143

AGE AT WALKING, AT ERUPTION OF DEGIDUOUS TEETHAND RESPONSE TO EPHEDRINE

IN CHILDREN WITH DOWN'S SYNDROME-

J. KUCERAThe Institute for the Care of Mother and Child, Nabrezi Karla Marxe 157,

Prague, Czechoslovakia

Between 10th October, 1957 and 30th September, 1967 the author examined132 children with Down's syndrome at the Clinic for Congenital Malformations inPrague. They were bom between 1948 and 1966. Investigations included personaland family histories, clinical assessment, chromosomal analysis, and, in particulardetail: Age at walking, age at onset of eruption of deciduous teeth, response toephedrine and to procaine solution, response to vaccination against smallpox and thecharacter of foetal movements. Some of these items are examined below. For age atwalking and at tooth eruption, the sample has been divided into three groups,according to year of birth (Table 1).

Table 1

Frequency of visit to Clinic No. of cases Year of birth

Single, rarely repeated examinations 52 Before 1954

Repeated examinations 46 1955-1960

Continuous observations since birth 34 1961-1966

Total 132

AGE AT ERUFJION OF FIRST DECIDUOUS TOOTH

Table 2 compares the age distributions at eruption of the first deciduous toothof mongols, of non mongol severely subnormal children and of normal controls. Table3 compares means and other parameters of the mongols and non-mongols.

The mongol results are similar to those of other authors. For instance, 0ster(1953) reported the onset of eruption at or before six months in 19 of 262 mongols(8 out of 99 in our sample). 0ster found no appreciable sex differences in age ateruption and sexes are combined in the present sample. Roche and Barkla (1964)used a somewhat different method of assessment but, as far as can be judged, theresults are rather similar to our own. These authors also examined the age at eruptionof each tooth separately, the earliest to erupt being almost always the central incisorsof the lower jaw. This was so, in the present sample.

(Received January 20th, 1969)

144 AGE AT WALKING

Table 2

Teething in mongols, non-mongol severely subnormals and normal controls

Age inmonths

— 3

— 4

— 5

— 6

— 7

— 8

— 9

—10

—11

—12

—13

—14

—15

—16

—17

—18

—19

—20

21—

Totals

Mean

Down'ssyndrome

1

—

1

6

6

7

12

6

6

15

9

12

3

1

2

2

2

3

5

99

12.46

Non-mongolseverely subnormal

1

1

14

15

7

12

7

1

3

6

2

4

1

1

—

—

1

—

• —

76t8.03

Normalinfants*

—

-

33

90

27

40

44

32

13

21

—

—

—

—

—

—

—

—

—

300

7.92

•Children (infants) admitted in Pediatric Department (lying-in hospital) for difFerent pathologicconditions of exogenous nature.

tUntil June, 1968.

J. KUCERA 145

The mean age at first eruption of the non-mongol subnormal sample is onlyslightly higher than that of the controls. However, Table 2 shows that about 15 percent of the former had not erupted at or before the age of 12 months. There arenumerous causes of mental subnormality and this finding suggests that some of themare associated with delayed dentition.

AGE AT WALKING

Data about age at walking are shown in Tables 4 and 5 which demonstrateconsiderable delay. The average age at which a normal infant starts to walk is about12 months.

Table 3

Teething in children with Down's syndrome

Years ofbirth

-1954

1955-1960

1961-1966

No. ofchildren

44

32

23

Mean age(months)

12.20

12.03

11.52

Variance

30.36

13.40

10.28

Standarddeviation

5.51

3.66

3.21

Standarderror

0.83

0.65

0.66

95% confidenceinterval

10.53-13.87

10.74-13.82

10.21-12.83

Teething in non-mongol severely subnormals [until March, 1968)*

1955-1960

1961-1968

1955-1968

41

32

74+

8.41

8.03

8.19

17.89

12.36

15.30

4.23

3.52

3.91

0.66

0.62

0.46

7.09- 9.73

6.79- 9.27

7.28- 9.10

•Out-patients investigated between 1957 and 1968 at the Clinic for Congenital Malfonnations.

tOne child born before 1955 in this group is included.

