjasz  A , Clarós-Pujol  A , Pujol  C , Clarós  A , Wiatrow  A .  Long-term outcomes in Down syndrome children after cochlear implantation: particular issues and considerations.   Otol Neurotol. 2019;40(10):1278-1286. doi:10.1097/MAO.0000000000002410PubMedGoogle ScholarCrossref
Kent  RD , Vorperian  HK .  Speech impairment in Down syndrome: a review.   J Speech Lang Hear Res. 2013;56(1):178-210. doi:10.1044/1092-4388(2012/12-0148)PubMedGoogle ScholarCrossref
Piatti  G , Allegra  L , Ambrosetti  U , De Santi  MM .  Nasal ciliary function and ultrastructure in Down syndrome.   Laryngoscope. 2001;111(7):1227-1230. doi:10.1097/00005537-200107000-00016PubMedGoogle ScholarCrossref
Miller  JD , Capusten  BM , Lampard  R .  Changes at the base of skull and cervical spine in Down syndrome.   Can Assoc Radiol J. 1986;37(2):85-89.PubMedGoogle Scholar
Donnelly  LF , Shott  SR , LaRose  CR , Chini  BA , Amin  RS .  Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with Down syndrome as depicted on static and dynamic cine MRI.   AJR Am J Roentgenol. 2004;183(1):175-181. doi:10.2214/ajr.183.1.1830175PubMedGoogle ScholarCrossref
Mitchell  RB , Call  E , Kelly  J .  Ear, nose and throat disorders in children with Down syndrome.   Laryngoscope. 2003;113(2):259-263. doi:10.1097/00005537-200302000-00012PubMedGoogle ScholarCrossref
Chamseddin  BH , Johnson  RF , Mitchell  RB .  Obstructive sleep apnea in children with Down syndrome: demographic, clinical, and polysomnographic features.   Otolaryngol Head Neck Surg. 2019;160(1):150-157. doi:10.1177/0194599818797308PubMedGoogle ScholarCrossref
Dyken  ME , Lin-Dyken  DC , Poulton  S , Zimmerman  MB , Sedars  E .  Prospective polysomnographic analysis of obstructive sleep apnea in down syndrome.   Arch Pediatr Adolesc Med. 2003;157(7):655-660. doi:10.1001/archpedi.157.7.655PubMedGoogle ScholarCrossref
Marcus  CL , Keens  TG , Bautista  DB , von Pechmann  WS , Ward  SLD .  Obstructive sleep apnea in children with Down syndrome.   Pediatrics. 1991;88(1):132-139. doi:10.1542/peds.88.1.132PubMedGoogle ScholarCrossref
Wijayaratne  PR , Williams  K , Davey  MJ , Horne  RSC , Nixon  GM .  Factors associated with referral for polysomnography in children with Down syndrome.   Sleep Med. 2021;82:29-36. doi:10.1016/j.sleep.2021.03.019PubMedGoogle ScholarCrossref
Bush  D , Galambos  C , Ivy  DD , Abman  SH , Wolter-Warmerdam  K , Hickey  F .  Clinical characteristics and risk factors for developing pulmonary hypertension in children with Down syndrome.   J Pediatr. 2018;202:212-219.e2. doi:10.1016/j.jpeds.2018.06.031PubMedGoogle ScholarCrossref
Lal  C , White  DR , Joseph  JE , van Bakergem  K , LaRosa  A .  Sleep-disordered breathing in Down syndrome.   Chest. 2015;147(2):570-579. doi:10.1378/chest.14-0266PubMedGoogle ScholarCrossref
Maris  M , Verhulst  S , Saldien  V , Van de Heyning  P , Wojciechowski  M , Boudewyns  A .  Drug-induced sedation endoscopy in surgically naive children with Down syndrome and obstructive sleep apnea.   Sleep Med. 2016;24:63-70. doi:10.1016/j.sleep.2016.06.018PubMedGoogle ScholarCrossref
Ong  AA , Atwood  CM , Nguyen  SA ,  et al.  Down syndrome and pediatric obstructive sleep apnea surgery: a national cohort.   Laryngoscope. 2018;128(8):1963-1969. doi:10.1002/lary.27063PubMedGoogle ScholarCrossref
Sedaghat  AR , Flax-Goldenberg  RB , Gayler  BW , Capone  GT , Ishman  SL .  A case-control comparison of lingual tonsillar size in children with and without Down syndrome.   Laryngoscope. 2012;122(5):1165-1169. doi:10.1002/lary.22346PubMedGoogle ScholarCrossref
Manuel  R , Shah  GB , Mitchell  RB , Johnson  RF .  Weight gain and severe obstructive sleep apnea in adolescents with Down syndrome.   Laryngoscope. 2021;131(11):2598-2602. doi:10.1002/lary.29575PubMedGoogle ScholarCrossref
