Care of children with Down syndrome. Sharing and dividing responsibilities between the community physician and sub-specialists

Down syndrome is a cronic condition that can be regarded as a prototype to the complexity of management of children with special needs. This complexity involves medical, emotional, social, economic and educational aspects. The role of the primary physician in preserving continuity, while keeping effective coordination with other providers is an essence. Accessibility and the ability to care for these patients in a family centerd orientation are major strengths of the primary physician. However, these are traded-off with the limited ability of the primary physician in keeping-up with the level of expertise of the sub-specialists. As co-morbidity of children with special needs demands the intervention of many consultants it is essential that the mode of each patient will be tailored based on the local facilities and the values and demands of the families.