If you’re expecting a Down syndrome baby, you might wonder what this will mean in terms of feeding your baby.

Perhaps you’ve heard that breastfeeding a baby with Down syndrome isn’t possible. If this is the case, you might be surprised to hear that a diagnosis of Down syndrome for your baby does not mean you cannot breastfeed.

Some babies with Down syndrome experience no difficulties with breastfeeding. However, for others, it can be a challenge to establish breastfeeding.

For new parents, facing extra challenges can be difficult at a time when you might already be dealing with a range of concerns and emotions.

It can take some time to get it working well for you and your baby. In the meantime, 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 the 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 a Down syndrome baby

Breastfeeding is important, regardless of whether or not a baby has Down syndrome.

There are reasons, however, why breastfeeding is particularly important for a Down syndrome baby.

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 requires a greater effort to maintain a position or to move. Breastfeeding helps a baby develop muscle tone in the mouth and tongue, which is important for later feeding skills and for development of speech skills
Babies with Down syndrome tend to get more lung infections, because of their narrow nasal passages, and have increased mucous in their airways. Babies who are not breastfed don’t receive the important immune protective factors that are in breast milk. 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 poor muscle tone in the gut. Breast milk is easy to digest and breastfed babies have poos that are very soft and easy to pass
Breastfeeding is about more than just nutrition and anti-infective factors. It’s also about nurturing. Children with Down syndrome have an increased risk of various health problems. Dealing with medical problems often means more visits to the doctors, more tests and various treatments. Aside from the proven benefits of breast milk, the special benefits of skin to skin contact 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

Children with Down syndrome tend to have low muscle tone. Low tone can mean:

There is some difficulty getting a baby’s lips to form a tight seal on the breast
The baby has difficulties with tongue coordination, or with sucking, swallowing and breathing rhythmically
The baby’s tongue may push the nipple out of the mouth

Prematurity

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.

For more information about breastfeeding a premature baby, you can read BellyBelly’s article Breastfeeding A Premature Baby | 7 Great Tips.

Early sleepiness

Many newborns with Down syndrome tend to be very sleepy in the early weeks. A baby with Down syndrome can get tired quickly during feeds and might not drink enough milk from her mothers’ breasts.

Tips to help your baby breastfeed

There are various things breastfeeding mothers can do to make sure their babies get enough milk to grow and thrive.

Tips to help with low tone

Give your baby good support during feeds. This will help maintain attachment and maximize the amount of breast milk transferred throughout the feed. Whatever position you use, hold your baby in close and apply gentle but firm support to the base of the head and the shoulder blades. Using less energy to support the head and neck means babies have more energy to use for successful breastfeeding
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, you can read BellyBelly’s article How To Breastfeed | 5 Critical Steps For New Mothers.
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
If your milk flow is fast and your baby seems to be drinking too quickly, you might find it helpful to lean back – either by sitting in a chair that reclines 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 breastfeed a premature baby

If your baby was born prematurely, these tips will help your breastfeeding experience:

Tips to help with sleepiness

Get your breast milk flowing before putting your baby to the breast, so that she doesn’t have to spend energy sucking. Gentle hand expressing, gentle massage and the use of warmth on the breast (e.g. with a heat pack) will encourage your milk to let down
Breast compressions will 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 to the first breast. Repeat this process until she seems satisfied. Some mothers find it helpful to combine breast compressions with switch feeding.

How to maintain your breast milk 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 milk, you can refer to BellyBelly’s article Baby Is Getting Enough Milk | 3 Reliable Signs.

Some newborns with Down syndrome are very sleepy in the early weeks and have to work harder to get the same amount of breast milk. The result can be that they don’t drain the breast effectively. Over time, this can result in a low milk supply, and slower weight gain for the baby.

To make sure 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 breast milk).

A lactation consultant can provide you with information about how effectively your baby is feeding and advise whether you need to express and supplement. Lactation consultants can also help you work out how often you might need to express, and which pump is best for you.

Some mothers need to express and supplement for only a short period of time – just until their babies are stronger and less sleepy. Others need to do it for longer; some might pump exclusively. A lactation consultant will help you work out what’s best in your unique situation.

For tips on increasing your milk supply, you can read BellyBelly’s article How To Increase Milk Supply Fast! 9 Best Things To Do.

Methods of supplementation

There are various ways to supplement a baby. A lactation consultant can help you decide which method of supplementation will work best for you.

Here are some examples:

Bottle feeding with special needs feeders (previously known as Habermann feeders)
Using a small, open cup to offer extra milk after a feed
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.

Click here to see special growth charts for babies with Down syndrome.