Abstract
Children with Down syndrome often face significant feeding difficulties and health comorbidities that may contribute to undernutrition or obesity. This study assessed dietary habits and nutritional status among 104 children with Down syndrome in Croatia, representing 11.5% of this population. Results showed that over 30% of children aged 1 to 15 were overweight. Over 60% never consumed whole grain bread, while more than 50% avoided fish, nuts, or seeds. Despite rural families more frequently producing their own food (meat p = 0.009; fruits/vegetables p = 0.035), no significant improvement was observed in the children's diets compared to their urban counterparts. Urban children consumed milk (p = 0.008) and fermented dairy (p = 0.005) more often. Children of university-educated mothers had higher vegetable (p = 0.031), meat (p = 0.025), olive oil (p = 0.003), and nut (p = 0.029) consumption, and a lower intake of processed meats (p = 0.008) and salty snacks (p = 0.040). Families spending less than 50% of income on food also showed significantly healthier dietary patterns. Feeding difficulties in children with Down syndrome are commonly associated with sensory sensitivities, oral-motor impairments, and comorbid medical conditions. These challenges are often intensified by parental anxiety, delayed introduction of diverse foods, and inadequate professional support. Collectively, these factors contribute to selective eating, poor nutrient intake, and disordered eating behaviors. This study underscores the need for individualized nutritional interventions that address the unique physiological and sensory requirements of both children and adults with Down syndrome. Effective strategies should extend beyond general dietary recommendations to include early exposure to a variety of food textures, specialized feeding support, and the management of coexisting health conditions. Family education and engagement play a crucial role in achieving positive nutritional outcomes. Empowering parents and caregivers-especially those in socioeconomically disadvantaged or rural communities-can facilitate the alignment of food accessibility with healthy dietary practices. The findings of this research offer valuable guidance for the development and implementation of national strategies aimed at enhancing the nutrition and long-term health of individuals with Down syndrome.