Nutrition and Lifestyle Advice for Individuals with Down Syndrome: What You Eat – and When – Matters

Supporting healthy routines around eating, physical activity, and sleep can be especially challenging when caring for a loved one with Down syndrome. As a dietitian for the Multidisciplinary Obstructive Sleep Apnea (MOSA) Clinic at Texas Children’s, I work closely with families to support healthy eating and lifestyle routines that promote better health outcomes. I’ve created this guide to offer practical, compassionate strategies to help families build habits that foster positive eating experiences and overall well-being.

Why nutrition matters 

From infancy through adulthood, individuals with Down syndrome may face unique challenges that impact nutrition and lifestyle. These include:

• Infant feeding difficulties: Poor latch, low muscle tone, and sensory aversions
• Weight concerns: Increased risk of overweight and obesity due to shorter stature, lower energy needs (hypotonia), and reduced physical activity
• Associated medical conditions:
  • Cardiac defects: May affect energy and feeding
  • Endocrine disorders: Hypothyroidism and diabetes
  • Sleep disorders: Obstructive sleep apnea (OSA), insomnia, behavioral disturbances
  • Gastrointestinal conditions: Celiac disease, malabsorption, constipation from decreased gut motility 

We know that sleep has a strong correlation with health. A narrative review from the Journal of the Academy of Nutrition and Dietetics (1) highlights how insufficient sleep can contribute to chronic medical conditions. Furthermore, excess weight gain can worsen sleep quality and increase the risk of sleep disorders, creating a cycle that’s hard to break without the right support system. 

• Foods associated with better sleep include high fiber choices (fruits, veggies, wholes grains) and healthier fats (vegetable oils, avocados, and nuts).
• Foods that disrupt sleep and metabolism include refined grains (chips, breads, cookies, cakes, and heavily processed packaged items), saturated fats (fried foods) and added sugars.  

Strategies for promoting healthy eating behaviors and weight management include the following: 

• Offer a variety of foods from each food group. (Visit the MyPlate website for more on healthy eating.)
• Prep fruits and vegetables in ready-to-eat portions.
• Limit access to low-nutrient foods early.
• Make water easily accessible throughout the day. 

Meal timing and spacing matters  

Nutrition affects health not only through what we eat but when we eat via timing of food consumption (2). New research shows that when our body’s natural sleep-wake cycle (called the circadian rhythm) gets off track, it can lead to health problems like obesity. Eating within a shorter time each day may help the body get back in sync and improve how it uses food. 

Most people eat over a span of 12 to 15 hours each day—from the start of their first meal to the end of their last meal. Eating for longer periods, like 15 hours or more, may be the factor in development of metabolic disorders. Keeping meals and snacks within a shorter time each day might help prevent some diseases.  

• Ideal feeding window: 12 hours or less per day
• Extended eating windows (15+ hours): Linked to increased risk of obesity and metabolic disorders
• Time-restricted eating (TRE): Improves glucose tolerance, blood pressure, and sleep quality—even without weight loss 

Pediatric dietitians often suggest a routine of three meals and one to two snacks spaced about every three hours. This pattern helps manage hunger, reduces the chance of overeating, and naturally fits within a 12-hour eating window. 

Sample Daily Eating Schedule 

Teaching hunger awareness 

Many parents share concerns about portion control, sneaking food, frequent snacking, and difficulty recognizing hunger and fullness cues. For children with Down syndrome, these milestones may take longer and require extra support. 

Mindful eating teaches children to tell the difference between physical hunger—felt in the stomach—and emotional hunger, which comes from cravings triggered by the brain. For instance, smelling popcorn at the movies might make someone want to eat, even if they just had a meal and aren’t truly hungry. Encouraging kids to pause and think before eating helps them build self-awareness and develop self-regulation skills.  

Mindful eating tips for parents include: 

• Set consistent meal and snack times
• Encourage slowing down (e.g., put fork down between bites)
• Use timers or visual cues to extend meals to 20 minutes
• Create a calm, screen-free eating environment
• Chew thoroughly to support digestion
• Eat together as a family to foster connection
• Avoid using food as a reward in home or therapy settings 

Sometimes, children feel “hungry” outside of scheduled meals. This may be emotional hunger—triggered by boredom, stress, or habit. 

These are ways to help children explore their feelings and find alternatives to eating: 

• Journaling or crafting
• Going for a walk*
• Playing a sport or meeting a friend*
• Finding a new hobby 

*Increasing physical activity also helps reduce between-meal snacking and supports energy balance. 

Texas Children’s expertise

Even small steps—like a shared meal, mindful moment, or a walk in the park—can make a big impact. Dietitians play a vital role in supporting children with Down syndrome by addressing feeding challenges, promoting healthy growth, and tailoring nutrition strategies to meet their unique medical and developmental needs. 

At Texas Children’s, the Clinical Nutrition Department provides meals, special formula services, and nutrition services to patients in the hospital and general nutrition counseling to outpatients. 

Our additional resources that help our patients with Down syndrome are our Down Syndrome Clinic and the Multidisciplinary Obstructive Sleep Apnea (MOSA) Clinic. 

Patient and family resources

Academy of Nutrition and Dietetics: eatright.org 
Down Syndrome | Birth Defects | CDC 
MyPlate.gov | U.S. Department of Agriculture 
Nutrition and Down Syndrome | National Down Syndrome Society (NDSS) 
Primary care for children and adolescents with Down syndrome - PubMed 

References 

1. Wilson, K, St-onge M, Tasli E. Diet Composition and Objectively Assessed Sleep Quality: A Narrative Review. Journal of the Academy of Nutrition and Dietetics. 2022; 122(6):1182-1195. 

2. Adafer R, Messaadi W, Meddahi M et al. Food timing, circadian rhythm, and Chrononutrition: A systemic review of time-restricted eating’s effects on human health. Nutrients. 2020 Dec 8;12(12):3770. doi: 10.3390/nu12123770.