From Feeding Difficulties to Nutritional Risk in Children with Down Syndrome

Children with Down syndrome (DS) may experience feeding difficulties arising from interactions among hypotonia, cardiorespiratory and gastrointestinal conditions, swallowing dysfunction, oral-motor and sensory differences, delayed feeding skill development, and psychosocial or environmental factors. These difficulties may compromise feeding safety and efficiency, restrict dietary diversity, and contribute to inadequate fluid or nutrient intake, faltering growth, micronutrient deficiencies, or excess adiposity. This narrative review synthesized the literature selected for its relevance to feeding development and nutritional risk in children and adolescents with DS. Sources were identified through PubMed/MEDLINE, Scopus, and the Web of Science Core Collection, supplemented by reference-list review and citation tracking; cited sources were last verified on 26 August 2026. Evidence was organized according to developmental stage and clinical domain, with attention to study design, sampling, assessment methods, and applicability to the pediatric DS population. The findings indicate that breastfeeding is possible but may require early assessment of milk transfer and nutritional adequacy. Oropharyngeal dysphagia and silent aspiration are important clinical concerns, although much of the evidence comes from selected clinical and referral-based cohorts. Impaired chewing, delayed texture progression, and food selectivity may restrict the consumption of meat, vegetables, whole grains, and other nutrient-dense foods, potentially reducing dietary variety and the intake of protein, fiber, and specific micronutrients. Reliance on a narrow range of accepted soft or energy-dense foods may nevertheless provide adequate or excessive energy, allowing poor dietary quality to coexist with excess body weight. Nutritional assessment should therefore consider food choices, texture adaptations, and actual nutrient intake alongside growth and body mass index. The strongest support is for systematic, individualized, and multidisciplinary care integrating swallowing safety, feeding skills, actual dietary and fluid intake, growth, biochemical status, associated medical conditions, and family circumstances. Evidence for specific feeding therapies, supplements, and nutrition-related interventions remains limited by small samples, heterogeneous methods, and short follow-up. More representative longitudinal and intervention studies using standardized, age-appropriate outcomes are needed.