Poor weight gain /
Failure to thrive
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| Low threshold for clinical feeding eval &/or radiographic swallowing study when showing clinical signs or symptoms of dysphagia |
Obesity w/metabolic syndrome
| Nutritional intervention incl restricted caloric intake Standard treatment for insulin resistance / diabetes Standard treatment for hyperlipidemia
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GERD
| Standard therapy | |
Constipation
| Stool softeners, prokinetics, osmotic agents, or laxatives as needed | |
Short stature
| Consideration of GH therapy | Affected persons w/short stature should benefit from off-label GH supplementation to improve body height. GH therapy may also have positive effects on muscle strength & body composition. Polysomnography & adenotonsillar eval should be completed prior to initiation of GH therapy.1
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Acute respiratory distress in infancy
| Invasive or noninvasive assisted ventilation for acute respiratory distress | Tracheostomy may be required for severe, prolonged respiratory compromise. |
Sleep apnea
| Overnight application of noninvasive ventilation (e.g., CPAP) | Low threshold for performing addl sleep apnea tests / sleep studies |
Skeletal abnormalities
| Standard treatment for contractures, clubfoot, & scoliosis per orthopedist | |
Low bone mineral density
| Standard treatment per endocrinologist |
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DD/ID
| See Developmental Delay / Intellectual Disability Management Issues. | |
Epilepsy
| Standardized treatment w/ASM by experienced neurologist |
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Abnormal vision &/or strabismus
| Standard treatment(s) per ophthalmologist | Community vision services through early intervention or school district |
Undescended testes
| Standard treatment per urologist | |
Hypogonadism
| Consideration of short course of testosterone therapy in early infancy for males w/small penis (stretched penile length <−2 SD) | |
Pubertal abnormalities
| Standard hormonal treatment per endocrinologist | |
Hypothyroidism
| Thyroid hormone replacement therapy | |
Family/Community
| Ensure appropriate social work involvement to connect families w/local resources, respite, & support. Coordinate care to manage multiple subspecialty appointments, equipment, medications, & supplies.
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