Table 1. Summary of medical problems and management.

Medical problem	Prevalence	Age of presentation	Severity	Complications	Recommendations	Follow up
Growth	Low birth weight - FXCRC: 9% - Other studies: 8%	- Brain overgrowth 2–5 years	Moderate	- Overweight	- Lifestyle changes including healthy diet and exercise to minimize problems associated with increased weight	- Monitor patient's weight, height and head circumference closely in each visit
	Preterm - FXCRC: 16% - Other studies: 12%	- Height deceleration: after puberty
Otitis media	- FXCRC: 55% - Other studies: 45–85%	Childhood	Mild	- Acute sinusitis - Recurrent otitis media - Exacerbate the cognitive and language deficits - Conductive hearing loss	- Pneumococcal and influenza vaccines - Breastfeeding for at least 4–6 months - Eliminate passive exposure to tobacco smoke - Reduce pacifier and bottle usage - Antibiotic therapy - Ear tubes placement	- Surveillance of the potential adverse effects of antibiotic prophylaxis including hypersensitivity reaction and gastrointestinal problems
Seizures	- FXCRC: 10 % - Other studies: 12–18%	Early childhood	Mild to severe	- Developmental and behavioral morbidity	- Educate parents and follow up patients with history of seizures - Carbamazepine - Valproic acid	- EEG - Drug-specific blood test - Discontinue medication after patient is seizure-free for 2 years unless EEG is abnormal
Mitral valve prolapse	- FXCRC: 0.8% - Other studies: 50%of males and 20% of females	Childhood to adolescence	Mostly asymptomatic	- Rarely mitral regurgitation, congestive heart failure and endocarditis	- Mitral valve repair or replacement rarely required	- Surveillance cardiac evaluation
Gastrointestinal problems	- FXCRC: 2%–8% - Other studies: 11%	Childhood to adolescence	Mild	- Failure to thrive - Irritability - Behavioral problems	- Thickening agents - Antacids - Histamine-2 blockers - Proton pump inhibitors	- Surveillance on height and weight
Sleep problems	- FXCRC: 26.9% - Other studies: 32%–47%	Infancy and childhood	Mild to moderate	- Disturbance in daytime performance - Behavioral problems	- Behavioral intervention - Melatonin - Clonidine	- Monitor the side effects of sleep medications - Careful history of sleep habits
Obstructive sleep apnea	- FXCRC: 7% - Other studies: 21–32%	Childhood	Moderate to severe	- Vigilance impairment and neuropsychological deficit - Decrease in day time performance - Increase in behavioral problems	- Steroids to reduce tonsillar hypertrophy - Continuous positive airway pressure - Surgical intervention including tonsillectomy - Behavioral therapy	- Monitoring and managing obstructive sleep apnea in every child visit - Refer to sleep specialist
Strabismus	- FXCRC: 17% - Other studies: 8%	Early childhood	Mild to moderate	- Amblyopia	- Corrective eyeglasses - Visual training exercise - Surgery	- Comprehensive ophthalmologic examination of every child with FXS by age 4 or sooner if strabismus is detected
Tic disorder	- FXCRC: 6% - Other studies: 15%	Before 18 years of age	Mild	- Usually uncomplicated	- Educational and supportive approach - Medications rarely necessary	- Long term relationships to improve patients self-esteem and coping with their tics
Toileting issues	49%	Delayed several years	Mild to moderate	- Enuresis - Encopresis	- Behavioral therapy - Desmopressin - Fiber supplements in case of constipation	- Toileting counselling by 1 year of age
Sensory integration problem	20%–50%	Early childhood	Moderate to severe	- Lack of participation in activities that are necessary for brain development	- Medications related to inattention, anxiety, aggression and autonomic symptoms - OT therapy	- Assessment tools such as sensory profile questionnaire, etc.

FXCRC: Fragile X Clinical and Research Consortium Study; FXS: Fragile X syndrome.