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Down Syndrome

Solomon Behar, MD and Stuart Swadron, MD, FAAEM
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Down syndrome is a genetic condition affecting multiple systems of the body. We review the 2011 AAP Health Supervision Guidelines for children with Down syndrome, breaking it down from prenatal diagnosis to system-based healthcare check-up needs.


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Beezer M. -

Practically speaking, how would you order the C-spine x-ray? If the x-ray of the C-spine in the neutral position has to be checked to make sure it is normal before progressing to the flexion-extension studies, then it is dangerous to order all three at the same time. In an outpatient setting, one would have to order the C-spine x-ray in the neutral position, then check the x-ray, then order the flexion/extension x-ray. This may even take two office visits. What is the standard of care? Can we normally trust the x-ray tech or the radiologist to be checking this if we order it as a "C-spine x-ray, and if normal, then do flexion and extension"?

Solomon B., MD -

I think though it may be logistically painful to do, I would want the neutral position plain film to be done and interpreted by the radiologist before I manipulated the patient's neck for flex/ex views...I would make a very clear note to the radiology technician to not manipulate the Down syndrome patient's neck. A phone call to the radiologist laying out your concern for the potential of atlanto-axial instability and a written comment in your order should do the trick!

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Trippin' In Vegas! Full episode audio for MD edition 185:07 min - 87 MB - M4AHippo Peds RAP March 2016 Summary 458 KB - PDF