If you’re expecting a baby with Down syndrome, you might wonder what this will mean in terms of feeding your baby.
Perhaps you've even heard that breastfeeding a baby with Down syndrome isn't possible.
A diagnosis of Down syndrome for your baby does not mean you cannot breastfeed.
Some babies with Down syndrome experience no difficulty breastfeeding.
However, for others, establishing breastfeeding can be a challenge.
It can take some time to get it working well for you and your baby.
Facing extra challenges can be difficult at a time when you might already be dealing with a range of concerns and emotions.
It helps to be prepared with information about what breastfeeding challenges you might face and how to overcome them.
What Is Down Syndrome?
Down syndrome is the most common of chromosomal disorders. It’s usually the result of an error during cell division of the egg or sperm before conception. Some or all of the cells in people with Down syndrome have an extra full or partial copy of chromosome 21.
Why Breastfeeding Is Important For Babies With Down Syndrome
Breastfeeding is important regardless of whether a baby has Down syndrome or not.
However, there are certain reasons why breastfeeding is particularly important for babies with Down syndrome. For example:
- Babies with Down syndrome often have low muscle tone. Muscle tone refers to the tension in muscles at rest. Low muscle tone means it takes greater effort to maintain a position or move. Breastfeeding helps a baby develop muscle tone in her mouth and tongue muscles, which are important for later feeding skills and speech development.
- Babies with Down syndrome tend to get more lung infections because of their narrow nasal passages and increased mucous in their airways. Babies who are not breastfed don’t receive the important immune protective factors in breastmilk. This is partly why babies who are not breastfed have a higher risk of infection (including lung infections). Breastfeeding helps protect babies from infection.
- Breastfeeding is important for brain development and is particularly important for a baby with Down syndrome who might already face challenges in this area.
- Babies with Down syndrome are more likely to suffer bowel problems (e.g. constipation) due to the decreased muscle tone in the gut. Breastmilk is easy to digest and breastfed babies have poos that are very soft and easy to pass.
- Breastfeeding is more than just about nutrition. It is also about nurturing. Babies with Down syndrome have an increased risk of various health issues. Dealing with medical problems often means more doctors’ visits, tests and various treatments. Breastfeeding can provide babies with comfort during times of stress or illness.
Breastfeeding Challenges You Might Face
There are 3 main breastfeeding challenges for a baby with Down syndrome – low muscle tone, prematurity and sleepiness.
Low Muscle Tone
Babies with Down syndrome tend to have low muscle tone. Low tone can mean that a baby:
- Has trouble getting her mouth around the breast and attaching well
- Has trouble coordinating her sucking, swallowing and breathing
- Might gulp as she feeds and/or slip off frequently
- Has trouble getting enough milk with feeds
- Can become tired more quickly during feeds
Babies with Down syndrome are more likely to be born prematurely. Premature babies might not be able to breastfeed effectively until they mature and grow stronger.
Many newborns with Down syndrome tend to be very sleepy in the early weeks. A baby with Down syndrome is likely to tire more easily during feeds and might not drink enough milk from her mothers’ breasts.
Tips To Help Your Baby Breastfeed
There are various things you can do to help your baby breastfeed and get the milk she needs.
Tips To Help With Low Tone
- Giving your baby good support during feeds will help her to get more milk and tire less easily. Whatever position you use, hold your baby in close and apply gentle but firm support to the base of her head and shoulder blades. If she uses as little energy as possible to hold her head and neck up, she can use her energy for feeding.
- Some mothers find the football (underarm) hold works well, some prefer the straddle hold and others the cross-cradle hold. It is important to use a breastfeeding position that works best for you and your baby. As your baby gets older and stronger, you can try other positions. For more tips about positioning and attachment read here.
- Use the Dancer Hand position. This is where you support your breast and your baby’s chin while she feeds. 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 index finger and support your baby's jaw with that U.
- If your baby seems to be drinking too quickly and gulping, you might find it helpful to lean back (e.g. by sitting in a chair that reclines back or by leaning back with pillows behind you for support). It might also help to have your baby sit up in a straddle position on your lap.
- A speech pathologist will be able to suggest some exercises to help boost your baby’s muscle tone.
Tips To Help Breastfeed A Premature Baby
For information and tips about breastfeeding a premature baby read here.
Tips To Help With Sleepiness
- Get your milk flowing before putting your baby to the breast, so that she doesn’t have to spend energy doing it. Gentle hand expressing, gentle massage and use of warmth on the breast (e.g. with a wheat bag) will encourage your milk to let down.
- Breast compressions encourage your baby to continue to suck actively (meaning she also swallows). Use one hand to squeeze your breast gently but firmly to encourage your baby to start swallowing again. Keep squeezing until she stops sucking altogether or stops swallowing. Repeat the squeezing and releasing until it doesn’t make her swallow any more, and then offer her the other breast.
- Switch feeding can also encourage a baby to continue to suck actively. Watch your baby, and when she is no longer swallowing, break the suction by inserting a clean finger into the corner of her mouth. Then, offer the other breast – she will probably suck more effectively. When her sucking slows again, switch her back. Keep repeating this until she seems satisfied. Some mothers find it helpful to combine breast compressions with switch feeding.
How To Keep Up Your Supply
Although you cannot see how much your baby is drinking during breastfeeding, there are ways to tell whether she is getting enough. To read about the reliable signs that your baby is getting enough, read here.
Some newborns with Down syndrome are very sleepy in the early weeks and have to work harder to get the same amount of breastmilk. The result can be that they don’t drain your breast so well. Over time, this can result in a low milk supply, and slower weight gain for the baby.
To ensure your baby gets enough, and to help establish and maintain your supply, you might need to:
- Feed more frequently (and use breast compressions and/or switch feeding)
- Express and supplement your baby (e.g. with your expressed breastmilk)
A lactation consultant can provide you with information about how effectively your baby is feeding and advise whether you need to express and supplement. A lactation consultant can also help you work out how often you might need to express, and which pump is best for you.
Some mothers only need to express and supplement for a short period of time – just until their babies are stronger and less sleepy. Others need to do it for longer, some might exclusively pump. A lactation consultant will help you work out what’s best in your unique situation.
If you are struggling with your supply, there are things you can do to increase it. A lactation consultant can show you additional strategies.
There are various ways to supplement a baby. A lactation consultant can help you decide what method of supplementation will work best for you.
Here are some examples:
- Medela special needs feeders (previously known as Habermann feeders)
- Small cups
- Breastfeeding supplementers
Babies With Down Syndrome Grow Differently
Babies with Down syndrome are typically smaller than the general population. Down Syndrome Australia recommends the use of the Down Syndrome Medical Interest Group (DSMIG) Growth Charts.
Find out more about why we should use specific charts here.
Help And Support For Down Syndrome
For more help and support, there are many Down Syndrome Associations in Australia:
Tel: 1300 658 873
Email: [email protected]
- South Australia
- Northern Territory
Tel: (08) 8985 6222
Email: [email protected]
Tel: 1300 592 050
Email: [email protected]
- Western Australia