Unlike the age at tooth eruption, there is a notable difference in age at walkingof mongols bom before and since 1954, the former showing appreciably greaterdelay. Age at walking, unlike age at dentition, is greatly influenced by environmentalfactors, such as the amount of attention and of active training devoted to the mongolchild. The increased stimulation by parents and other relatives given to the laterbom mongols may thus be responsible for this difference. Inaccuracy due to themother's forgetfulness about the age at walking may, of course, be partly responsiblefor it.

Age at walking was investigated in a small sample of mongols by Erbs andSmith (1962) who found a mean age of 26.8 months, with a range of 16 to 48 months,a result similar to that of the present author.

146 AGE AT WALKING

Table 4Walking age in children with Down's syndrome in detail

Age periodin months

-12

13-15

16-18

19-21

22-24

25-27

28-30

31-33

34-36

37-39

40-42

43-45

46-48

49-

Total

Not determined

Not yet walking

Died in lst year

Grand total

-1954

—

—

3

3

10

5

7

2

6

2

4

—

2

1

45

7

—

—

52

Children born1955-^0

—

2

5

11

10

4

1

1

—

—

1

—

• —

—

35

5

—

6

46

1961-^6

—

1

7

5

3

7

—

1

—

—

1

—

—

—

25

4

4

1

34

Tota

—

3

15

19

23

16

8

4

6

2

6

—

2

1

105

16

4

7

132

RESPONSE TO EPHEDRINE

The response of children with Down's syndrome to the administration did notproduce results that lent themselves to statistical treatment but in this, as in othertraits, the subjects with Down's syndrome 'showed a high degree of biologicalvariability commonly observed in respect of other characteristics. Nearly all controlsgave a fairly standard type of response whereas a considerable variety of side effects,were observed in mongols (Table 6).

J. KUCERA 147

•asQ

&5

a oCO

COCO

iri

CO

•ri

to

Sex

Age

Sex

oCO

CO

J ̂bo •-• ^ CM >n ^N o

. ^ TJ* »-« CM ^ »-t CO

C O C M C M - a l ^ - •£OS •̂ ^ Oi 3 C ***•eo «n CO O ** oj "^^ _ d .« «, o =

-Q ' .M

.s-soo ii 5

,u 5 t CO o OlS -^j 2 "^ "> *"^ c j - — d - ; - _

S 2 3 g, ... 2t5 Co 60

01

u - > - - <£) •^ < - < f i n o i ""-o

« 3 § c o c o - " P ^ «

H 2 I r. . CO h _: | . J s s "s | 1

C ^ O " o b o — " i n r * i t i o

"i, - I s ?; s !_ ^ < ^ * « _̂̂^ |i - - ^ ^ . . P

.K •*; E " 5 r II "^

^ I ^ 2 (X, ^^S * ^ *> a <u M T . ! 2

=̂^ i|S

O i n i o i o a ' ~ _ b o g j 3^ - C O I O I O I 0 - 3 ^ " E

| l " J i i | I 5 - 2 S: ̂ S Ul^N _ . • (o eO

•I I S S ko to 2 2 2,•2 • ^•a • V2 ?? CM CM m5 < CM CM CM

148 AGE AT WALKING

We have employed ephedrine for tranquillising the most disturbed childrenand in the hope of accelerating the development of walking and speech, for whichwe have the impression that the drug is beneficial, but have not been able_ to verifythis statistically.

SUMMARYA consecutive series of children with Down's syndrome who attended the

Institute for the Care of Mother and Child in Prague over a ten-year period wereserially examined in respect of dentition time and age at walking. Results, whichwere compared with controls, showed delays comparable to those found by otherauthors.

The effect of ephedrine on development was believed to be valuable and thedrug also seemed to be useful as a tranquilliser. Side-efTects, however, wereappreciably commoner than amongst normal children.

REFERENCES

ERBS, R. C. and SMITH, G. F. (1962) Unpublished observations quoted by Penrose and Smith(1966)..

0STER, J. (1953) Mongolism. Copenhagen: Danish Science Press Ltd.PENROSE, L. S. and SMITH, G. F. (1966) Down's anomaly. London: J. & A. Churchill.ROCHE, A. F. and BARKLA, D . H . (1964) The eruption of deciduous teeth in mongols. / . ment.

Defic. Res.. 8, 54.