Farhood  Z , Isley  JW , Ong  AA ,  et al.  Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea.   Laryngoscope. 2017;127(6):1465-1470. doi:10.1002/lary.26398PubMedGoogle ScholarCrossref
Mitchell  RB , Archer  SM , Ishman  SL ,  et al.  Clinical practice guideline: tonsillectomy in children (update).   Otolaryngol Head Neck Surg. 2019;160(1)(suppl):S1-S42. doi:10.1177/0194599818801757PubMedGoogle ScholarCrossref
Abijay  CA , Tomkies  A , Rayasam  S , Johnson  RF , Mitchell  RB .  Children with Down syndrome and obstructive sleep apnea: outcomes after tonsillectomy.   Otolaryngol Head Neck Surg. 2022;166(3):557-564. doi:10.1177/01945998211023102PubMedGoogle ScholarCrossref
Ingram  DG , Ruiz  AG , Gao  D , Friedman  NR .  Success of tonsillectomy for obstructive sleep apnea in children with Down syndrome.   J Clin Sleep Med. 2017;13(8):975-980. doi:10.5664/jcsm.6698PubMedGoogle ScholarCrossref
Nation  J , Brigger  M .  The efficacy of adenotonsillectomy for obstructive sleep apnea in children with Down syndrome: a systematic review.   Otolaryngol Head Neck Surg. 2017;157(3):401-408. doi:10.1177/0194599817703921PubMedGoogle ScholarCrossref
Baker  AB , Farhood  Z , Brandstetter  KA , Teufel  RJ  II , LaRosa  A , White  DR .  Tonsillectomy in children with Down syndrome: a national cohort of inpatients.   Otolaryngol Head Neck Surg. 2017;157(3):499-503. doi:10.1177/0194599817711377PubMedGoogle ScholarCrossref
Dudoignon  B , Amaddeo  A , Frapin  A ,  et al.  Obstructive sleep apnea in Down syndrome: benefits of surgery and noninvasive respiratory support.   Am J Med Genet A. 2017;173(8):2074-2080. doi:10.1002/ajmg.a.38283PubMedGoogle ScholarCrossref
Trucco  F , Chatwin  M , Semple  T , Rosenthal  M , Bush  A , Tan  HL .  Sleep disordered breathing and ventilatory support in children with Down syndrome.   Pediatr Pulmonol. 2018;53(10):1414-1421. doi:10.1002/ppul.24122PubMedGoogle ScholarCrossref
Verhulst  S .  Long term continuous positive airway pressure and non-invasive ventilation in obstructive sleep apnea in children with obesity and Down syndrome.   Front Pediatr. 2020;8:534. doi:10.3389/fped.2020.00534PubMedGoogle ScholarCrossref
Hyzer  JM , Milczuk  HA , Macarthur  CJ , King  EF , Quintanilla-Dieck  L , Lam  DJ .  Drug-induced sleep endoscopy findings in children with obstructive sleep apnea with vs without obesity or Down syndrome.   JAMA Otolaryngol Head Neck Surg. 2021;147(2):175-181. doi:10.1001/jamaoto.2020.4548PubMedGoogle ScholarCrossref
Abdel-Aziz  M , Abdel-Naseer  U , Elshahawy  E , Elsherbeeny  M , Nassar  A .  Persistent obstructive sleep apnea in children with Down syndrome after adenotonsillectomy: drug induced sleep endoscopy-directed treatment.   J Craniofac Surg. 2022;33(2):e185-e187. doi:10.1097/SCS.0000000000008246PubMedGoogle ScholarCrossref
Akkina  SR , Ma  CC , Kirkham  EM , Horn  DL , Chen  ML , Parikh  SR .  Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down syndrome and obstructive sleep apnea?   Acta Otolaryngol. 2018;138(11):1009-1013. doi:10.1080/00016489.2018.1504169PubMedGoogle ScholarCrossref
Propst  EJ , Amin  R , Talwar  N ,  et al.  Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: biomarkers for success.   Laryngoscope. 2017;127(3):757-763. doi:10.1002/lary.26104PubMedGoogle ScholarCrossref
Prosser  JD , Shott  SR , Rodriguez  O , Simakajornboon  N , Meinzen-Derr  J , Ishman  SL .  Polysomnographic outcomes following lingual tonsillectomy for persistent obstructive sleep apnea in down syndrome.   Laryngoscope. 2017;127(2):520-524. doi:10.1002/lary.26202PubMedGoogle ScholarCrossref
Diercks  GR , Wentland  C , Keamy  D ,  et al.  Hypoglossal nerve stimulation in adolescents with Down syndrome and obstructive sleep apnea.   JAMA Otolaryngol Head Neck Surg. 2018;144(1):37-42.PubMedGoogle Scholar
