Lisa:  One hallmark “symptom” of Down Syndrome is low muscle tone. Hypotonia is manifest throughout the body in most people with Down Syndrome.  Arms and legs may be floppy, especially during the first few weeks after birth as physiological flexion dissipates. In the absence of feeding strategies aimed at tongue retraction, the tongue begins to protrude. Even smooth muscle surrounding the lumen of the small intestines is hypotonic. This results in diminished peristalsis, which yields constipation. Sounds like I’m painting a bleak picture. Fortunately, much can be done to improve and even reverse hypotonia.  Adequate dietary protein intake is necessary for proper musculoskeletal development.  Interventions utilizing a targeted neurodevelopmental approach are paramount, and they most certainly yield positive changes.  (For more information on the neurodevelopment approach, visit  Our friends at the National Association for Child Development are changing lives everyday.  I could spend hours talking about them.  Thank you, Bob, Ellen, and Company!)

Let’s focus on one specific manifestation of hypotonia in the hopes that I can save you a few gray hairs:  constipation.  I know, I know.  Ewww.  But do you know how much grief this darned issue caused us??  Caused me??!!  Yeah, John never got too worked up about it.  He has always left health-related issues up to me to figure out.  In the absence of other underlying issues such as hypothyroidism, Hirschsprung’s disease, irritable bowel syndrome, or even celiac disease, constipation can be very manageable.  We had to find this out the hard way–no pun intended!  Sophie struggled with constipation for over a decade before we got it under control. I’ve often joked that she and I have sprinted to every public restroom in the Midwest.  We would invariably be out and about, she’d feel the urge, I’d panic, John would pull over abruptly, Soph and I would race inside, and then…nothing, zip, zilch.  We tried everything: enemas, Miralax, Milk of Magnesia, homeopathic agents, and many, many other remedies.  At long last, we have FINALLY been able to control Sophie’s constipation with this “triple crown” approach: adequate hydration, diet/exercise, and 2 dates a day.   (We’ll save hydration and diet/exercise for a separate discussion.)  The mistake I made all those years was assuming that Sophie would not like dried fruit.  Ironically, she very much likes dried cranberries, raisins, prunes, and most of all dates.  After trial and error, we’ve determined that two dates a day keep the doctor away!

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