Down Syndrome

More than half of the children with Down syndrome show obstructions of the airways during sleep. For this, one of the most important treatment concepts today is the so-called orofacial regulation therapy (Castillo-Morales). So far, plate therapy starts relatively late within the Castillo-Morales concept. However, this could lead to long-term consequences as a result of oxygen deficiency due to the respiratory disorder. To avoid these consequences, we use conventional palatal plates in the early treatment of respiratory disorders. The goal is to make this therapy concept available to other children with Down syndrome in other clinics.

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Department of Orthodontics,
Medical Director Prof. Dr. Bernd Koos

frontend.sr-only_#{element.contextual_1.children.icon}: Osianderstr. 2-8
72076 Tübingen, Germany

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frontend.sr-only_#{element.contextual_1.children.icon}: +49 7071 29-82160

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Therapy

One of the most important treatment concepts for children with Down syndrome today is the so-called orofacial regulation therapy (Castillo-Morales), in which a palatal plate is an important therapeutic tool in addition to motor exercises for the mouth and facial area, taking into account the whole body. Therefore, the use of a palatal plate in children with Down syndrome has become established in some clinics. This is made of plastic after an impression of the upper jaw and individually adapted. The influence of the palatal plate on an improvement of the mouth closure and reduction of the tongue displacement as well as on an improvement of the speech development could be proven.

The significance of this plate for respiratory regulation and a possible positive influence on airway obstruction has not yet been investigated in the neonatal period. However, this can be assumed from previous experience in our clinic.

Plate therapy of the Castillo-Morales concept

So far, plate therapy within the Castillo-Morales concept starts relatively late. However, this could mean that some children with Down syndrome and airway obstruction can be helped too late and long-term consequences of oxygen deprivation have already occurred.

Tübingen treatment concept

In order to avoid these consequences of oxygen deficiency, we have proven the effectiveness of the conventional palatal plate in the early treatment of respiratory disorders. This is done in cooperation with the Department of Orthodontics at the University Hospital of Tübingen. The aim is to make this therapy concept available to other children with Down syndrome in other clinics.

Tübingen Respiratory Plate

If treatment with the conventional palatal plate does not lead to the desired success (prevention of airway obstruction with oxygen deficiency), then we would provide your child with a new type of palatal plate, an effective concept in the treatment of severe airway obstruction that has been tested in our clinic. The Tübingen Respiratory Plate is a special, slightly longer palatal plate with an integrated spur that, when inserted into the oral cavity, pushes the tongue forward, helping to eliminate throat constriction and stimulating mandibular growth. This has resulted in many cases in significant improvement in breathing, growth and development of children. After completion of the palatal plate, it is individually adjusted and corrected if necessary. The further course of the examination remains unaffected.

Treatment procedure

On the day of recordingOn the day of admission, a blood gas analysis and determination of the hematocrit, i.e., the solid components in the blood, are performed as part of a blood draw that is necessary anyway. These values from the blood count provide an initial indication of the extent of the impaired breathing. In order to be able to prove a positive effect of the therapy, we want to check this value before discharge in the course of a blood sampling that is necessary again. Beyond that, no further blood samples are necessary.
In the first 6 weeks of lifeWithin the first 6 weeks of life, your child's breathing will be recorded during sleep (polysomnography). This examination is completely painless, is performed using only adhesive sensors, and includes recording of chest, abdominal, nasal, and mouth breathing, sleep, heart activity, blood oxygen and carbon dioxide levels, and sleep movements. Your child will be connected to the recording device for 12 hours and should sleep as much as possible during this time. After that, the recording will be evaluated and the extent of the breathing disorder will be determined.

At the same time, an upper jaw impression is taken of your child for the fabrication of the palatal plate and the effect of the palatal plate on breathing is checked.
In the 3rd, 6th, 9th and 12th month of life.In order to check the effectiveness of the treatment on breathing in the further course of the first year of life, we ask you to visit our clinic again in the 3rd, 6th, 9th and 12th month of life to perform a breathing recording. This only requires an inpatient admission for one night, when you can be with your child. By participating in our examination, you will learn exactly how pronounced the breathing disorder is in your child and what success the palatal plate shows in your child. Your child's breathing will be examined much better than usual. So you have a direct advantage by participating in the examination and at the same time you help that after a positive conclusion many other children will also benefit from this treatment.
At the end of the infant periodWe also offer children with Down syndrome the opportunity to be diagnosed with a possible respiratory disorder at the end of infancy so that any necessary therapeutic steps can be initiated.

Risks

Your child will not be exposed to any increased risk by participating in this examination. All planned examinations (blood sampling, breath recording, upper jaw impression) and measures (conventional short palate plate) have been tested and safe for many years. To date, no adverse events have been observed as a result of these examinations or measures. In addition, some of the measures (blood draw, breath record, and upper palate impression) are performed anyway as part of normal clinical routine. Therefore, your child's additional exposure during the scheduled examination results from the increased number of breath recordings (6 times). However, your child's exposure to the breath recording is very low. In our experience, children get used to the adhesive sensors after a maximum of 30 minutes and can then sleep without further problems. Beyond that, no further stress to your child from the examination is to be expected.

Further information on the clinical picture

What does this mean for your child?

Your child suffers from Down syndrome, in which a chromosomal disorder results in a very typical clinical picture.

Consequences of the malformation

In addition to the characteristic external appearance, children with Down syndrome may have dysfunctions of the mouth and facial area, which, in combination with an enlarged tongue and enlargement of the palatine and pharyngeal tonsils, can lead to sleep-disordered breathing with obstruction of the upper airway.

Risk

The resulting disturbances of sleep and blood gases with carbon dioxide increase and oxygen deficiency can lead to failure to thrive, hypertension of pulmonary vessels, right heart failure and sudden death of children.

Optimal therapy

Various invasive and distressing surgical techniques such as tongue reduction, hyoid bone displacement, and maxillary and midface displacements are used in children with Down syndrome to improve airway obstruction in severe cases.