Breastfeeding a baby with Down Syndrome (Trisomy 21)

Elise Armoiry My Baby Moon
Mar 27
4 min read

Contrary to popular belief, breastfeeding a baby with Down syndrome is possible, and can be quite an adventure!

Every baby is unique, and some will have no particular difficulty breastfeeding at all.

For others, challenges may arise: for example hypotonia, a sleepy baby, or difficulties coordinating sucking, swallowing and breathing, all of which can make feeds more complicated. Cardiac or digestive malformations (sometimes requiring surgery) can also affect the establishment of breastfeeding and the baby's ability to suckle effectively.

What are the benefits of Breastfeeding a baby with Down Syndrome?

Benefits of Breast Milk

It is more easily digested and supports the baby's optimal microbiome, reducing the risk of constipation, diarrhoea and reflux — all of which are more common in babies with Down syndrome
Immune protection: babies with Down syndrome are at higher risk of infection. Breast milk reduces the risk of ear infections, respiratory infections and gastrointestinal illness
Reduced risk of type 1 and type 2 diabetes, obesity and leukaemia
Improved cognitive development
Improved motor development

Benefits of feeding directly at the breast

Improved oro-facial development, which supports language acquisition
Reduced risk of ear infections
Reduced risk of orthodontic problems (malocclusion, narrow palate)
Reduced risk of sleep apnoea, which is more prevalent in babies with Down syndrome
Reduced risk of chewing difficulties

Benefits of the breastfeeding relationship: supports secure attachment bonding

Antenatal preparation when Down syndrome has been diagnosed:

Understand how birth circumstances can affect breastfeeding
Learn to recognise signs of hunger, fullness, effective feeding, or difficulty at the breast (e.g. baby arching backwards, grimacing, crying, or splaying their fingers)
Learn to hand-express and collect colostrum in late pregnancy, with your doctor's agreement (see the blog article on this topic and the video in the "expressing milk" programme)
Obtain a breast pump
Learn the different methods for giving supplements if needed: paced bottle feeding with pauses, or a supplemental nursing system (SNS) at the breast or finger. A nasogastric tube may also be necessary in cases of prematurity, which is more common with Down syndrome
Familiarise yourself with the specific challenges that may arise: weak suck, a sleepy baby, and difficulty latching

In practice, once baby arrives:

Prioritise skin-to-skin contact and initiate breastfeeding as soon as possible
Establish and protect your milk supply: if baby is not feeding effectively at the breast, express manually or pump 8 times per 24 hours (day and night) using an efficient double electric breast pump to properly build your supply. Getting the right flange size is important for both comfort and milk output. => You'll find helpful tips on this in the "expressing milk" programme and in the blog articles on pumping technique
The mothers I have supported in this context typically needed to establish their milk supply by pumping and to give their own expressed milk as top-ups alongside feeds — in the early days, babies often do not yet have the stamina to drain the breast fully or to feed for long stretches
Wake baby for feeds if they are sleeping through, as babies with Down syndrome are prone to being sleepy at the breast
Supplements of expressed breast milk or formula may be necessary, and in some cases a nasogastric tube as well
Offer many short, frequent feeds at baby's own pace, using breast compression throughout
Helpful tools include: nipple shields, a supplemental nursing device, and a bottle offered before or after the feed
Weighted feeds can give a useful picture of how much milk baby is actually transferring
Specific feeding positions can also help with latching when tongue protrusion or hypotonia is present, for example:
- the straddle position (Koala Hold), which also facilitates breast compression
- the Dancer hand position, where the mother cups baby's cheeks to compensate for insufficient tone to hold the breast in the mouth
- the cross-cradle hold
- the football (underarm) hold

In conclusion,

in this context it is worth remembering that:

Breastfeeding helps build the bond with your baby. When your baby has additional needs, forming that connection can sometimes feel more challenging — breastfeeding can be a meaningful way to nurture it
Breast milk helps protect against the infections to which babies with Down syndrome are more vulnerable
Feeding at the breast strengthens the facial muscles and tongue coordination, which will later support the transition to solid foods and the development of speech

Baby will almost certainly need extra help and time to feed in the early weeks due to low tone. Pumping alongside breastfeeding will help you build and maintain your supply during this period. It can take two to three months to reach exclusive breastfeeding at the breast.

Specific positions can make a significant difference.