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Facts about Down Syndrome

Boy with his head on his deskDown syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms during pregnancy and how the baby’s body functions as it grows in the womb and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.

Even though people with Down syndrome might act and look similar, each person has different abilities. People with Down syndrome usually have an IQ (a measure of intelligence) in the mildly-to-moderately low range and are slower to speak than other children.

Some common physical features of Down syndrome include:

  • A flattened face, especially the bridge of the nose
  • Almond-shaped eyes that slant up
  • A short neck
  • Small ears
  • A tongue that tends to stick out of the mouth
  • Tiny white spots on the iris (colored part) of the eye
  • Small hands and feet
  • A single line across the palm of the hand (palmar crease)
  • Small pinky fingers that sometimes curve toward the thumb
  • Poor muscle tone or loose joints
  • Shorter in height as children and adults

Down syndrome remains the most common chromosomal condition diagnosed in the United States. Each year, about 6,000 babies born in the United States have Down syndrome. This means that Down syndrome occurs in about 1 out of every 700 babies.1

 

Types of Down Syndrome

There are three types of Down syndrome. People often can’t tell the difference between each type without looking at the chromosomes because the physical features and behaviors are similar.

Trisomy 21: About 95% of people with Down syndrome have Trisomy 21.2 With this type of Down syndrome, each cell in the body has 3 separate copies of chromosome 21 instead of the usual 2 copies.

Translocation Down syndrome: This type accounts for a small percentage of people with Down syndrome (about 3%).2 This occurs when an extra part or a whole extra chromosome 21 is present, but it is attached or “trans-located” to a different chromosome rather than being a separate chromosome 21.

Mosaic Down syndrome: This type affects about 2% of the people with Down syndrome.2 Mosaic means mixture or combination. For children with mosaic Down syndrome, some of their cells have 3 copies of chromosome 21, but other cells have the typical two copies of chromosome 21. Children with mosaic Down syndrome may have the same features as other children with Down syndrome. However, they may have fewer features of the condition due to the presence of some (or many) cells with a typical number of chromosomes.

 

Down syndrome: Caleb’s Story

There are many different emotions a mother and father go through when their child is born with a disability, but the emotion that most often gets stymied in the midst of tests and uncertainties is the simple beautiful joy of having a baby.  Our son Caleb was born with Down syndrome a few months ago, and I did not wish to hide or ignore the diagnosis, but I found it difficult to celebrate as countless tests and pending results kept knocking at the door.   Each time I looked at my baby boy, all I could see was a marvelous creation.  He was not like any other baby—he was uniquely himself and he was altogether mine.  Having a child with disabilities gives you a new cup by which to measure; a simple smile is no longer simple, it is a triumph and a glorious sight, and a common milestone on the doctor’s chart becomes the very cornerstone of great hopes.  We do not know how far our children will go, but we do know the depth of our love.   I cherish my little boy each day and don’t waste the present worrying about the future.  
-written by his mom, Stacy

Causes and Risk Factors

The extra chromosome 21 leads to the physical features and developmental challenges that can occur among people with Down syndrome. Researchers know that Down syndrome is caused by an extra chromosome, but no one knows for sure why Down syndrome occurs or how many different factors play a role. One factor that increases the risk for having a baby with Down syndrome is the mother’s age. Women who are 35 years or older when they become pregnant are more likely to have a pregnancy affected by Down syndrome than women who become pregnant at a younger age.3-5However, the majority of babies with Down syndrome are born to mothers less than 35 years old, because there are many more births among younger women.6,7

 

Diagnosis

Doctors can diagnose Down syndrome during pregnancy or after the baby is born. Some families want to know during pregnancy whether their baby has Down syndrome. Diagnosis of Down syndrome during pregnancy can allow parents and families to prepare for their baby’s special needs.


During pregnancy

There are two basic types of tests available to detect Down syndrome during pregnancy.  Screening tests are one type and diagnostic tests are another type.  A screening test can tell a woman and her healthcare provider whether her pregnancy has a lower or higher chance of having Down syndrome.  So screening tests help decide whether a diagnostic test might be needed. Screening tests do not provide an absolute diagnosis, but they are safer for the mother and the baby.  Diagnostic tests can typically detect whether or not a baby will have Down syndrome, but they can be more risky for the mother and baby.   Neither screening nor diagnostic tests can predict the full impact of Down syndrome on a baby; no one can predict this.

Screening tests
Screening tests often include a combination of a blood test, which measures the amount of various substances in the mother’s blood (e.g., MS-AFP, Triple Screen, Quad-screen), and an ultrasound, which creates a picture of the baby. During an ultrasound, one of the things the technician looks at is the fluid behind the baby’s neck. Extra fluid in this region could indicate a genetic problem.  These screening tests can help determine the baby’s risk of Down syndrome.  Rarely, screening tests can give an abnormal result even when there is nothing wrong with the baby. Sometimes, the test results are normal and yet they miss a problem that does exist.