Yu  PK , Stenerson  M , Ishman  SL ,  et al.  Evaluation of upper airway stimulation for adolescents with Down syndrome and obstructive sleep apnea.   JAMA Otolaryngol Head Neck Surg. 2022;148(6):522-528. doi:10.1001/jamaoto.2022.0455PubMedGoogle ScholarCrossref
Stenerson  ME , Yu  PK , Kinane  TB , Skotko  BG , Hartnick  CJ .  Long-term stability of hypoglossal nerve stimulation for the treatment of obstructive sleep apnea in children with Down syndrome.   Int J Pediatr Otorhinolaryngol. 2021;149:110868. doi:10.1016/j.ijporl.2021.110868PubMedGoogle ScholarCrossref
Giménez  S , Videla  L , Romero  S ,  et al.  Prevalence of sleep disorders in adults with Down syndrome: a comparative study of self-reported, actigraphic, and polysomnographic findings.   J Clin Sleep Med. 2018;14(10):1725-1733. doi:10.5664/jcsm.7382PubMedGoogle ScholarCrossref
Landete  P , Soriano  JB , Aldave  B ,  et al.  Obstructive sleep apnea in adults with Down syndrome.   Am J Med Genet A. 2020;182(12):2832-2840. doi:10.1002/ajmg.a.61853PubMedGoogle ScholarCrossref
Li  C , Boon  M , Ishman  SL , Suurna  MV .  Hypoglossal nerve stimulation in three adults with Down syndrome and severe obstructive sleep apnea.   Laryngoscope. 2019;129(11):E402-E406. doi:10.1002/lary.27723PubMedGoogle ScholarCrossref
Hamilton  J , Yaneza  MM , Clement  WA , Kubba  H .  The prevalence of airway problems in children with Down’s syndrome.   Int J Pediatr Otorhinolaryngol. 2016;81:1-4. doi:10.1016/j.ijporl.2015.11.027PubMedGoogle ScholarCrossref
Cockerill  CC , Frisch  CD , Rein  SE , Orvidas  LJ .  Supraglottoplasty outcomes in children with Down syndrome.   Int J Pediatr Otorhinolaryngol. 2016;87:87-90. doi:10.1016/j.ijporl.2016.05.022PubMedGoogle ScholarCrossref
Salloum  S , Mahsoun  Y , Al-Khatib  T , Marzouki  H , Zawawi  F .  Supraglottoplasty in the management of laryngomalacia in children with Down syndrome: a systematic review.   Int J Pediatr Otorhinolaryngol. 2021;142:110630. doi:10.1016/j.ijporl.2021.110630PubMedGoogle ScholarCrossref
Preciado  D , Zalzal  G .  A systematic review of supraglottoplasty outcomes.   Arch Otolaryngol Head Neck Surg. 2012;138(8):718-721. doi:10.1001/archoto.2012.1251PubMedGoogle ScholarCrossref
Miller  R , Gray  SD , Cotton  RT , Myer  CM  III , Netterville  J .  Subglottic stenosis and Down syndrome.   Am J Otolaryngol. 1990;11(4):274-277. doi:10.1016/0196-0709(90)90089-EPubMedGoogle ScholarCrossref
Boseley  ME , Link  DT , Shott  SR , Fitton  CM , Myer  CM , Cotton  RT .  Laryngotracheoplasty for subglottic stenosis in Down syndrome children: the Cincinnati experience.   Int J Pediatr Otorhinolaryngol. 2001;57(1):11-15. doi:10.1016/S0165-5876(00)00426-2PubMedGoogle ScholarCrossref
Fockens  MM , Hölscher  M , Limpens  J , Dikkers  FG .  Tracheal anomalies associated with Down syndrome: a systematic review.   Pediatr Pulmonol. 2021;56(5):814-822. doi:10.1002/ppul.25203PubMedGoogle ScholarCrossref
Lawlor  C , Smithers  CJ , Hamilton  T ,  et al.  Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy.   Laryngoscope. 2020;130(2):E65-E74. doi:10.1002/lary.27938PubMedGoogle ScholarCrossref
Jackson  A , Maybee  J , Moran  MK , Wolter-Warmerdam  K , Hickey  F .  Clinical characteristics of dysphagia in children with Down syndrome.   Dysphagia. 2016;31(5):663-671. doi:10.1007/s00455-016-9725-7PubMedGoogle ScholarCrossref
Narawane  A , Eng  J , Rappazzo  C ,  et al.  Airway protection & patterns of dysphagia in infants with down syndrome: videofluoroscopic swallow study findings & correlations.   Int J Pediatr Otorhinolaryngol. 2020;132:109908. doi:10.1016/j.ijporl.2020.109908PubMedGoogle ScholarCrossref
Stanley  MA , Shepherd  N , Duvall  N ,  et al.  Clinical identification of feeding and swallowing disorders in 0-6 month old infants with Down syndrome.   Am J Med Genet A. 2019;179(2):177-182. doi:10.1002/ajmg.a.11PubMedGoogle ScholarCrossref
