Neonates
Breast milk, particularly the antibody-rich colostrum, is particularly beneficial to bolster the weaker immune system of babies born with Down syndrome. The extra work of sucking required of breastfeeding babies can be extremely beneficial to oral-motor development, preparing the mouth for speech activities later in life. While the extra work is often too much for some neonates with Down syndrome, who have significant congenital heart disease or other issues, many newborns with Down syndrome and heart defects do successfully breastfeed.

Newborns with Down syndrome who have difficulty with breastfeeding share some common problems:

• Becoming easily tired during the feeding process (particularly babies with heart defects)
• Having difficulty mastering the process of "latching on" to the mother’s nipple
• Being unable to suck vigorously enough to get sufficient milk from the breast
  

On top of these inherent physical problems with breastfeeding, many mothers are disheartened or misled by well-meaning health professionals who discourage breastfeeding for neonates with Down syndrome and significant health issues. While there are certainly circumstances that preclude breastfeeding in ill infants, many mother-baby pairs have succeeded, thanks to help from lactation specialists or occupational therapists who are experienced in working with newborns with disabilities.

Infants and Toddlers
Children with disabilities, including the population with Down syndrome, often have difficulty using all of their senses in an appropriate manner in the eating process. Because of sensory processing issues, oral-motor issues, or motor impairments, they may be unable to successfully meet one or more of the following needs that are integral to successful oral feeding:

• We smell the food while it’s cooking and when it’s on our plate.
• We hear it being prepared. We hear it when we chew it too.
• We see the food when it is presented to us. We also see it while it’s being prepared.
• We feel it either when we pick it up in our hands or in our mouth. If we’re lucky we feel it both ways.
• We taste it if we put it in our mouth.
• We need to be able to balance ourselves to coordinate the movements required to pick it up and eat it.
• We need to have an understanding of our body. Once we eat the food, we need to know where it went and how to follow it in our mouth with our tongue and not lose it.
• And last, we need to agree to swallow it. Swallowing a food is a commitment to allowing it to become a part of us.
  

It’s important to institute appropriate physical adaptations to the child’s environment, and eating tools, to allow successful intake of healthy, developmentally-appropriate foods. Some accommodations commonly used for youngsters with Down syndrome include the following:

• Use appropriate utensils that are easy to use, consulting with an O.T. or speech therapist as needed.
• Use non-skid material (dycem or shelf liner) under bowls and plates to keep them in place while the child is learning to scoop or stab food.
• Place rolled towels or small pillows to keep the youngster positioned in the high chair.
• Once the child outgrows the high chair, use a small stool to support his feet under the table.
• Choose bowls and dishes with easy-to-use handles.
  

Childhood
Many children with Down syndrome are picky eaters, preferring certain food textures and tastes. Strong food preferences and avoidances can be secondary to sensory processing issues in these boys and girls. Medlen suggests the following tips for introducing new foods to children who are notably resistant to trying new flavors or textures:

• Remember that children need to complete four sensory stages for successful eating: sampling the food, exploring the properties of the food, accepting its odor, and accepting the presence of the food.
• Understand that it may take many exposures to a new food before the child is ready to try it. A rule of thumb is 10 exposures for most children, and 50 or even 500 exposures for a youngster with Down.
• Introduce new foods as a side dish instead of the main course.
• Talk about the new food in an interesting manner.
• Don’t comment on what the child decides to put on his plate or in his mouth.
• Avoid pressure tactics.
• Let the child help prepare new dishes.
• Give the child choices about new foods. Let them choose from a list of 3-4 options.