Nutritional and gastrointestinal problems

Childhood (Age: 2-11) Enquire about nutritional problems and bowel habit. Treat constipation. Symptomatic colonic diverticular disease has been reported in children as young as 9 years. Consider diverticulosis in a child with recurrent abdominal pain. Screen for coeliac disease around 3 years of age with low threshold to repeat if symptoms suggestive. Significant gastro-oesophageal reflux tends to reduce with age but may remain problematic. Risk of oesophageal strictures if untreated.

Baby (Age: 0-1) Take feeding history. Enquire about bowel habit, vomiting and symptoms of gastro oesophageal reflux (GOR). If failing to thrive, measure plasma calcium, thyroid function tests and coeliac screen. Refer for appropriate dietetic support. Manage GOR with standard therapies and investigate for potential hiatus hernias or strictures where symptoms persist or infant fails to thrive. Manage rectal prolapse conservatively, treating constipation. Faltering growth is common in WS. Use the syndrome specific growth charts and consider nasogastric or percutaneous gastrostomy feeding.