As a result of the baby’s floppy nature, he may find it quite a huge task to maintain his head in midline to look at his mother or even turn it to look at his environment which would include all the toys he has around him. Parents are taught everyday activities that will encourage the baby to develop good head control to further help him to learn to sit appropriately.
Correcting posture - In sitting
Due to their low muscle tone, the baby finds it difficult to maintain his posture in sitting due to reduced strength of the trunk muscles, which eventually leads to the development of Kyphosis (round back).
The baby also learns to sit with a posterior pelvic tilt and his head back on his shoulders. Without any intervention, the baby never learns how to maintain a correct alignment and if this persists it will lead to impaired breathing and a decreased ability to rotate his trunk or move his trunk from one side to the other to look around his environment.
The physiotherapist would help correct the posture by providing support first at the upper trunk and other areas and lastly by giving pelvic (hip) support.
The support given at each level keeps the spine and pelvis in its apt alignment until the baby develops the strength to maintain those alignments.
At home, is always advisable to ensure that the baby’s back, rests against a means of support especially when he’s learning to sit to prevent him from developing a round back.
The baby should also spend considerable time on his tummy to encourage him to actively use his trunk muscles and strengthen them to improve his posture in sitting.
In standing and walking
The child with Down’s Syndrome also finds it difficult to gain stability in standing and walking as a result of hypotonia and weak lower limb muscles.
However, since he wants to move around he learns to walk with his feet wide apart (widening his base of support), his knees straight and his feet turned outwards.
This movement pattern allows him to gain the stability he needs to move around; unfortunately over a prolonged period of time he would begin to have problems in his feet and knees.
That particular gait pattern pushes his weight onto the inside borders of the feet, but the feet are designed to have the weight borne on the outside borders. This ultimately gets worse making walking painful.
The Physiotherapist examines the various movement patterns of the child and helps him to learn the correct and beneficial way to stand and walk - feet positioned under the hips and pointing straight ahead with a slight bend in the knees.
Most children with Down’s Syndrome also need appropriate footwear as they learn to walk to prevent any secondary orthopaedic conditions from arising.
There is no cure for Down's syndrome, but there are a number of management methods that can help your baby with the condition to lead a healthy, active and more independent life.
By Dorothy Ekua Adjabu
The writer is a Senior Physiotherapist at the 37 Military Hospital.