Concomitant medical conditions Certain age-specific routine screening of affected infants and children helps identify conditions associated with Down syndrome (see the 2011 American Academy of Pediatrics Guidelines Health Supervision for Children with Down Syndrome): Echocardiography: At prenatal visit or at birth Thyroid screening (thyroid-stimulating hormone [TSH] levels): At birth, 6 months, 12 months, and annually thereafter Hearing evaluations: At birth, every 6 months thereafter until normal hearing established (about age 4 years), then annually (more frequently if indicated) Ophthalmology evaluation: By 6 months, then annually until age 5; then every 2 years until age 13 and every 3 years until age 21 (more frequently if indicated) Growth: Height, weight, and head circumference plotted at each health supervision visit using a Down syndrome growth chart Sleep study for obstructive sleep apnea: Completed by age 4 years Routine screening for atlantoaxial instability and celiac disease is no longer recommended; children are tested based on clinical suspicion.