Table 5.

Strategies for families to support their children with down syndrome to adopt health-promoting behaviors.

Promoting Healthy Eating	Promoting Physical Activity
At Home:	At Home:
Act as role models in eating healthy foods.	Build exercise into the weekly routine, and schedule when you will do it
Avoid using food as a reward.	Consider remote physical activity programs designed for youth with DS.
Involve children in planning meals, food shopping and cooking (if able).	Consider ways to be active as a family: dance to music, take walks/hike, play outside games.
Introduce 1–2 new foods every week.	Consider involving the child in physical chores such as raking leaves or sweeping or carrying groceries as a way to promote movement in a positive way: helping!
Include at least one safe food that the child likes in every meal.	Engage in and teach the family about active living - using the surrounding streets and buildings to be active every day: walk to school and work, walk to stores and restaurants, take the stairs, get off one stop early when using public transportation and walk the rest of the way to the destination.
Avoid pressuring child to try the new foods	Get involved in Special Olympics or community-based physical activity groups.
Don't stress if the child does not eat the food right away, it can take many attempts for a child to accept a new food.	At Childcare or School:
Limit energy dense foods such as sweets and chips to 1–2 times a week.	Explore ways to increase physical activity during the school day., e.g., movement breaks as sensory accommodations and travel training as a way to practice independence and improve tolerance for walking.
Offer a fruit or vegetable with every meal, including snacks.	Request PT/OT (physical therapy/occupational therapy) services to address readiness to access the K-12 physical education (PE) curriculum in Early Intervention years and for preschool IEP.
Portion snacks in advance.	Recommend that a physical education teacher be included on the child's IEP team and include physical therapy and/or physical activity goals in the child's IEP that support them accessing the K-12 physical education (PE) curriculum
Offer water instead of sugar-sweetened beverages (Soda, juice, chocolate milk)	Request an assessment for adaptive physical education (APE) services if a child is not successful in the general PE program.
Use positive language when talking about food or body weight.	Be sure recess is not limited or taken away as a punishment or to provide services.
Eat meals together as a family.
Remove screens (TVs, tablets, and phones) when eating.
Offer the child choices at each meal (Do you want blueberries or strawberries with dinner?)
Consider modifying the texture of foods that align with the child's texture preferences and swallowing abilities.
At Childcare or School:
Review monthly school menus and pack a lunch/snack if needed. Pack water or flavored water instead of juices for lunch/snack.
Include healthy eating goals and alternatives to food rewards in Individual Education Plan (IEP) and Transition Plans. For example, request food not be given as a reward in school settings.
Develop behavior plans that do not use food as a reward. Document specific alternatives to food-based rewards.