Recurrent Upper Respiratory Infections In Children With Down Syndrome
Individuals with Down syndrome have small facial bone structures and shallow or absent sinus cavities. They also have a small airway with a shallow high-arched palate. When an individual gets an upper respiratory infection. several things happen in the body in an attempt to control the infection. Antibodies like gamma globulin are produced against the virus or bacteria. These antibodies act by engulfing the foreign material and help to remove these viruses and bacteria from the boda. Cells lining the trachea, nose, ears and lungs produce sticky mucus that traps material entering these structures and prevents the material from gaining entry into the body. When all is working well, an individual should be able to handle uncomplicated upper respiratory infections and should recover in due time.
Let us now look at the child with Down syndrome. The child has small narrow ear canals with a shallow drainage angle. Fluid that accumulates behind the ear drum becomes stagnant. With time, the fluid becomes thick and gelatinous due to the reabsorption of water by the tissues. This thick gelatinous material interferes with normal hearing and provides a rich growth medium for viruses and bacteria. In addition, thick secretions pour out of the nose and eyes and flow down the esophagus and trachea, because the sinus cavities are absent or unable to contain the volume of secretions produced. The immune system may also not function efficiently to inactivate the invading organisms. The result is a child with chronic ear infections and some hearing loss. Poor sleep, loss of appetite, diarrhea, and inability to concentrate and learn are also noted.
Children with Down syndrome therefore need to be aggressively managed when they show signs of persistent and debilitating upper respiratory infection. Chronic ear infections with hearing loss may respond to placement of myringotomy tubes in the ears to allow for drainage of the thick secretions. Removal of the adenoids and tonsils may be necessary if the airway is very narrow and the enlarged structures are causing airway obstruction with reduced oxygen intake, Thick green-yellow secretions may represent secondary infection that should be treated with antibiotics.
The goal is to keep the children healthy. This will allow them to participate in their therapy and school sessions more effectively and therefore maximize their learning.