Management of Down Syndrome in Children:A Narrative Review

Background: Down syndrome (DS) is a multisystem genetic condition requiring anticipatory, longitudinal, and development-centred care. Although survival has improved significantly, morbidity remains substantial due to congenital anomalies, neurodevelopmental disabilities, and acquired medical conditions. Objective: To synthesise current international and Indian guidelines and provide a practical, age-anticipatory clinical framework for the comprehensive management of children with DS. Methods: This review integrates evidence from established guidelines and contemporary literature, adopting a problem-oriented, age-based approach. It outlines the expected timeline of comorbidities, their clinical presentation, recommended investigations, and evidence-based management strategies. Results: A structured clinical framework is presented that emphasises early recognition, timely evaluation, and individualised interventions. Key domains include surveillance of systemic comorbidities and a strong focus on neurodevelopmental and behavioural assessment, identified as primary determinants oflong-term functional outcomes. The review also highlights context-specific considerations relevant to diverse healthcare settings. Conclusion: An age-anticipatory, integrated approach to DS care enables improved clinical outcomes through early diagnosis, targeted management, and informed counselling. Strengthening neurodevelopmental surveillance and aligning practice with evolving guidelines are essential to optimise survival, quality of life, and long-term prognosis in children with DS.