>1. what medical information would be useful for the >physician and myself (both of us are already convinced breastfeeding is >worth the effort)? Hypotonia is the main issue in getting children with Down Syndrome to nurse effectively. They also often have small mouths and jaws, but regular sized tongues (usually described as having big tongues, but that isn't really the case). They often have impaired immune systems, thus the normal development of the immune system and the augmentation of the child's immune system provided by breast milk are all the more important for these children. Likewise, the potential for an addition 5-10 IQ points will be especially important for this baby, as he will most likely have some degree of mental retardation. Those 5 points mean a lot more at the low end of the scale than they do at the high end. If the baby is NOT successful in extracting milk from the breast, the mother should be encouraged to pump and feed with a bottle for as long as possible. In fact, it might not be a bad idea to have her pump with a good pump from the beginning to try to bring in a good supply of milk -- rather than wait a week or so to see if the baby will be strong enough to breastfeed, and *then* decide that the milk supply is dwindling and try to bring it back. It may also be a good idea for her to pump after each feeding and give any high fat hind milk that the baby has left. 2. what information would be of most use to the mother? The information that her child will be a very *easy* baby -- very content, very happy, very cuddly, but otherwise 99% like a regular child. And that her child will grow up and be able to walk and talk, read and write, enjoy TV and movies, play baseball, tell silly jokes, and do most of the other things kids do. That although she will forever grieve for the child she didn't have (the normal baby of her imagination), that the pain of that loss will fade with time, and that she and her family will be immensely enriched by the presence of this angel in their midst. Tell her to flood the baby with sensory input and stimulation of all kinds. There is a good bood called "Babies with Down Syndrome" that she should get and read. Tell her to avoid reading anything more than about 10 years old. And tell her not to listen to dire predictions of outcome. Katherine A. Dettwyler, Ph.D. Associate Professor of Anthropology and Nutrition Texas A&M University