Down syndrome is the most common chromosomal abnormality in babies. Normally, the nucleus of each cell of a baby’s body contains 23 pairs of chromosomes, half of which are inherited from mum and half from dad. Down syndrome occurs when some or all of a person’s cells have an extra full or partial copy of chromosome 21. Some babies with Down Syndrome may have poor muscle tone, so may find it hard to maintain attachment to the breast during a feed. Others, especially those with an associated cardiac issue, may tire very easily and not be able to take a full feed in one go.
Benefits of Breastfeeding
Breastfeeding a baby with Down syndrome is not only possible, but it also provides important benefits to both mum and baby.
- Breastmilk boosts your baby’s immune system and contains anti-infective factors including antibodies against germs that you and your baby are exposed to. This is especially important for babies with Down syndrome since they are prone to respiratory[i] and viral infections.
- Babies with Down syndrome can have low muscle tone. The specific sucking action needed during breastfeeding will help strengthen your baby’s lips, tongue, and face[ii]. This serves as a stepping stone for eating other foods and speech development[iii].
- Breastmilk is both food and drink for your baby and it contains all of the nutrients, calories, and fluids your baby needs, but it is also much more than just nutrition. It provides your baby with comfort and warmth and the physical closeness when you are feeding helps create a special bond between you and your baby.
The first days and weeks of breastfeeding are a time for you and your baby to get to know each other and learn together how to breastfeed effectively. As you get to know your baby better, you might discover that there are some specific physical characteristics of babies with Down syndrome that may have an impact on your breastfeeding journey. Of course, every baby is unique so you might not encounter all of the challenges mentioned. If your baby has difficulties breastfeeding at first, then ask for support and remember that many mums and babies need extra help to breastfeed and that ongoing support and time can help you both learn how to breastfeed effectively.
If you are having difficulties to begin with, then you can choose to express and feed your baby breastmilk. This can help by giving you both more time to learn whilst also making sure your baby is still getting the benefits of breastmilk and it can also be useful if your baby needs to be apart from you in the early days or if they need feeding by a tube for any reason. To begin with you would need to express around 8-10 times in 24 hours, including at least once overnight as that helps build your milk supply. It can help to have your baby nearby when you express if possible or to have a photo or something that smells like your baby. You might want to hand express or use a pump, if you are still in the hospital you could ask about borrowing a hospital grade pump. We have lots more information on expressing and storing breastmilk here.
Hints and tips for breastfeeding a baby with Down Syndrome
Low muscle tone
Babies with Down syndrome can have low muscle tone and so may have trouble attaching effectively to the breast[iv] and staying there for a full feed. Some babies may also have difficulty coordinating their sucking, swallowing and breathing and may gulp or splutter as they feed. They might get less milk for their efforts and they often get tired quickly. This generally improves with practice and time. The act of breastfeeding will actually improve your baby’s muscle strength. As baby gets stronger and learns to breastfeed more effectively, he will be able to drink more milk. As well as the breastfeeding positions that people commonly use there is also a position called Dancer Hand position that can sometimes help by providing your little one with gentle support for their head when they go to attach to your breast. For this position you need to have your baby sat upright on your lap facing you, cup your hand under your breast, then slide it forward so that three fingers support your breast. Make a U-shape with your thumb and first finger and use that U shape to support your baby’s jaw. Ask your healthcare provider if you want to know more about this position.
If you find your baby has a tongue that sticks out more than usual it can sometimes make breastfeeding harder. You can help by trying to position your baby in a way that really encourages him to open his mouth really wide and to keep his tongue down and touching his bottom lip when he goes to attach onto your breast. You might be able to help with this by very gently pressing on his chin to open his mouth wider as he goes to latch on. There are also very simple tongue exercises that can sometimes help. Ask your health care provider if you think these might be useful for you.
Some babies with Down syndrome can be very sleepy or tire more quickly, especially if they have any issues with their heart. Positioning your baby in a comfortable and supportive arrangement can also help your baby get more milk for his efforts, better stimulate your milk supply and mean that he doesn’t get tired so quickly. You can help by starting your milk flowing before you put your baby to the breast, so that he will not have to spend energy sucking without any milk coming out. Gentle hand expressing, rolling your nipple between your thumb and forefinger, gentle massage and perhaps a warm face cloth on the breast can help encourage your milk to let down.
Babies with Down syndrome can sometimes gain weight slower than other babies. There are specific weight charts available for children with Down syndrome so that this can be monitored carefully, especially if your baby also has other medical issues that mean they might gain weight slower than usual. All the same things apply in terms of knowing if your baby is getting enough milk, including looking at the number of wet and dirty nappies and how content your baby is between feeds. If you have any concerns about weight gain or whether your baby is getting enough milk please speak to your health care provider.
The Breastfeeding Network
Sarah Edwards, Training Development Manager and Breastfeeding Supporter
[i] Pisacane, A., Toscano, E., Pirri, I., et al (2003), Down syndrome and breastfeeding. Acta Paediar 92(12),1479–1481.
[ii] Dowling, D., Danner, S., Coffey, P., Wellman, L. (2007), March of Dimes Defects Foundation. Breastfeeding the infant with special needs. New York: March of Dimes Foundation
[iii] Buckley, S. (2000), Speech and language development for individuals with Down Syndrome – an overview. Hampshire: The Down Syndrome Education Trust
[iv] Buckley, S. (2000), Speech and language development for individuals with Down Syndrome – an overview. Hampshire: The Down Syndrome Education Trust