A new test available since 2010 for certain chromosome problems, including Down syndrome, screens the mother’s blood to detect small pieces of the developing baby’s DNA that are circulating in the mother’s blood. This test is recommended for women who are more likely to have a pregnancy affected by Down syndrome.  The test is typically completed during the first trimester (first 3 months of pregnancy) and it is becoming more widely available.

Diagnostic Tests
Diagnostic tests are usually performed after a positive screening test in order to confirm a Down syndrome diagnosis. Types of diagnostic tests include:  

  • Chorionic villus sampling (CVS)—examines material from the placenta
  • Amniocentesis—examines the amniotic fluid (the fluid from the sac surrounding the baby)
  • Percutaneous umbilical blood sampling (PUBS)—examines blood from the umbilical cord

These tests look for changes in the chromosomes that would indicate a Down syndrome diagnosis.


After birth

Once a baby is born, a doctor will examine the baby and most likely will be able to diagnose a baby with Down syndrome. Doctors usually order tests of the baby’s blood to confirm whether there is an extra chromosome (chromosome 21) in the baby’s cells. 

Because almost half of babies born with Down syndrome have a heart defect, all newborns with Down syndrome should receive an echocardiogram (an ultrasound picture of the heart).

For more information on diagnosing Down syndrome, please visit the Diagnosis webpage.

 

Other Health Problems Among Children With Down syndrome

Many people with Down syndrome have the common facial features and no other major birth defects. However, some people with Down syndrome might have one or more major birth defects or other medical problems. Some of the more common health problems among children with Down syndrome are listed below8:

  • Hearing loss (up to 75% of people with Down syndrome may be affected)
  • Obstructive sleep apnea, which is a condition where the person’s breathing temporarily stops while asleep (between 50 -75%)
  • Ear infections (between 50 -70%)
  • Eye diseases (up to 60%), like cataracts and eye issues requiring glasses
  • Heart defects present at birth (50%)


Other less common health problems among people with Down syndrome include:

  • Intestinal blockage at birth requiring surgery
  • Hip dislocation
  • Thyroid disease
  • Anemia (red blood cells can’t carry enough oxygen to the body) and iron deficiency (anemia where the red blood cells don’t have enough iron)
  • Leukemia in infancy or early childhood
  • Hirschsprung disease

Health care providers routinely monitor children with Down syndrome for these conditions. If they are diagnosed, treatment is offered.

 

Living with Down syndrome

Down syndrome is a lifelong condition. Services early in life will often help babies and children with Down syndrome to improve their physical and intellectual abilities. Most of these services focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapy, and they are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

Many people with Down syndrome lead productive and fulfilling lives well into adulthood. They can have jobs and live independently. However, it is important for people with Down syndrome to be involved in their community, take good care of themselves, and see a healthcare provider regularly. Families of people with Down syndrome often can help their loved ones by connecting with other families that have had children with Down syndrome. This may help families gain insight into overcoming potential differences in caring for their child with Down syndrome.

 

References

  1. Parker SE, Mai CT, Canfield MA, et al. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol. 2010;88:1008-16.
  2. Shin M, Siffel C, Correa A. Survival of children with mosaic Down syndrome. Am J Med Genet A. 2010;152A:800-1.
  3. Allen EG, Freeman SB, Druschel C, et al. Maternal age and risk for trisomy 21 assessed by the origin of chromosome nondisjunction: a report from the Atlanta and National Down Syndrome Projects. Hum Genet. 2009 Feb;125(1):41-52.
  4. Ghosh S, Feingold E, Dey SK. Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction, and maternal age across populations. Am J Med Genet A. 2009 Jul;149A(7):1415-20.
  5. Sherman SL, Allen EG, Bean LH, Freeman SB. Epidemiology of Down syndrome. Ment Retard Dev Disabil Res Rev. 2007;13(3):221-7.
  6. Adams MM, Erickson JD, Layde PM, Oakley GP. Down's syndrome. Recent trends in the United States. JAMA. 1981 Aug 14;246(7):758-60.
  7. Olsen CL, Cross PK, Gensburg LJ, Hughes JP. The effects of prenatal diagnosis, population ageing, and changing fertility rates on the live birth prevalence of Down syndrome in New York State, 1983-1992. Prenat Diagn. 1996 Nov;16(11):991-1002.
  8. Bull MJ, the Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011;128:393-406.
"A gene is a part of DNA (the genetic instructions in all living things). People inherit one copy of each gene from their mother and one copy from their father. The genes that a person inherits from his or her parents can determine many things, like what a person will look like and whether the person might have certain diseases."
"DNA is the genetic instructions in all living things."
"Hirschsprung disease is when the nerves to parts of the intestine, usually the colon, don’t develop, so the muscles of the colon don’t work well to push stool along. This can lead to constipation and blockage of the colon."
 

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