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Atlantoaxial Instability in Children with Down Syndrome

​Children with Down syndrome are at increased risk of developing compression of the spinal cord called atlantoaxial instability. This problem is caused by a combination of low tone, loose ligaments and bony changes. The spinal cord can be pressed by the bones and cause nerve damage. Symptoms of nerve damage can occur at any time and there is no test or x-ray that can tell who is at risk.

Parents should watch their child for any changes in how they walk, use their arms or hands, a head tilt, complaints of pain in the neck, or change in bowel or bladder function, change in general function or new onset weakness.

Contact physician immediately for an x-ray of the neck in neutral position if your child has:

  • Change in how he or she walks

  • Change in how he or she uses arms/hands

  • Change in bowel or bladder control

  • Head stays tilted

  • Neck Pain

  • New onset weakness

  • Decreased activity level or function

If the x-ray is abnormal or symptoms persist, the child should be referred as soon as possible to a pediatric neurosurgeon or pediatric orthopedic surgeon experienced in managing atlantoaxial instability.

Additional Information & Resources:

Marilyn J. Bull, MD, FAAP
Last Updated
Used with Permission of Marilyn J. Bull, MD, FAAP (Copyright © 2016)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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