Question
In my experience I have found children with Down Syndrome often grunt and make back noises. Does someone have a suggestion to break this habit? I am also searching for an answer to change this child from an open mouth breather to a nose breather.
Answer
Many clinicians are unaware that individuals with Down syndrome often have severe enlargement of the tonsils resulting in compromise of the oropharynx and hypopharynx. The problem is exacerbated by their shorter-than-normal necks and reduction in overall pharyngeal dimensions. Coupled with a larger than normal tongue, and smaller than normal maxilla, the posterior aspect of the oral and pharyngeal cavities are very crowded and may result in "backing" of speech sounds, snorting sounds, and other back-of-throat noises. At the opposite end of the scale, tongue protrusion and "tongue-thrusting" (I do hate that term) may be seen as a mechanism to enlarge airway to prevent persistent dyspnia. I would also suggest asking questions about sleep behavior, snoring, and obstructive sleep apnea...all quite common in Down syndrome. Oral examination will probably be inadequate to assess tonsillar size, and fiberoptic endoscopy is preferred, or perhaps radiographic study with nasally instilled contrast. Tonsillectomy is often indicated.
Robert J. Shprintzen, Ph.D. is currently Director of the Communication
Disorder Unit, The Center for the Diagnosis, Treatment and Study of
Velo-Cardio-Facial Syndrome, and The Center for Genetic Communicative
Disorders at Upstate Medical University, Syracuse, NY. He is Professor of
Otolaryngology and Professor of Pediatrics. He is author of over 170
journal articles, 30 chapters, and four textbooks. Many of his publications
have focused on communicative disorders in association with genetic
syndromes and craniofacial anomalies. He is credited with discovering four
genetic syndromes, including velo-cardio-facial syndrome, the most common
contiguous gene disorder in humans.