Question:
Sometimes my child with Down syndrome will have an elevated temperature in the afternoon (between 99.1-99.6) and become lethargic. If he rests for an hour or two his temperature goes back to a normal 98.3-98.6 degree temperature range and seems to perk up. Do people with Down syndrome experience temperature elevations when they are tired?
Answer:
In this article about risks of anesthesia in children with Down syndrome (DS) from 2022, the author states, “Temperature control in children with Down syndrome has yet to be described in detail but could be an important anesthetic consideration given temperature variability in children with Down syndrome and the importance of temperature for homeostasis.”That seems to be a good summary of the limited general understanding of temperature regulation in people with DS. There is much that isn’t known.What do we know?
- Temperature regulation in all people is managed by the hypothalamus in the brain that communicates with the skin, the sweat glands, and the vascular system via the autonomic nervous system (the part of the nervous system that works automatically without our thinking about it).
- There are increasing data showing the autonomic nervous system does not work the same in people with DS compared to those without DS. For example, people with DS tend to have lower heart rates, lower blood pressures, and more constipation, all of which are controlled at least partially by the autonomic nervous system.
- In our practice, many individuals with DS and their families report that the individual with DS sweats less than others. Some of us who have participated in athletic events with adults with DS have witnessed this phenomenon.
- Similarly, individuals with DS and their families have reported and we have witnessed individuals with DS get overheated and seen their body temperature rise when in warmer weather (and they are often noted to not be sweating as much as others).
While none of the individuals with DS that we have encountered have reported similar symptoms as you describe, it is possible that others have experienced it without recognizing the link between lethargy and elevated body temperature.
If one is not drinking enough fluids, the body may have more difficulty cooling off and the body temperature may rise. Theoretically, one’s body temperature could slowly rise in the first several hours of the day (as you describe) if the person is not drinking enough fluid. Resting and hydrating should bring the temperature down. It is possible that good hydration all day long may prevent a temperature elevation in the afternoon. Knowing that body temperature regulation may be an issue for a person with DS, responses in addition to good hydration may be:
- assessing the amount of clothing worn.
- adjusting the intensity or amount of activity or scheduling short breaks during an activity especially if the environmental temperature is higher.
- Using fans or other cooling measures during activity.
It is also possible that there is a difference in circadian rhythm (the natural change in body activity during the day) that could contribute to the changes you noted. However, we found very little research that has been done on this topic in people with DS, and most of the little we did find focuses on sleep (not temperature regulation). We could not find research that describes the natural rise and fall of body temperature for people with DS throughout the day.
Additional information is available in our Temperature Regulation in People with Down Syndrome and Tips for Staying Hydrated articles in our online resource library.