Reprinted from Down Syndrome Quarterly , Volume 4, Number 3, September 1999

Down Syndrome Health Care Guidelines (1999 Revision) Record Sheet

Sheet #1: Birth to Age 12 Years


Name: ________________________________         Birthday: ______________________________

 
Age, in years
Medical
Issues 		At Birth
or at
Diagnosis 		6-mo 1 1-1/2 2 2-1/2 3 4 5 6 7 8 9 10 11 12
Karotype &
Genetic
Counseling 		_____  
Usual Preventative
Care 		_____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Cardiology Echo  
Audiologic
Evaluation 		ABR or
OAE 		___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Ophthalmologic
Evaluation 		Red reflex _____ ___   ___   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Thyroid
(TSH & T4) 		State
screening 		_____ ___   ___   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Nutrition _____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Dental Exam1   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Celiac
Screening2 		  ___  
Parent Support _____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Developmental
& Educational
Services 		Early
Intervention 		___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Neck X-rays &
Neurological
Exam3 		  X-
ray 		___ ___ ___ ___ ___ ___ ___ ___ ___
Pneumococcal
Conjugate
Vaccine Series 		  _______  

Instructions: Perform indicated exam/screening and record date in blank spaces. The grey or shaded boxes mean no action is to be taken for those ages.

1Begin Dental Exams at 2 years of age, and continue every 6 months thereafter.
2IgA antiendomysium antibodies and total IgA.
3Cervical spine x-rays: flexion, neutral and extension, between 3-5 years of age. Repeat as needed for Special Olympics participation. Neurological examination at each visit.
© Down Syndrome Quarterly, 1999. This record sheet may be printed out for individual use but may not be reproduced on any website without prior permission.
 
 
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