Smith  CH , Teo  Y , Simpson  S .  An observational study of adults with Down syndrome eating independently.   Dysphagia. 2014;29(1):52-60. doi:10.1007/s00455-013-9479-4PubMedGoogle ScholarCrossref
Lazenby  T .  The impact of aging on eating, drinking, and swallowing function in people with Down’s syndrome.   Dysphagia. 2008;23(1):88-97. doi:10.1007/s00455-007-9096-1PubMedGoogle ScholarCrossref
Chenbhanich  J , Wu  A , Phupitakphol  T , Atsawarungruangkit  A , Treadwell  T .  Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital.   J Intellect Disabil Res. 2019;63(3):266-276. doi:10.1111/jir.12572PubMedGoogle ScholarCrossref
Hata  T , Todd  MM .  Cervical spine considerations when anesthetizing patients with Down syndrome.   Anesthesiology. 2005;102(3):680-685. doi:10.1097/00000542-200503000-00030PubMedGoogle ScholarCrossref
Nakamura  N , Inaba  Y , Aota  Y ,  et al.  New radiological parameters for the assessment of atlantoaxial instability in children with Down syndrome: the normal values and the risk of spinal cord injury.   Bone Joint J. 2016;98-B(12):1704-1710. doi:10.1302/0301-620X.98B12.BJJ-2016-0018.R1PubMedGoogle ScholarCrossref
Tsou  AY , Bulova  P , Capone  G ,  et al; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup.  Medical care of adults with Down syndrome: a clinical guideline.   JAMA. 2020;324(15):1543-1556. doi:10.1001/jama.2020.17024PubMedGoogle ScholarCrossref
Spina  CA , Smith  D , Korn  E , Fahey  JL , Grossman  HJ .  Altered cellular immune functions in patients with Down’s syndrome.   AJDC. 1981;135(3):251-255. doi:10.1001/archpedi.1981.02130270043015PubMedGoogle ScholarCrossref
Bloemers  BL , van Furth  AM , Weijerman  ME ,  et al.  High incidence of recurrent wheeze in children with down syndrome with and without previous respiratory syncytial virus lower respiratory tract infection.   Pediatr Infect Dis J. 2010;29(1):39-42. doi:10.1097/INF.0b013e3181b34e52PubMedGoogle ScholarCrossref
Selikowitz  M .  Health problems and health checks in school-aged children with Down syndrome.   J Paediatr Child Health. 1992;28(5):383-386. doi:10.1111/j.1440-1754.1992.tb02697.xPubMedGoogle ScholarCrossref
Ram  G , Chinen  J .  Infections and immunodeficiency in Down syndrome.   Clin Exp Immunol. 2011;164(1):9-16. doi:10.1111/j.1365-2249.2011.04335.xPubMedGoogle ScholarCrossref
Borland  LM , Colligan  J , Brandom  BW .  Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures.   Paediatr Anaesth. 2004;14(9):733-738. doi:10.1111/j.1460-9592.2004.01329.xPubMedGoogle ScholarCrossref
Lewanda  AF , Matisoff  A , Revenis  M ,  et al.  Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.   Paediatr Anaesth. 2016;26(4):356-362. doi:10.1111/pan.12841PubMedGoogle ScholarCrossref
Graber  E , Chacko  E , Regelmann  MO , Costin  G , Rapaport  R .  Down syndrome and thyroid function.   Endocrinol Metab Clin North Am. 2012;41(4):735-745. doi:10.1016/j.ecl.2012.08.008PubMedGoogle ScholarCrossref
Lavigne  J , Sharr  C , Elsharkawi  I ,  et al.  Thyroid dysfunction in patients with Down syndrome: results from a multi-institutional registry study.   Am J Med Genet A. 2017;173(6):1539-1545. doi:10.1002/ajmg.a.38219PubMedGoogle ScholarCrossref
Quintanilla-Dieck  L , Khalatbari  HK , Dinauer  CA ,  et al.  Management of pediatric Graves disease: a review.   JAMA Otolaryngol Head Neck Surg. 2021;147(12):1110-1118. doi:10.1001/jamaoto.2021.2715PubMedGoogle ScholarCrossref
Goday-Arno  A , Cerda-Esteva  M , Flores-Le-Roux  JA , Chillaron-Jordan  JJ , Corretger  JM , Cano-Pérez  JF .  Hyperthyroidism in a population with Down syndrome (DS).   Clin Endocrinol (Oxf). 2009;71(1):110-114. doi:10.1111/j.1365-2265.2008.03419.xPubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.