Airway problems and trisomy 21

The diagnosis of trisomy 21 (Down syndrome) is confronting for many families. Aside from the common complication of congenital heart abnormalities (40%), upper airway problems are frequent and include laryngomalacia, glue ears, recurrent viral croup, tracheal stenosis and obstructive sleep apnoea. 

Upper airway obstruction will present with stridor if severe. The stridor will be inspiratory but may also have an associated expiratory noise if there is a fixed airway obstruction. Diagnostic considerations include laryngomalacia, which typically begins in the neonatal period with stridor which is variable in intensity, being more marked at times of higher airflow (feeding, bathing and crying) but quieter or absent in quiet sleep. 

It tends to increase over the first six months and then become quieter in the second six months as the larynx cartilage stiffens. 

Recurrent upper airway viral infections are common in all children. With poor